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POGO Satellite Manual

3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents

3.1.1 Personal Protective Equipment

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Personal Protective Equipment (PPE) provides protection to reduce workers’ exposure to hazardous drug (HD) aerosols and residues. Additional PPE may be required to handle the HDs, such as treating a patient or cleaning a spill. Types of PPE used in handling hazardous drugs:

  • Disposable PPE must not be re-used.
  • Reusable PPE must be decontaminated and cleaned after use.
  • Two pairs of chemotherapy gloves are required for administering antineoplastic HDs.
  • Gowns shown to resist permeability by HDs are required when administering injectable antineoplastic HDs.

Appropriate PPE to be worn should be based on your institution’s safety plan and assessment of risk. For its PPE (gowns, gloves, goggles, masks, face shields), your institution should ensure the manufacturer has provided documented evidence of impermeability to HDs.

See the table below as a guide. This table is derived from The Hospital for Sick Children’s policy on Safe Handling of Hazardous Drugs. The administering guides below were made based on the inclusion of a closed system transfer device (CSTD).

Personal Protective Equipment for Hazardous Drug (HD) Administration and Other Tasks

Dose FormPersonal Protective Equipment
For injections (IM/SC)Chemo Gloves, Chemo Gown and Face Shield/Mask combo
For IVChemo Gloves, Chemo Gown and Face Shield/Mask combo
For oral liquid dosesChemo Gloves, Chemo Gown and Face Shield/Mask combo
For topical administration (creams and ointments)Double Chemo Gloves, Chemo Gown
For intact oral or ready-to-use dosage formsChemo Gloves
For aerosolized administrationFollow drug-specific hospital policies
For compromised oral dosage forms (capsule opening/pill crushing when no oral dose exists)Chemo Gloves, Chemo Gown, Face Shield and N95 Respirator on blue pad OR prepare in Biosafety Cabinet
Patient excreta handling (urine hats, urinals, emptying Foley bags, changing diapers, hygiene bag handling and emesis)Chemo Gloves, Chemo Gown and Face Shield/Mask combo
Blood samplingChemo Gloves, Face Shield/Mask combo
Urine testing (point of care)Chemo Gloves, Chemo Gown and Face Shield/Mask combo
Spill managementDouble Chemo Gloves, Chemo Gown, Face Shield/Safety Goggles and N95 Respirator
Room cleaningChemo Gloves, Chemo Gown, Face Shield/Safety Goggles and N95 Respirator

See below for examples of a Hazardous Drugs Precautions PPE poster and a Hazardous Drugs Precautions room sign.

1. Hazardous Drugs Precautions PPE Poster

Example of a hazardous drugs (HDs) precautions PPE poster, including room set-up, labelling, drug preparation, handling precautions for administration, patient excreta handling, disposal of patient excreta, waste disposal, blood sampling, urine testing, spill management and room cleaning.

2. Hazardous Drugs Precautions Room Sign

Use personal protective equipment (PPE), including chemo gloves, chemo gown, face shield/mask combo, goggles, face shield, and N95 respirator as per fit test. Use the right equipment, including hazardous waste container, hazardous waste sharps container, and soiled linen hamper with lid. Wash hands for soap and water before leaving room.

For more information on types of PPE that are safe for handling HDs, please visit the USP Healthcare Quality & Safety Free General Chapter Downloads form and select the box marked as <800> Hazardous Drugs – Handling in Healthcare Settings (Informational).

This guidance document was developed by Mr. Kaniska Young Tai, The Hospital for Sick Children, Toronto and Ms. Sylvie Kozlowskyj, Northeast Cancer Centre, Health Sciences North, Sudbury. Reviewed in consultation with Ms. Janie Lappan, McMaster Children’s Hospital, Hamilton Health Sciences, Hamilton, Ms. Mary Jo De Courcy, Children’s Hospital, London Health Sciences Centre, London and Ms. Christina McCauley, POGO/The Hospital for Sick Children, Toronto based on the sources in Sub-Section 3.1.7.

Disclaimer: Source Accuracy

You are welcome to download and save a local copy of this document in the Word and/or PDF formats provided. As the POGO Satellite Manual is subject to ongoing revisions and updates by POGO, we recommend you regularly check the online version posted at https://www.pogo.ca/satellite-manual/ to ensure you have the most up-to-date content. In the event of any inconsistency between the content of a local copy and the online version of the POGO Satellite Manual, the content of the online version shall be considered correct. Please see also the POGO Satellite Manual Disclaimer.

