Hazardous Drugs: Preparation and Handling
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Questions and Answers

What is the primary purpose of decontamination in the context of hazardous drug exposure?

  • To thoroughly clean equipment used for hazardous drugs
  • To transfer contaminants from fixed surfaces to disposable surfaces (correct)
  • To prevent spills during hazardous drug preparation
  • To neutralize hazardous drugs to make them safe

What action should be taken after managing a spill of hazardous drugs?

  • Dispose as hazardous waste (correct)
  • Leave the area to ensure safety
  • Report the spill to a supervisor immediately
  • Dispose of the spill as regular waste

Which of the following is an example of deactivation in handling hazardous drugs?

  • Covering hands with gloves before working
  • Using chemical treatments to lessen drug hazards (correct)
  • Wiping down surfaces with cloths
  • Cleaning up spills immediately after occurrence

Why is it important to manage glove contact time when dealing with hazardous substances?

<p>To prevent prolonged exposure of the gloves to hazardous drugs (B)</p> Signup and view all the answers

During which process would you place the inner glove under the sleeve of a gown?

<p>When compounding hazardous preparations (B)</p> Signup and view all the answers

When should an N95 mask be disposed of?

<p>When soiled, moist or contaminated (B)</p> Signup and view all the answers

What is the correct disposal method for a chemotherapeutic gown?

<p>Dispose as hazardous waste (A)</p> Signup and view all the answers

What type of eye protection is recommended during cleaning and deactivating a biosafety cabinet?

<p>Safety goggles or face shield (D)</p> Signup and view all the answers

How often should a chemo gown be replaced according to NAPRA standards?

<p>Every 2-3 hours (A)</p> Signup and view all the answers

What should be done with the shoe covers after leaving the cleanroom?

<p>Dispose as hazardous waste (C)</p> Signup and view all the answers

What personal protective equipment is required at all times in the cleanroom?

<p>Bonnet, N95 mask, and chemo gown (A)</p> Signup and view all the answers

What is the recommended action after a chemical spill?

<p>Use gloves and shoe covers to clean it (D)</p> Signup and view all the answers

What is required when using a chemical cartridge respirator?

<p>Clean and disinfect after each use (D)</p> Signup and view all the answers

Which of the following statements is true about glove usage during compounding?

<p>Two pairs of gloves should be worn (B)</p> Signup and view all the answers

What should be considered when selecting shoes for the cleanroom?

<p>Dedicated shoes should be used (B)</p> Signup and view all the answers

What is the main route of exposure to hazardous drugs through the skin?

<p>Direct contact with contaminated surfaces (B)</p> Signup and view all the answers

Which of the following practices can help prevent ingestion of hazardous drugs?

<p>Regular handwashing (A)</p> Signup and view all the answers

What is a key component of a Safe Handling Program for hazardous drugs?

<p>Identifying and defining hazardous products (A)</p> Signup and view all the answers

What is one critical requirement for rooms designated for hazardous drug preparation?

<p>Must utilize Class 2 Type B II biological safety cabinet (D)</p> Signup and view all the answers

Which piece of personal protective equipment is recommended for pharmacy staff handling hazardous drugs?

<p>Chemotherapy-tested gowns (A)</p> Signup and view all the answers

What does medical surveillance include for workers handling hazardous medications?

<p>Monitoring of urine and physical exams (D)</p> Signup and view all the answers

How can the risk of injection exposure in a pharmacy be minimized?

<p>Implementing strict aseptic techniques (A)</p> Signup and view all the answers

What is a recommended practice to mitigate inhalation exposure in a healthcare setting?

<p>Using ventilated workspaces continually (C)</p> Signup and view all the answers

Which of the following processes is crucial in managing contaminated waste?

<p>Using standardized cleaning procedures (D)</p> Signup and view all the answers

What is emphasized in USP standards for handling hazardous drugs in healthcare settings?

<p>Promoting patient safety and environmental protection (A)</p> Signup and view all the answers

What must be available in an area where hazardous drugs are stored, prepared, and administered?

<p>Spill kits (C)</p> Signup and view all the answers

What is a requirement for transporting hazardous products?

<p>Transport by trained personnel only (D)</p> Signup and view all the answers

Which item is NOT typically included in a spill kit for hazardous drugs?

<p>Response plan manual (B)</p> Signup and view all the answers

What is an essential component of a quality control program related to hazardous drugs?

<p>Regular equipment audits (A)</p> Signup and view all the answers

Which statement is true regarding spill management procedures?

<p>Availability of signs warning of restricted access is crucial. (B)</p> Signup and view all the answers

What must happen if a spill occurs involving hazardous drugs?

<p>The spill should be documented and assessed according to policy. (C)</p> Signup and view all the answers

Which practice is essential for personnel safety when handling hazardous drugs?

