How to Put on PPE

From the World Health Organization:


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Courtesy of Alberta Health Services :


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How to Protect Yourself From Accidental Exposure to Hazardous Drugs: Use of PPE

Personal Protective Equipment

a.  Gloves. Research indicates that the thickness of the gloves used in handling HD's is more important than the type of material, since all materials tested have been found to be permeable to some HD's.^3,19,53 The best results are seen with latex gloves. Therefore, latex gloves should be used for the preparation of HD's unless the drug-product manufacturer specifically stipulates that some other glove provides better protection.^{19,53,72,93,100} Thicker, longer latex gloves that cover the gown cuff are recommended for use with HD's. Gloves with minimal or no powder are preferred since the powder may absorb contamination.^3,104

The above referenced sources have noted great variability in permeability within and between glove lots. Therefore, double gloving is recommended if it does not interfere with an individual's technique.³ Because all gloves are permeable to some extent and their permeability increases with time, they should be changed regularly (hourly) or immediately if they are torn, punctured, or contaminated with a spill. Hands should always be washed before gloves are put on and after they are removed. Employees need thorough training in proper methods for contaminated glove removal.

b.  Gowns. A protective disposable gown made of lint-free, low-permeability fabric with a closed front, long sleeves, and elastic or knit closed cuffs should be worn. The cuffs should be tucked under the gloves. If double gloves are worn, the outer glove should be over the gown cuff and the inner glove should be under the gown cuff. When the gown is removed, the inner glove should be removed last. Gowns and gloves in use in the HD preparation area should not be worn outside the HD preparation area.³

As with gloves, there is no ideal material. Research has found nonporous Tyvek and Kaycel to be more permeable than Saranex-laminated Tyvek and polyethylene-coated Tyvek after four hours of exposure to the CD's tested.⁵⁴ However, little airflow is allowed with the latter materials. As a result, manufacturers have produced gowns with Saranex or polyethylene reinforced sleeves and front in an effort to decrease permeability in the most exposure prone areas, but little data exists on decreasing exposure.

c.  Respiratory Protection. A BSC is essential for the preparation of HD's. Where a BSC is not currently available, a NIOSH-approved respirator appropriate for the hazard must be worn to afford protection until the BSC is installed. [NIOSH recommendation at the time of this publication is for a respirator with a high-efficiency filter, preferably a powered, air-purifying respirator.] The use of respirators must comply with OSHA's Respiratory Protection Standard,¹⁰⁵ which outlines the aspects of a respirator program, including selection, fit testing, and worker training. Surgical masks are not appropriate since they do not prevent aerosol inhalation. Permanent respirator use, in lieu of BSC's, is imprudent practice and should not be a substitute for engineering controls.

d.  Eye and Face Protection. Whenever splashes, sprays, or aerosols of HD's may be generated that can result in eye, nose, or mouth contamination, chemical-barrier face and eye protection must be provided and used in accordance with 29 CFR 1910.133. Eyeglasses with temporary side shields are inadequate protection.

When a respirator is used to provide temporary protection as described above, and splashes, sprays, or aerosols are possible, employee protection should be:

• a respirator with a full face piece; or
• a plastic face shield or splash goggles complying with ANSI standards² when using a respirator of less than full-face piece design.
  
  Eyewash facilities should also be made available.

e. PPE Disposal and Decontamination. All gowns, gloves, and disposable materials used in preparation should be disposed of according to the hospital's hazardous drug waste procedures and as described under this review's section on Waste Disposal. Goggles, face shields and respirators may be cleaned with mild detergent and water for reuse.