Record of Updates
Version NumberDate of EffectSummary of Revisions
16/28/2021Original version posted.
3.1.2 Preparation, Transport and Storage
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In this Section

  • 1.1 History and Overview
  • 1.2 Acknowledgements
  • 1.3 Committees and Working Groups
  • 1.4 POGO Satellite Manual Disclaimer
  • 2.1 Principles of POGO Satellite Clinic Care
    • 2.1.1 POGO Satellite Care Decision Flowchart
  • 2.2 Eligible Patients
    • 2.2.1 Children Eligible for Chemotherapy Administration in a POGO Satellite Clinic
    • 2.2.2 Children Eligible for the Management of Complications in a POGO Satellite Clinic
    • 2.2.3 Children Eligible for Supportive Care in a POGO Satellite Clinic
  • 2.3 Scope of POGO Satellite Clinic Practice
  • 2.4 Expanded POGO Satellite Clinic Practice
  • 3.1 Safe Handling, Administration and Disposal of Chemotherapy Agents
    • 3.1.1 Personal Protective Equipment
    • 3.1.2 Preparation, Transport and Storage
    • 3.1.3 Administration of IV Hazardous Drugs
    • 3.1.4 Administration of Oral Hazardous Drugs
    • 3.1.5 Disposal of Equipment/Personal Protective Equipment used to Administer Hazardous Drugs
    • 3.1.6 Safe Handling for Pharmacy
    • 3.1.7 References
  • 3.2 Accidental Exposure/Spills
  • 3.3 Extravasation Management
    • 3.3.1 Prevention and Management of Extravasations
    • 3.3.2 Antidotes and Treatments for Extravasation
    • 3.3.3 Sample Extravasation Documenting Tool
    • 3.3.4 References
  • 3.4 Injecting SC Medication Via an Insuflon
  • 3.5 Chemotherapy Administration Reference List
  • 3.6 Central Venous Catheter Care
  • 3.7 Chemotherapy Quick Reference
    • 3.7.1 Rapid Hydration
    • 3.7.2 Provider Guide: Prevention and Management of Irinotecan-Induced Diarrhea
    • 3.7.3 Capizzi Methotrexate
    • 3.7.4 Erwinia Asparaginase
    • 3.7.5 Crisantaspase (Rylaze) Asparaginase
    • 3.7.6 Nelarabine
  • 4.1 Management of Fever and Neutropenia
    • 4.1.1 Routine Order Sample Sheet
    • 4.1.2 Sample Fever Cards
    • 4.1.3 Outpatient Fever and Neutropenia in POGO Satellites
  • 4.2 Pentamidine Administration
    • 4.2.1 Inhaled Pentamidine
    • 4.2.2 Intravenous Pentamidine
  • 4.3 Antiemetics
  • 4.4 Treatment of Varicella-Zoster Infections
  • 4.5 Immunization of Children with Cancer
  • 4.6 Transfusion
  • 4.7 Clinical Circumstances that Warrant Consultation with the Specialized Childhood Cancer Program
  • 5.1 Palliative Care Overview
  • 5.2 Communication
  • 5.3 Settings of Care
  • 5.4 Symptom Management
  • 5.5 End of Life
  • 5.6 When a Child Dies at the POGO Satellite Clinic
  • 5.7 Appendix: Sample Bereavement Materials
    • 5.7.1 Reconciling Your Grief
    • 5.7.2 Funeral Arrangement Checklist
    • 5.7.3 Helping Children Who Grieve
    • 5.7.4 Coping with the Holidays
    • 5.7.5 The Grief Experience
  • 5.8 References
  • 6.1 Goals and Objectives
  • 6.2 Participant Site Selection
    • 6.2.1 Tertiary Hospital Site Selection
    • 6.2.2 Community Hospital Site Selection
  • 6.3 POGO’s Roles
    • 6.3.1 PHIPA, Privacy and Research
  • 6.4 Funding
    • 6.4.1 Funding Support for Tertiary Hospital Activity
    • 6.4.2 Funding Support for Community Hospital Activity
  • 6.5 Infrastructure and Formal Requirements
    • 6.5.1 Specialized Childhood Cancer Program Partners’ Role in the POGO Satellite Program
    • 6.5.2 POGO Satellite Clinic Partners’ Role in the POGO Satellite Program
  • 7.1 Preamble
  • 7.2 Investigator Responsibilities
  • 7.3 Training Requirements
    • 7.3.1 General Training for Conduct of Research
    • 7.3.2 Protocol-Specific Training
  • 7.4 Research Activities That May Be Completed in POGO Satellite Clinics Under Supervision of DSI
  • 7.5 Research Activities to be Completed in Specialized Childhood Cancer Programs Only
  • 7.6 Recognition and Reporting of Adverse Events (AEs)
  • 7.7 Data Transfer
  • 7.8 Pharmacy Drug Accountability
  • 7.9 Site Inspections and Quality Assurance
  • 8.1 Pediatric Oncology Shared Care Initial Data Transfer Sheet
  • 9.1 POGO Satellite Clinic Preparedness Checklist
  • 9.2 POGO Satellite Clinic Quality Assurance Checklist
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