Safe Handling Small molecule inhibitors are considered hazardous drugs according to a draft of updated guidelines from the National Institute for Occupational Safety and Health (NIOSH, [2020]). Although they may not be carcinogenic and may not be directly cytotoxic, many small molecule inhibitors meet the NIOSH criteria for hazardous drugs because the manufacturer’s prescribing information has included special handling instructions to protect workers who are handling the drug. Some small molecule inhibitors are considered hazardous because they have the potential to cause adverse developmental or reproductive effects. A list of hazardous drugs can be found in the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2016 (NIOSH, 2016). APHON recommends using “safe handling procedures for any biotherapy agent labeled hazardous by the manufacturer or the Occupational Safety and Health Administration (e.g., interferon, bortezomib, brentuximab, inotuzumab, all tyrosine kinase inhibitors)” (Conley et al., 2019, p. 155). Another set of standards has been set forth in the United States Pharmacopeia (USP) General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings , created by the United States Pharmacopeial Convention in December 2019. This document sets out standards and guidelines for safe practices and processes in handling hazardous drugs, in order to minimize damage to public health across the United States, especially through occupational exposure. USP <800> has provided recommendations for personal protective equipment (PPE) that should be worn by healthcare workers who handle hazardous drugs. Table 3 briefly summarizes PPE requirements relevant to small molecule inhibitors.
Table 3. Appropriate Personal Protective Equipment According to Administration Route
Form or Route of Administration
Double Gloves
Protective Gown
Eye Protection
Respiratory Protection
Engineering Control
Intact tablet or capsule
No, single pair of gloves
No
No
No
N/A
Tablet or capsule (manipulated)
Yes
Yes
Yes
Yes, if not done in control device
N/A
Oral liquid
Yes
Yes
Yes, if spitting up is potential
No
N/A
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Pediatric Chemotherapy and Biotherapy Provider Renewal (2021–2023) • © 2021 APHON
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