<p>Creating a Medical Surveillance Program (D)</p> Signup and view all the answers

What type of container is recommended for transporting hazardous materials?

<p>A rigid container that minimizes risk of breakage (C)</p> Signup and view all the answers

What is the purpose of using sterile 70% isopropyl alcohol wipes in hazardous drug preparation?

<p>To decontaminate surfaces before removal from BSC (C)</p> Signup and view all the answers

What is a characteristic of a Class II, Type B Biological Safety Cabinet?

<p>It has external venting through HEPA filters (B)</p> Signup and view all the answers

Which statement about air pressure in the cleanroom is true?

<p>The hazardous cleanroom should have negative air pressure relative to the surrounding areas (B)</p> Signup and view all the answers

How often should equipment for preparing sterile hazardous drugs be cleaned?

<p>Twice daily (C)</p> Signup and view all the answers

What is the maximum volume that can be withdrawn from a syringe during preparation?

<p>75% of the syringe capacity (D)</p> Signup and view all the answers

What should be done with any excess drug from an ampoule?

<p>It must be placed in an empty vial for disposal (B)</p> Signup and view all the answers

What is the main function of a pass-through window in a hazardous drug preparation area?

<p>To minimize contamination during compounding (B)</p> Signup and view all the answers

How should leftover hazardous drug in an ampoule be managed?

<p>It must be drawn up for disposal (D)</p> Signup and view all the answers

What is the role of alarms in the facilities for preparation of sterile hazardous products?

<p>To signal air pressure changes (B)</p> Signup and view all the answers

What does the term 'negative pressure' refer to in hazardous drug compounding facilities?

<p>Air pressure that is lower than the surrounding areas (C)</p> Signup and view all the answers

What is the first step to take when managing a chemo spill?

<p>Collect necessary clean-up supplies and bring a helper (C)</p> Signup and view all the answers

Where are spill kits not located?

<p>In patient care areas (A)</p> Signup and view all the answers

What should you do if you cannot manage the spill yourself?

<p>Call 5555 to report the spill and inform your manager (B)</p> Signup and view all the answers

What is the correct order for donning PPE for a spill?

<p>Inner gloves, gown, P100 respirator, shoe covers, outer gloves (C)</p> Signup and view all the answers

What method should be used for cleaning a liquid spill?

<p>Lay absorbent pads over the spill and then wash the area (A)</p> Signup and view all the answers

What should be done after the spill has been cleaned?

<p>Call housekeeping for a final rinse of the floor (D)</p> Signup and view all the answers

What is the purpose of using water soaked spill towels for powder spills?

<p>To gently cover the powder for containment (A)</p> Signup and view all the answers

Which type of waste bag should be used for disposal of materials used in cleaning a hazardous spill?

<p>Cytotoxic waste bag (A)</p> Signup and view all the answers

What step should be taken before removing your PPE?

<p>Complete the cleaning process (B)</p> Signup and view all the answers

Which of these is NOT a recommended way to clean reusable PPE?

<p>Cleaning the respirator surfaces with alcohol (C)</p> Signup and view all the answers

Flashcards

Stock Unpacking

Procedure for handling stock in a controlled environment.

Hazardous Drug Spill

Managing a spill by transferring contaminants to disposable surfaces for disposal as hazardous waste.

Hazardous Waste Disposal

Proper disposal method for hazardous products and spills.

Decontamination

Transferring hazardous materials from a surface to a disposable surface.

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Deactivation

Treatment of hazardous drugs to reduce their hazard.

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Hazardous Drug Handling

A set of procedures used to minimize exposure to hazardous drugs in healthcare settings.

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Routes of Exposure

Ways hazardous materials can enter the body (skin, ingestion, injection, inhalation).

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Skin Absorption

Hazardous material absorbed through the skin by direct contact.

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Ingestion

Hazardous material entering the body through eating or putting objects in mouth.

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Injection

Hazardous material entering through accidental needle stick injury.

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Inhalation

Hazardous material entering the body through breathing in contaminated particles.

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PPE (Personal Protective Equipment)

Protective clothing and gear to prevent exposure to hazardous drugs (gloves, gowns, masks).

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Cytotoxic Drug Spill Response

Specific procedures for managing uncontrolled release of cytotoxic drugs.

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Biological Safety Cabinet (BSC)

Equipment used for containing hazardous materials during handling.

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Hazardous Drug Preparation Area

Designated area dedicated to handling and preparing hazardous drugs

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N95 Mask

A type of respirators used in cleanrooms to prevent airborne contamination.

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Chemical Cartridge Respirator

Respiratory protection against chemical hazards in clean rooms, during cleaning and spill cleanup.

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Cleanroom Bonnet

Head covering worn in cleanrooms to prevent hair and head contamination.

