Do You Know How to Handle Hazardous Meds?

Periop Today

By: Periop Today

Published: 8/9/2023

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Protect Yourself & Patients from Hazardous Medication Exposure

Every year, nurses and other staff administer 12 billion doses of hazardous medications in healthcare facilities — that includes in periop settings. This puts you in danger of being exposed to these substances.

Currently, there are three established surgical procedures to treat cancer that involve a large volume of chemotherapy medication (aka antineoplastic agents) being pumped or aerosolized directly into the surgical cavity—risking contamination in the operating room environment.

“Such procedures elevate concerns about perioperative professionals being directly and indirectly exposed to hazardous medications,” cautions AORN Senior Perioperative Practice Specialist Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP.

That’s why she made extensive updates to the section on hazardous medications in AORN’s latest update to the Guideline for Medication Safety that published electronically in March. The guideline updates include new recommendations for how perioperative nurses should protect themselves when working with (or around) hazardous medications.

What makes a medication hazardous?

In addition to chemo drugs, certain antivirals, antibiotics, and bioengineered drugs used in the OR can also be hazardous. Medications are officially classified as hazardous by the National Institute for Occupational Safety and Health (NIOSH) because research has demonstrated the drugs can harm you in the following ways:

  • Permanently alter your DNA
  • Give you cancer
  • Impact your fertility
  • Cause developmental abnormalities to your growing fetus
  • Damage your organs

How can you protect yourself?

Awareness of these hazards and the personal protective equipment (PPE) you need to wear correctly to prevent occupational exposure is essential, Cahn stresses. Here’s what she says every periop nurse should know to stay safe:

  1. Know Your Risk of Exposure to Hazardous Medications
    To determine if hazardous medication contamination is present, your facility should be conducting environmental surface sampling of the areas where hazardous medications are administered, such as in the OR, to identify contamination from these meds, according to a new recommendation in the guideline. “Keep in mind that there is no safe level of exposure to hazardous medications and that environmental contamination may be invisible,” she cautions.

    Also, make sure to self-identify for alternate assignment if you are trying to conceive, are pregnant or breast-feeding because hazardous medication exposures may affect fetal/child development.

  2. Practice Correct PPE Use When Handling or Administering Hazardous Meds

    Updated recommendations for PPE in the Medication Safety guideline suggest OR team members exposed to hazardous meds in the OR should wear the following:
     - Goggles and single-use face shields
    - A disposable gown of the highest liquid barrier performance class
    - Two pairs of chemotherapy gloves

    Gown and glove changes should happen when needed, especially for chemotherapy permeation—this information can typically be found on the back of the box of gloves or the manufacturer’s instructions for use (IFU). When no manufacturer IFU are available, gloves should be changed every 30 minutes and gowns should be changed every 2-3 hours.

  3. Determining use of Respiratory Protection or a Surgical Mask

    Any time there is a risk for aerosolization of hazardous medications you need to use a respirator, Cahn notes. She says one challenge with this is that many professional organizations recommend the use of a respirator based on a perceived risk of hazard medication aerosolization but studies of large volume use of chemotherapeutic agents in the OR have not found aerosolization.

    When deciding if you should be using an N95 or higher level of respiratory protection, she says to consider information in your facility’s hazardous medication safety plan, the procedure being performed, how the medication is administered, and your perceived risk for exposure.

    Remember, “correct use of PPE when handling hazardous medications can prevent exposure but only if it’s worn and used correctly,” she stresses. “The evidence also shows that personnel handling these medications—even when pregnant—don’t always wear the recommended PPE.”

Cahn says leadership support and team-wide education on the latest guidance for PPE when exposed to hazardous medication should be a focus for any healthcare facility.

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