Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

8. DRUG PREPARATION
8.3.9 Preparing Non-sterile Hazardous Drugs RATING: +++
Ensure optimal protection when preparing non-sterile oral hazardous drugs.
RECOMMENDATIONS
8.3.9.1 Exposed workers must wear a protective gown and one (1) pair of gloves (see 4.1.7.7)
for the non-sterile preparation of drugs (e.g. counting drugs). They should wear two (2)
pairs of gloves for topical or liquid preparations. The wearing of face protection is
recommended if there is a risk of splashing (see 4.1.7.10).
8.3.9.2 A work area should be clearly defined and equipment reserved for the hazardous drug
preparations (e.g. properly identified, dedicated counter):
‣ a Class 1 biological safety cabinet exhausted to the outdoors should be used when
handling powders. If a separate hood is not available. the sterile hood may be used,
provided that it is decontaminated following its use with non-sterile drugs;
‣ the equipment used (e.g. scale, pill counter, spatula, etc.) for the non-sterile
preparations of hazardous drugs should not be used to prepare other drugs;
‣ the tray used to count solid oral forms of hazardous drugs should be cleaned
following each use with a gauze pad soaked in detergent and water, and
subsequently rinsed with water.
8.3.9.3 The preparation of creams, ointments and oral solutions, as well as the crushing of
hazardous drug tablets, should be performed in a protected environment (Class 1 or
Class II hood, glove box). Workers should be double-gloved and wear the same type of
gown as for work in the hood. If topical preparations are prepared using injectable
drugs (e.g. mechlorethamine cream), the measures used for an injectable drug should be
adopted.
8.3.9.4 The bagging machines (or other automated equipment) should not be used to package
unit doses of oral forms of hazardous drugs. Manual bagging devices (e.g. blister cards)
should be used, as these prevent cross-contamination with other, non-hazardous drugs.
8.3.9.5 The Pharmacy Department should attempt to limit additional handling of hazardous
drugs by other health professionals. Unit doses of hazardous drugs in liquid oral form
should be prepared in the pharmacy and placed in an oral syringe, ready for
administration. However, a Luer-Lock syringe must not be used for oral syringe
preparations, to avoid accidental parenteral administration.
8.3.9.6 Any material used to prepare oral forms of hazardous drugs must be disposed of in the
receptacles for cytotoxic waste. For practical purposes, a single type of waste receptacle
should be used for all hazardous drugs prepared in or outside the oncology pharmacy. If
a waste receptacle identified with the “Cytotoxic” hazard symbol is not used for the
other hazardous drugs prepared outside the oncology pharmacy, the receptacle used
should, at the very least, be marked “Pharmaceutical Waste – Incineration”.
APES, p. 5-9, 5-10 ♦ ASHP, p. 1182-83, 1189 ♦ CSHP, Sections 8.7.1, 8.7.3 ♦ ONS, p. 22 ♦
OSHA, Section Vc1g
8-8 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS