Policies & Procedures
Robust policies and procedures serve as administrative controls in the effort to decrease staff exposure to HDs, making the creation of P&Ps a key responsibility of the Designated Person. While compliance is strong with some of the straightforward requirements, such as using chemo gloves for all HD handling, the more complex requirements continue to stymie pharmacy. Look for opportunities to collaborate with other departments on more challenging requirements; for example, the hospital’s occupational health department is an excellent resource for creating a medical surveillance plan.
At most facilities (90%), all staff members—including receiving personnel, pharmacy technicians, and oncology nurses—use gloves that have been tested to the ASTM D6978 standard when handling HDs.
Compliance is not quite as strong when it comes to risk acknowledgement; 79% of facilities have provided a Risk Acknowledgement Form to their staff capable of reproduction (men and women), who come into contact with HDs. Every facility should create a standardized template that employees can sign to verify that they received HD training and understand the associated risks.
A troubling 78% of facilities do not require the use of a respirator when handling HDs outside of the PEC. When respiratory protection is required, an N95 respirator (or better) should be used, as a surgical mask is inadequate at protecting against airborne particles or vapors generated from HDs. Because a BSC or CACI provides containment, the compounder is protected; however, that respiratory protection is lost if manipulations occur outside of the PEC. There is the obvious need for protection in the event of an HD spill, but equally important is ensuring respiratory protection when receiving HDs with compromised packaging or any HD manipulation in the OR.
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