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Eye Protection Cleanroom

Safety glasses or goggles worn in cleanrooms to prevent contamination of eyes during cleaning, spill cleanup, and other activities

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Shoe Covers

Footwear used in cleanrooms to prevent contamination by limiting foot contact and preventing dirt from the outside from entering the cleanroom.

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Cleanroom Chemo Gown

Protective garment worn in cleanrooms to prevent contamination during chemotherapy handling.

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Cleanroom Gloves

Essential for preventing cross contamination during work in cleanroom.

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Cleanroom PPE

Personal Protective Equipment (PPE) used to minimize contamination spread in cleanrooms.

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Spill Cleanup PPE

Protecting yourself from contamination from spills and other hazardous materials.

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Hazardous Drug Transportation

Moving hazardous drugs requires specific precautions like using rigid containers, double bagging, clear labeling, and trained personnel for spill cleanup.

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Spill Management Policies

These policies outline procedures to prevent and handle spills, assign responsibilities, and address disposal, contamination, and medical support.

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Spill Kit Contents

A spill kit contains essential materials for cleaning up hazardous spills, including waste bags, eye protection, gowns, gloves, absorbent materials, and more.

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Quality Control Program

This program ensures the safety and effectiveness of handling hazardous drugs through personnel training, equipment maintenance, environmental monitoring, and product checks.

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Medical Surveillance Program

This program monitors the health of personnel handling hazardous drugs to identify potential exposures and risks.

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Reproductive Risks

Handling hazardous drugs can pose reproductive risks. Special considerations should be made for pregnant or breastfeeding individuals, or those planning a family.

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Room Temperature Storage

Hazardous drugs should be stored in a cool environment, less than 25 degrees Celsius.

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Refrigerator Storage

For optimal storage of hazardous drugs, a dedicated refrigerator with a temperature range of 2-8 degrees Celsius is required.

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Negative Air Pressure

A cleanroom environment with air pressure lower than the surrounding area. This prevents contamination from entering the cleanroom.

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Class II, Type B BSC

A biological safety cabinet used for containing contaminants during compounding procedures. It filters air downwards and external air exhausts vertically through a HEPA filter.

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Sterile 70% Isopropyl Alcohol Wipes

A cleaning solution used for decontaminating surfaces of containers before handling sterile preparations.

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Maximum Syringe Withdrawal

Limit to 75% syringe capacity to avoid drug spillage during withdrawal.

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Closed-Transfer System

Method of transferring sterile preparations to prevent aerosolization and cross-contamination (safety in dispensing).

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Labeling Hazardous Preparations

Marking final preparations as "hazardous" or "cytotoxic" to alert personnel of potential dangers.

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Ampoule Disposal

Any remaining drug in an ampoule must be transferred to an empty vial for disposal.

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Cleaning Twice Daily

Maintenance of the BSC (Biological Safety Cabinet) by wiping down important sections before and after use (safety and cleanliness).

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Deactivating the BSC

Weekly decontamination of the biological safety cabinet using 2% bleach (hypochlorite) to kill pathogens.

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Spill Kit Location

Spill kits are stored in designated areas like staging, non-sterile hazardous rooms, anterooms, and on carts during hazardous drug transport.

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Spill Assessment

Before cleaning a spill, you need to assess the situation. If you can't manage it, you'll need to call for help.

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Spill Restrictions

Use the sign provided in the spill kit to restrict access to the spill area while cleaning.

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Spill Cleaning Order

When cleaning a spill, work from the least contaminated to the most contaminated area. You should work in pairs, with full PPE and two pairs of gloves.

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Donning PPE for Spills

Put on inner gloves, then a chemotherapy-protective gown, a properly fitted P100 respirator and eye protection, shoe covers, and finally, outer gloves over the gown's cuffs.

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Cleaning Liquid Spills

Cover the spill with chemo-absorbent pads, shiny side up. Use a scoop and scraper to remove the pads, place them in a chemo waste bag. Absorb any remaining liquid with absorbent pads. Wash the area three times with detergent, then twice with water. Finally, use surface safe packets and rinse with water.

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Cleaning Powder Spills

Cover the powder with water-soaked spill towels, then lay chemo-absorbent pads over the towels. Use a scoop and scraper to remove the pads and towels, placing them in a chemo waste bag. Wash the area three times with detergent, then twice with water. Clean with surface safe packets and rinse with water.

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PPE Removal Order

After cleaning a spill, remove PPE in the following order: shoe covers, outer gloves, gown, eye protection, respirator. Dispose of the PPE in a cytotoxic waste bag.

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Cleaning Reusable PPE

After a spill, clean the P100 respirator and eye protection with water and mild detergent. Hang to dry and store separately in clean re-sealable bags.

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Staff SOR

After cleaning a spill, complete a staff safety observation report (SOR) for each staff member involved in the spill.