Courtesy of: OSHA
https://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html

Antineoplastic drugs including those withmanufacturers’ safe handling guidance (MSHG)
decitabine to ifsofamide
http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138_v3.pdf

Drug	AHFS classification		MSHG		Reason for listing		Links
decitabine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; Drugbank
degarelix		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; Drugbank
docetaxel	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
doxorubicin	10:00 antineoplastic agents		yes		IARC Group 2A carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
epirubicin	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; Drugbank
eribulin		10:00 antineoplastic agents		FDA Pregnancy Category D		DailyMed; DrugBank
erlotinib		10:00 antineoplastic agents		FDA Pregnancy Category D		DailyMed; DrugBank
estramustine	10:00 antineoplastic agents		yes		FDA Pregnancy Category X		DailyMed; Drugbank
etoposide	10:00 antineoplastic agents		yes		IARC Group 1 carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
everolimus	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; Drugbank
exemestane		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; DrugBank
floxuridine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
fludarabine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
fluorouracil	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
flutamide		10:00 antineoplastic agents		Indicated only for men; FDA Pregnancy Category D		DailyMed; DrugBank
fulvestrant		10:00 antineoplastic agents		FDA Pregnancy Category D		DailyMed; DrugBank
gemcitabine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
gemtuzumab ozogamicin	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
goserelin		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; Drugbank
hydroxyurea	10:00 antineoplastic agents		yes		Special warning on handling bottles and capsules FDA Pregnancy Category D		DailyMed; DrugBank
idarubicin	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
ifosfamide	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank



Hazardous Drugs bicalutimide to daunorubicin

Links http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138_v3.pdf
bicalutimide		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; DrugBank
bleomycin	10:00 antineoplastic agents		yes		IARC Group 2B; FDA Pregnancy Category D		DailyMed; DrugBank
bortezomib	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
brentuximab vedotin	10:00 antineoplastic agents		yes		Conjugated monoclonal antibody; FDA Pregnancy Category D		DailyMed; DrugBank
busulfan	10:00 antineoplastic agents		yes		IARC Group 1 carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
cabazitaxel	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
capecitabine	10:00 antineoplastic agents		yes		Metabolized to 5-fluorouracil; FDA Pregnancy Category D		DailyMed; DrugBank
carboplatin	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
carmustine	10:00 antineoplastic agents		yes		IARC Group 2A carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
chlorambucil	10:00 antineoplastic agents		yes		IARC Group 1 carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
cisplatin	10:00 antineoplastic agents		yes		IARC Group 2A carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
cladribine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
clofarabine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
crizotinib		10:00 antineoplastic agents		FDA Pregnancy Category D		DailyMed
cyclophosphamide	10:00 antineoplastic agents		yes		IARC Group 1 carcinogen; FDA Pregnancy Category D		DailyMed; Drugbank
cytarabine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
dacarbazine	10:00 antineoplastic agents		yes		FDA Pregnancy Category C		DailyMed; Drugbank
dactinomycin	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; DrugBank
dasatinib	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed; Drugbank
daunorubicin	10:00 antineoplastic agents		yes		IARC Group 2B, AKA daunomycin; FDA Pregnancy Category D		DailyMed; Drugbank

Antineoplastic drugs including those withmanufacturers’ safe handling guidance abiraterone to bexarotene

Table 1. Antineoplastic drugs including those withmanufacturers’ safe handling guidance (MSHG)

http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138_v3.pdf  

Drug	AHFS classification		MSHG		Reason for listing		Links
abiraterone*		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; DrugBank
ado-trastuzumab emtansine	10:00 antineoplastic agents		yes		Conjugated monoclonal antibody; FDA Pregnancy Category D		DailyMed; DrugBank
altretamine	10:00 antineoplastic agents		yes		FDA Pregnancy category D		DailyMed; DrugBank
amsacrine	NA antineoplastic agents		yes		IARC Group 2B		DrugBank
anastrozole		10:00 antineoplastic agents		FDA Pregnancy category X		DailyMed; DrugBank
arsenic trioxide	10:00 antineoplastic agents		yes		IARC Group 1 carcinogen**; FDA Pregnancy Category D		DailyMed; DrugBank
azacitidine	10:00 antineoplastic agents		yes		IARC Group 2A carcinogen; FDA Pregnancy Category D		DailyMed; DrugBank
bacillus calmette Guerin (BCG)***	80:12 vaccines		yes		See special handling requirements**; FDA Pregnancy Category C		DailyMed
bendamustine	10:00 antineoplastic agents		yes		FDA Pregnancy Category D		DailyMed;
bexarotene		10:00 antineoplastic agents		FDA Pregnancy Category X		DailyMed; DrugBank