Administration of Hazardous Drugs

VTH Policy: PharmH650

Implementation Date: 11/2021

Date of Last Revision: 6/24/2023

Next Review Due: 6/23/2026

 

Reviewed by VTH Administrative Team: 11/2021

Reviewed by VTH Board: N/A

 

Reviewed by VTH Director : 11/2021

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

Policy

The intent of this policy is to implement safety standards and techniques to safely administer hazardous drugs. This applies to healthcare personnel approved for the administration of hazardous drugs.

Hazardous drugs must be administered with proper protective techniques, with the appropriate PPE worn, avoid manipulating hazardous drugs if possible, and use CSTD when required.

Guidelines

  1. Healthcare personnel should avoid manipulating hazardous drugs, such as cutting or crushing tablets or opening capsules, if possible. Liquid formulations are preferred if solid oral dosage forms are not appropriate for the patient. When dosage forms require manipulation, personnel must don appropriate PPE and use a plastic pouch to contain any dust or particles generated from crushing a tablet or opening a capsule.

  2. CSTDs (Closed System Transfer Device) must be used for administration of antineoplastic hazardous drugs when the dosage form allows. Techniques and any additional devices that minimize the risk posed by open systems must be used when administering HDs through certain routes. Protective technique examples include spiking or priming of an IV line with a non-HD solution in a C-PEC and crushing tablets in a plastic pouch while wearing appropriate PPE.

  3. Potential opportunities for exposure may include the generation of aerosols during administration by various routes (e.g., injection, oral, inhalation, or topical application); priming an IV line; or performing certain specialized procedures.

  4. Appropriate PPE must be worn when administering HDs. After use, PPE must be removed and disposed of in a waste container approved for trace-contaminated HD waste, at the site of drug administration. Any equipment (tubing, needles, etc.) and packaging materials must be disposed of properly after administration.

  5. Administration of Cytarabine and other chemotherapy requires the use of a CSTD, two pairs of chemo-rated gloves, eye protection (goggles or face shield), and a chemo gown.

Procedure (if applicable)

HD Formulation

Activity

Double chemotherapy gloves

Protective gown

Eye/face protection

Respiratory protection

Ventilated engineering control

Intact tablet or capsule

Administration from unit-dose package

*single glove can be used unless spills occur*

no

no

no

N/A



Tablets or capsules

Cutting, crushing or manipulating tablets or capsules; handling uncoated tablets

YES

Yes

No

Yes, if not in a control device

Yes, if possible

Administration

No *single glove can be used, unless spills occur*

no

Yes, if potential vomiting

No

N/A

Oral liquid drug or feeding tube

Compounding

YES

YES

Yes, if not a control device

Yes, if not in a control device

YES

Administration

YES

YES

Yes,

if potential vomiting

 

N/A

Topical drug

Administration

YES

yes

Yes, if potential splashing

Yes, if inhalation potential

N/A

SQ/IM injection from a vial

Preparation (withdrawal from vial)

YES

YES

Yes, if not in a control device

Yes, if not in a control device

YES, BSC OR CACI

Administration from prepared syringe

YES

Yes

Yes, if potential splashing

No

N/A

Withdrawing/ mixing IV

/ IM solution from vial or ampule

Compounding

YES

YES

No

No

Yes, BSC or CACI;use of CSTD recommended

Administration from prepared solution

YES

YES

Yes, if potential splashing

no

N/A ; CSTD if dosage form allows

Solution for irrigation

Administration

YES

yes

yes

yes

N/A

Powder/ aerosol treatment / solution for inhalation

Aerosol administration

YES

YES

YES

YES

N/A

Administration

YES

YES

Yes, if potential splashing

Yes, if inhalation potential

N/A

Spills

Cleaning

YES

YES

YES

YES

N/A

Drug-contaminated waste

Disposal and cleaning

YES

YES

Yes, if potential splashing

Yes, if inhalation potential

N/A

Drugs and metabolites in body fluids

Disposal and cleaning

YES

YES

Yes, if potential splashing

Yes, if inhalation potential

N/A

Definitions (if applicable)

  • CTSD : Closed System Transfer Device
    • Drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of HD or vapor concentrations outside the system
  • PPE : Personal Protective Equipment
  • USP : United States Pharmacopeia
  • BSC : Biological Safety Cabinet
  • C-PEC : Containment Primary Engineering Control
  • CACI : Compounding Aseptic Containment Isolator
  • HD : Hazardous Drug

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.

 



Keywordshazardous, drugs, NIOSH, PPE, CSTD, Equashield   Doc ID129540
OwnerJenny C.GroupUofI College of Veterinary Medicine Teaching Hospital
Created2023-07-05 16:13 CDTUpdated2023-07-05 16:24 CDT
SitesUniversity of Illinois College of Veterinary Medicine Teaching Hospital
Feedback  0   0