Personal protective equipment for handling cytotoxic medicines

Duty to employees

Employers should provide fit-for-purpose personal protective equipment (PPE) to employees who handle cytotoxic medicines and related waste. Do a risk assessment to identify the appropriate PPE for each stage of the cytotoxic medicine and related waste management pathway.

Use PPE in conjunction with other risk control measures. In most circumstances, PPE is not a sufficient risk control when used as the only control measure.

PPE should be:

• clean
• functional
• readily available for employees to access.

Employers must give employees the information, instruction, training or supervision they need to work safely. For example, employees need to be trained to correctly apply and remove PPE, especially when handling cytotoxic medicines and contaminated waste.

If PPE becomes contaminated:

• Affected employees should safely remove it as soon as possible.
• It should be properly laundered or disposed of. See ‘Laundering non-disposable PPE and linen’ below.

Types of PPE

The type of PPE that is reasonably practicable depends on the:

• work activity undertaken
• risk of exposure it presents.

Examples of PPE may include:

• impermeable gowns or coveralls with elastacised cuffs, long sleeves and closed fronts
• nitrile or polyvinyl chloride (PVC) industrial gloves that are long enough to cover the cuff of the gown/coverall when the arm is bent or stretched – consider a double layer of gloves
• suitable safety footwear for the environment
• impermeable overshoes
• safety glasses or goggles
• respiratory protective equipment (P2/N95 face-fitting respirator)
• face shield.

Respiratory protective equipment where there is an inhalation risk

Respiratory protective equipment (RPE) is a type of PPE designed to protect the wearer from airborne contaminants. These can be generated:

• in the preparation of cytotoxic medicines where exposure to dust/powder may occur
• when managing a spill.

If there is a risk of an employee inhaling cytotoxic dusts, mists or vapours, a P2 or N95 is recommended. A surgical mask should not be used.

Where RPE is required to protect employees from airborne hazards, employers should have a respiratory protection program in place. The program should include:

• Information on suitable respirators for the task. For example, when a P2 or N95 may be required where an inhalation risk exists.
• Fit-testing at defined intervals.
• Fit-checking at each use.
• Donning and doffing.
• Limitations, such as facial hair or glasses.

RPE and its selection, use and maintenance should meet:

• AS/NZS 1716:2012 Respiratory Protective Device or its equivalent.
• AS/NZS 1715:2009 Selection, use and maintenance of respiratory protective equipment or its equivalent.

For more information on the most suitable type of respiratory protection for a task, check with:

• The manufacturer or supplier of the respirator.
• A person with skills and knowledge in respiratory protective devices. For example, an occupational hygienist.

Laundering non-disposable PPE and linen

Precautions are needed when laundering non-disposable PPE (gowns) that may be contaminated with cytotoxic medicines. Follow the requirements of the manufacturer or supplier of the PPE. Systems should be established to:

• Safely store contaminated PPE/linen before it is collected.
• Protect laundry employees from cytotoxic medicine residue or waste, including biological waste. Laundry employees may need to wear PPE.
• Dispose of heavily contaminated PPE instead of laundering.
• Ensure PPE is decontaminated prior to reuse.

There are specialised companies who can provide and launder cytotoxic-contaminated non-disposable PPE.

In services where there is limited requirement for PPE, disposable items may be most practical.

If an independent business collects or launders linen, employers should:

• tell them that the linen is contaminated with cytotoxic medicines or related waste
• work with them to develop decontamination strategies where appropriate.

Employees should use the following PPE when handling soiled linen that is likely to be contaminated with cytotoxic medicines:

• impermeable gown or coveralls with elasticised cuffs
• nitrile gloves – consider a double layer of gloves
• RPE, such as a P2/N95 face-fitting respirator.