USP 800 & Safe Handling
True or false: USP 800 was designed to protect healthcare workers from exposure to hazardous drugs?
True - provides guidelines to protect HCWs.
Surprise! You've been chosen to demonstrate how to properly don PPE for chemotherapy administration!
Gown, 2 sets of gloves, optional face shield
Where can you find the poster that describes the various waste disposal bins at CHLA?
Hanging in the med rooms
1. Spill kit
2. Gown
Explain the purpose of the "yellow bags"
Yellow bags are used to transport USED chemo containers/tubing/syringes from the patient's room to the med room. They should also contain your USED PPE.
True or false: "hazardous drugs" include only chemotherapy agents.
False! Many other drugs are defined as hazardous, including most antifungals and antivirals.
You are going to administer an oral chemotherapy agent to your patient, who often spits out their meds. What PPE should you wear?
2 sets of gloves, face shield/eye protection, gown
What is the difference between the yellow bin and black bin (found in pharmacy)?
Yellow bin - disposal of trace chemo waste
Black bin - found in pharmacy, used for disposal of large-volume chemo waste
*Small* black bin - for Arsenic trioxide only
Each spill kit can contain how many mLs of fluid?
1000mL
Families are often taught how to administer chemotherapy agents (IV, PO, and SubQ) at home. What are two things we need to teach these families?
1. Pregnant caregivers should not be handling medications.
2. Keep medications out of reach of children and pets.
3. Disposal of waste: NO flushing meds down toilet or throwing away into normal trash can.
When sending a specimen to lab for a patient who receives hazardous drugs, do any special labels need to be added?
Yes! Please add the "hazardous drugs" yellow label to a specimen (does not apply to blood, but applies to urine, stool, etc.). Labels usually stocked at each p-tube system.
After you have prepared your IV chemo for administration, is it ok to hang up your gown for a few minutes to be used again when taking the chemo to the patient's room?
No! Gowns are one-time use
Where do we dispose of radioactive diapers?
Purple bin (located on 4W)
Surprise! You've been selected to open the spill kit and explore its contents. Let's figure out the process for cleaning a spill.
For how long after receiving chemotherapy should healthcare providers double glove while handling patient waste (urine, feces, vomit)?
At least 48 hours
You are about to administer PO voriconazole suspension to your 2yo patient. What PPE should you wear?
Double gloves & optional face shield if risk of spitting/splashing
As you enter a patient's room, do you need to make any changes to your PPE prior to initiating their chemotherapy?
Yes - remove your outer pair of gloves (since they touched the door handle) and put on a new outer pair of gloves.
When a patient goes home after receiving chemotherapy, how many times do they need to flush the toilet? And for how long after receiving the chemo?
For up to 48hrs after chemo, at home should flush twice (in hospital only once).
What code do we call for a LARGE chemo spill?
Code Orange
What are the 4 components of the "Back to Basics" hygiene bundle for patients with central lines?
1. Oral care 2x per day
2. Linen change daily
3. Bath (or bath wipes) daily
4. CHG treatment daily (after bath)
Some drugs are only available in pill form, but many children are not able to swallow pills. What is the correct way to prepare a hazardous drug for administration if it needs to be converted to liquid?
Use an oral syringe transfer device - DO NOT CRUSH hazardous drugs (risk of aerosolization = danger to healthcare workers).
Discuss the correct way to doff (remove) PPE as you leave a patient's room.
Remove outer pair of gloves, (eye protection), gown, (shoe covers), and then inner pair of gloves. Finally, wash hands.
If a patient is diapered and receiving chemotherapy, where should these diapers be thrown away?
In hospital: can go into normal trash can unless SATURATED in chemo pee.
At home: sealed into a plastic bag then thrown into the trash can. Keep out of reach of kids and pets.
If only a partial bag of chemo has spilled (the rest is still in the bag), where do we dispose of the remaining bag of chemo?
Call pharmacy - needs to go into black bin
Where can you find hospital policies related to chemotherapy administration and safe handling?
In the Policy and Procedure library!