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Study Notes

Hazardous Drugs: Preparation and Handling

  • Hazardous drugs include chemicals, cancer drugs, biologic agents, antiviral agents, hormones, immunosuppressants, toxic agents, and irritants.
  • Hazardous drugs exhibit characteristics like carcinogenicity, teratogenicity, reproductive toxicity, organ toxicity at low doses, and genotoxicity in humans or animals.
  • Cytotoxic drugs are hazardous and affect living cells but not all hazardous drugs are cytotoxic.
  • All hazardous drugs must be prepared in a Class 2 biological safety cabinet by trained personnel.

Who is at Risk for Exposure?

  • Healthcare professionals (physicians, nurses, pharmacy staff) are at risk.
  • Delivery personnel (porters, drivers, inventory personnel) may also be exposed.
  • Housekeeping staff, family members, and friends might be exposed.

When Can Exposure Occur?

  • Exposure can happen during receiving inventory (from suppliers or manufacturers), doses delivered to patient care areas, storage of hazardous products, preparation, administration of chemotherapy, clean-up of hazardous spills or contaminated patient waste.

Routes of Exposure

  • Skin absorption: Direct contact with contaminated surfaces or materials.
  • Ingestion: Eating contaminated food or putting contaminated objects in the mouth.
  • Injection: Accidental needle stick injury from contaminated needles/objects.
  • Inhalation: Breathing in contaminated particles or aerosols from the environment.

Protection from Hazardous Drugs

  • General Considerations: Conduct regular training and equipment audits to evaluate daily operations and handling practices.
  • Workplace Evaluation: Assess equipment, physical layout, drug types, and volumes. Include decontamination procedures and waste management.
  • Safe Handling Program: Establish policies for identifying hazardous drugs, labelling, and personnel training.

Personal Protective Equipment (PPE)

  • Specific PPE requirements for various tasks are listed.
  • PPE includes N95 masks, chemical cartridge respirators, gowns, eye protection, gloves, and shoe covers.
  • PPE should be worn according to specific procedures, including times, locations, and methods of removal.
  • Disposal methods for contaminated PPE are specified.

Decontamination and Deactivation

  • Decontamination involves transferring hazardous drug contaminants to disposable surfaces (like wipes).
  • Deactivation involves treating hazardous drugs to reduce their hazard level.
  • Examples of solutions for deactivation are sterile 70% isopropyl alcohol and accelerated hydrogen peroxide.

Facilities for Preparation of Sterile Hazardous Products

  • Separate areas for sterile hazardous product compounding.
  • Adequate air changes per hour (ACPH) with negative pressure relative to surrounding areas.
  • Air and ventilation controls to prevent cross-contamination.
  • Pass-through windows and alarms for monitoring air pressure changes

Equipment for Preparing Sterile Hazardous Drugs (C-PEC)

  • Class II Type B biological safety cabinets with specific design features.
  • ISO class 5 cleanroom environment with dedicated use.
  • Vertical HEPA filtered air flow, external venting, and frequent cleaning/deactivation methods.

Chemotherapy

  • Chemotherapy drugs can be referred to as anti-neoplastic agents, cytotoxic agents, or cancer chemotherapy agents.
  • Chemotherapy can be a combination of one or more cytotoxic agents designed to treat particular cancers.
  • Protocols may include medication for side effects (nausea, analgesics), hydration (IV fluids), and electrolytes.

Hazardous Spill Management

  • Policies and procedures for spill prevention, response, and cleanup are required.
  • Spill kits must include designated items, warnings, worker training, provisions for contaminated medical assistance, and a procedure for proper disposal.
  • Cleanup methods are described (e.g., for liquid and powder spills), including the correct use of absorbent pads, wipes, and cleaning solutions.
  • There's a procedure for removing contaminated PPE and cleaning equipment/areas.

Quality Control Programs

  • Quality control programs involve personnel training, equipment maintenance, environmental monitoring, and checks on product stability and disposal.

Cancer

  • Cancer is abnormal and uncontrolled cell growth that spreads via the blood and lymphatic systems.
  • Various types of cancer exist, each affecting different organs or cell types.

Cancer Treatments

  • Cancer treatments aim to kill, shrink, or slow malignant tumor growth.
  • Treatments may include surgery, radiation therapy, chemotherapy, or combinations.

Pharmacologic Classifications of Cancer Drugs

  • Specific drugs are classified as alkylating agents, antibiotics, plant extracts, and anti-metabolites.
  • Examples of drug classifications are shown, with their specific components (cisplatin, carboplatin, cyclophosphamide, etc).

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Hazardous Drugs Preparation and Handling - Exam Review PDF

Description

This quiz covers the essential information regarding hazardous drugs, including their characteristics, risks associated with exposure, and guidelines for safe preparation. It highlights the importance of safety protocols for healthcare professionals and others who may be at risk. Test your knowledge on how to handle these substances safely.

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