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U.S. Department of Health and Human Services
Indian Health Manual

Part 3, Chapter 27: Manual Exhibit 3-27-A

EXHIBIT 3-27-A – SAFE HANDLING OF HAZARDOUS DRUGS FOR PUBLIC HEALTH NURSES (PHN)

Sec.
1. Introduction
2. What are hazardous drugs?
3. How should hazardous drugs be transported?
4. What happens if the drugs spill or leak when I am transporting them?
5. How do I handle contaminated linen or clothing?
6. What if I spill hazardous drugs on me?
7. Other tips regarding hazardous drugs
  1. Introduction:  The following information is general guidance. Specific training, instruction and establishing PHN competencies for this activity should be sought in consultation with the pharmacy to identify hazardous drugs and appropriate precautions. For programs where this service is standardized, a formal policy and procedure for this activity is recommended.
  2. What are hazardous drugs?

    Hazardous drugs are a group of drugs that are associated with or suspected of causing adverse health effects. Hazardous drugs may possess any one of the following characteristics:
    1. The ability to cause a change or mutation in genetic material;
    2. The ability to cause cancer in animal models, humans, or both;
    3. The ability to cause defects in fetal development or fetal malformation;
    4. Fertility impairment or adverse reproductive outcomes in both men and women; and
    5. Serious toxicity at low doses in experimental animal models or treated patients.
    Hazardous drugs are commonly used in the treatment of cancer but may also be used to treat rheumatoid arthritis, human immunodeficiency virus, hepatitis, or other non malignant illnesses.

    Hazardous drugs are excreted from the patient for at least 48 hours and up to 7 days after treatment. The patient's bodily fluids are considered contaminated during these times. Observe standard precautions when handling the patient's body fluids or any linen, etc., contaminated with their bodily fluids. Patients and family members, as well as home health care workers, should be advised of safe practices for handling hazardous drugs.

    This should include awareness of how to clean up spills and how to properly dispose of waste.
  3. How should hazardous drugs be transported?
    1. Always transport hazardous drugs in a sealed, plastic container. If transporting an intravenous bag or other liquid, enclose the drug in a sealed bag and place the sealed bag in a rigid, sealed, plastic container.
    2. Wear chemotherapy gloves when handling hazardous drugs.
    3. Wash your hands before and after handling the hazardous drugs.
    4. Do not eat, drink, smoke, or apply makeup or lip balm while transporting hazardous drugs.
    5. Have a United States Pharmacopeia <800> approved hazardous drug spill kit with you when transporting hazardous drugs. You should receive training on how to use the spill kit.
    6. An appropriate waste container should also be available during transport as advised by pharmacy and/or facility safety officer.
  4. What happens if the drugs spill or leak when I am transporting them?
    1. For large spills of 5 milliliters (mL) or 5 grams (g) or more, contact the pharmacy and/or facility safety department for response instructions.
    2. For small spills less than 5 mL or 5 g, put on Personal Protective Equipment (PPE) from the spill kit and clean up following instructions in the spill kit.
    3. All waste materials should be transported to the medical facility for proper disposal.
    4. This should include the management and control of spill as described in the Indian Health Manual Part 3 Chapter 27 Exhibit 3-27-C.
  5. How do I handle contaminated linen or clothing?
    1. Whenever possible, the patient should handle his or her own contaminated linen or clothing.
    2. Institute standard precautions when handling excreta or contaminated linen for 48 hours after drug administration.
    3. Do not touch soiled areas with your bare hands, use two pairs of chemotherapy gloves. Wash the contaminated linen and clothing in hot water with regular detergent separately from other laundry. If clothing and linen type allows, add bleach to the wash. Wash a second time.
    4. If the linen or clothing cannot be washed immediately, place them in a sealed plastic bag until they can be washed.
  6. What if I spill hazardous drugs on me?
    1. Immediately remove the contaminated clothing and thoroughly wash the affected area with soap and water.
    2. If your clothing is contaminated, follow facility process for laundering contaminated clothing.
    3. Report the spill to your health care provider and report according to facility policies and procedures. Also, notify the health care facility who prepared the drugs that a spill occurred.
  7. Other tips regarding hazardous drugs.
    1. Store hazardous drugs out of the reach of children and pets.
    2. Diapers should be placed in zip-lock sealed plastic bags for disposal for two days after drug administration.