PPE is integral to ensuring staff protection from HD residue, and to affirm consistent use across the institution, PPE requirements should be clearly outlined in the P&Ps. Both glove and respirator use increased this year; however, further improvement is needed in both categories by facilities of all sizes.

Unpacking HDs comes with the risk of exposure as breakage or spillage may have occurred during transport. This risk exists for all staff members who handle HDs, not just those within the pharmacy. As such, all staff handling HDs, including receiving personnel, oncology nurses, pharmacy technicians, and any staff handling waste, should use gloves tested to the ASTM D6978 standard. While compliance with this requirement increased by 5% this year, 18% of facilities still have more work to do before December 1st. Notably, facility size has had only a small impact on compliance.

An increasing number of facilities are requiring respirator use for HD handling outside of the PEC, with facility size having only a small impact on this decision. Choosing the correct respiratory protection can be confusing, particularly as the standard surgical mask does not provide respiratory protection. An N95 respirator provides an acceptable physical barrier, but if there is a risk of gas or vapor exposure, a full-face chemical cartridge respirator or a powered air-purified respirator (PAPR) should be used.

Staff members capable of reproduction who come into contact with HDs must confirm in writing that they understand the handling risks. A straightforward solution is to provide an HD Risk Acknowledgement Form to all staff (men and women) who handle HDs. Two-thirds of all facilities are in compliance with this requirement, up from 50% two years ago. While this improvement is laudable, it is concerning that one-third of facilities have yet to take this simple step.

Identifying practice gaps in HD handling is proven to ensure ongoing process improvement. An impressive 91% of facilities are conducting gap analyses utilizing a broad array of available tools. Both the Joint Commission Resources/BD self-assessment tool and Homegrown tools increased in popularity this year.

Reflecting the challenges of establishing a meaningful medical surveillance program for staff working with HDs, there has been little progress in the number of facilities with such a program in place. In fact, one-third of all facilities do not currently plan to create such a program. USP <800> outlines the key components of a surveillance program as well as the necessary steps to create a post-exposure follow-up plan. The hospital’s occupational health department can be an excellent resource when undertaking the creation of a surveillance program.