Chemotherapy Preparation Safety for Pharmacy Techs

The Importance of Chemotherapy Safety

Chemotherapy agents are among the most hazardous medications handled in pharmacy settings. These drugs are designed to kill rapidly dividing cells, and occupational exposure can cause acute effects such as skin irritation, nausea, and headaches, as well as long-term effects including reproductive harm and increased cancer risk. Pharmacy technicians who prepare chemotherapy must follow strict safety protocols to protect themselves, coworkers, patients, and the environment.

The United States Pharmacopeia Chapter 800 (USP 800) establishes mandatory standards for handling hazardous drugs throughout the healthcare setting, from receipt and storage through preparation, administration, and disposal. Understanding and following these standards is not optional but a professional and legal obligation.

Identifying Hazardous Drugs

The National Institute for Occupational Safety and Health (NIOSH) maintains a list of hazardous drugs that is updated periodically. Hazardous drugs are categorized into three groups:

• Group 1 - Antineoplastic drugs: Traditional chemotherapy agents that are cytotoxic, such as cyclophosphamide, doxorubicin, cisplatin, and methotrexate
• Group 2 - Non-antineoplastic hazardous drugs: Medications that are hazardous but not primarily used for cancer treatment, such as ganciclovir, mycophenolate, ribavirin, and certain hormones
• Group 3 - Reproductive hazard drugs: Medications primarily posing reproductive risks, such as finasteride and certain retinoids

Each facility must maintain a list of hazardous drugs based on the NIOSH list and perform regular assessments of new drugs entering the formulary to determine their hazardous classification.

Engineering Controls for Chemotherapy Preparation

Primary Engineering Controls

Chemotherapy must be prepared in appropriate primary engineering controls (PECs) that protect both the product and the compounder:

• Class II Biological Safety Cabinet (BSC): The most common PEC for hazardous drug compounding. Class II Type B2 BSCs are preferred because they exhaust 100% of contaminated air externally through a dedicated exhaust system, rather than recirculating any air into the room.
• Compounding Aseptic Containment Isolator (CACI): An enclosed, negative-pressure isolator that provides both sterile compounding conditions and containment of hazardous drug vapors. The technician works through attached glove ports, providing a physical barrier between the compounder and the hazardous drugs.

Supplementary Engineering Controls

The room housing the PEC must meet specific requirements under USP 800:

• Negative pressure relative to surrounding areas (minimum 0.01 inches of water column)
• Minimum 12 air changes per hour, with externally vented exhaust
• A dedicated ante-room or equivalent area for gowning
• Surfaces that are smooth, impervious, and easy to clean in case of spills

Personal Protective Equipment (PPE)

Proper PPE is essential when handling hazardous drugs at any point in the medication-use process:

• Chemotherapy-rated gloves: ASTM D6978-tested gloves must be worn in pairs (double gloving). The inner glove goes under the gown cuff, and the outer glove goes over the cuff. Gloves must be changed every 30 minutes during continuous compounding or immediately if torn, punctured, or contaminated.
• Protective gown: A disposable, lint-free, non-absorbent gown with closed front, long sleeves, and tight-fitting cuffs. Standard pharmacy gowns are not adequate for hazardous drug handling.
• Eye and face protection: Required when there is risk of splash or spill outside of a BSC or CACI
• Respiratory protection: An N95 respirator or elastomeric half-mask respirator may be required for spill cleanup or when working outside of containment engineering controls

Safe Handling Procedures

Receiving and Storage

Hazardous drugs should be received in a designated area, and personnel unpacking them must wear appropriate PPE. Storage areas must be clearly labeled and separated from non-hazardous drugs. Hazardous drug storage must include provisions for spill containment and cleanup.

Preparation Techniques

During preparation, several techniques minimize exposure:

• Use closed-system transfer devices (CSTDs) when available, which create a sealed connection between the drug vial and the administration device, preventing the escape of drug vapor or aerosol
• Prime IV tubing with non-hazardous solution before adding the chemotherapy agent
• Use Luer-lock connections to prevent accidental disconnection
• Place an absorbent pad on the work surface to contain any drips or spills
• Avoid crushing or breaking tablets of hazardous drugs (this should be done in a containment enclosure if necessary)

Spill Management

Every area where hazardous drugs are handled must have a spill kit readily accessible. Spill kits should contain:

• Chemotherapy-rated gloves, gown, face shield, and shoe covers
• Absorbent pads and towels
• Hazardous waste disposal bags clearly labeled for chemotherapy waste
• Spill cleanup instructions posted on the kit

Technicians must be trained in spill response procedures and know when to call for additional help versus when they can safely clean up a spill themselves.

Waste Disposal

Hazardous drug waste must be disposed of in designated yellow chemotherapy waste containers, not regular trash or sharps containers. This includes contaminated gloves, gowns, pads, syringes, vials, IV bags with residual drug, and any materials that contacted hazardous drugs. Chemotherapy waste is regulated as hazardous waste and must be handled by licensed hazardous waste disposal companies.

Medical Surveillance

USP 800 requires facilities to offer medical surveillance to employees who handle hazardous drugs. This includes baseline health assessments, periodic monitoring, exposure-specific follow-up, and documentation of any reproductive or health concerns related to hazardous drug exposure.

PTCB Exam Preparation

Hazardous drug handling and USP 800 compliance are important PTCB exam topics. Focus on understanding engineering controls, PPE requirements, spill procedures, and waste disposal. Use our practice questions and flashcards to review chemotherapy safety concepts thoroughly.