285 - Minimization of Occupational Exposures to Chemotherapeutic Agents in the Perioperative Environment
Description: Clinical IssueChemotherapy is a widely known hazardous, antineoplastic drug that requires special personal protective equipment (PPE) and handling. In December 2019, United States Pharmacopeia (USP) General Chapter 800 standards for safe handling of hazardous drugs and risk mitigation will be enforceable. In the oncology environment, these special precautions are widely known and well-practiced through educational courses and efficient access to chemo-rated PPE. In the perioperative environment, antineoplastic agents were not recognized as an occupational hazard. A knowledge gap was identified related to risk for exposure and proper handling of antineoplastic agents. Description of TeamStakeholders included perioperative frontline clinical and support staff, an environmental hygienist, and subject matter experts from oncology and pharmacy. Preparation and PlanningUpon discovery of chemotherapeutic agents in the perioperative environment, perioperative leadership reached out to the frontline clinicians to solicit input. Electronic data was collected and analyzed to determine the frequency and impact of the specific chemotherapeutic agents used. AssessmentWe interviewed and observed the practice of frontline clinical staff in both the OR and PACU to identify the scope of the problem and to create countermeasures to ensure the safety of our employees.ImplementationWe developed a standardized process for the ORs and PACUs to ensure frontline clinicians had access to both non-sterile and sterile chemo-rated PPE. In the PACUs, a multidisciplinary team ensured the frontline clinicians had access to the same PPE used in the oncology environment by adding these items to their standard inventory supply cart. In the ORs, frontline clinicians were provided with a mobile “chemotherapy precautions cart” that is stocked with both non-sterile and sterile chemo-rated PPE and supplies. Tip sheets and interactive education was developed and disseminated in various forums to ensure staff understood donning and doffing chemo-rated PPE, minimizing exposure to hazardous agents, and handling of a chemotherapy spills. OutcomeAs a result of this initiative, frontline clinicians have access to appropriate PPE for chemotherapy administration and understand how to mitigate exposure risks associated with these drugs. We will continue to assess the market for advances and work with the USP 800 Steering Committee to ensure our team has the utmost protection and education to prevent exposures. Implications for Perioperative NursingPerioperative leadership needs to assess the medications being administered in their perioperative areas to ensure employee safety is being promoted through education and appropriate PPE. Preventing occupational exposures to hazardous drugs through education, PPE, and risk minimization fosters a culture of safety.