Part 3, Chapter 27: Manual Exhibit 3-27-D

Community Health Representatives (CHR) may at times transport or otherwise come into contact with hazardous drugs.  The following information sheet provides tips on how to safely handle hazardous drugs and should be distributed to the individual CHR if they are potentially exposed to hazardous drugs.

1. What are hazardous drugs?
   1. Hazardous drugs are a group of drugs that are associated with or suspected of causing adverse health effects.  Hazardous drugs may possess any one of the following characteristics:
      1. the ability to cause a change or mutation in genetic material;
      2. the ability to cause cancer in animal models, humans, or both;
      3. the ability to cause defects in fetal development or fetal malformation;
      4. fertility impairment or adverse reproductive outcomes in both men and women; and
      5. serious toxicity at low doses in experimental animal models or treated patients.
   2. Hazardous drugs are commonly used in the treatment of cancer but may also be used to treat rheumatoid arthritis, HIV, hepatitis, or other non-malignant illnesses.
   3. Hazardous drugs are excreted from the patient for at least 48 hours and up to 7 days after treatment.  The patient's bodily fluids are considered contaminated during these times.  Observe standard precautions when handling the patient's body fluids or any linen, etc., contaminated with their bodily fluids.
2. How should hazardous drugs be transported?
   1. Always transport hazardous drugs in a sealed, plastic container.  If transporting an IV bag or other liquid, enclose the drug in a sealed bag and place the sealed bag in a rigid, sealed, plastic container.
   2. Wear nitrile or latex gloves when handling hazardous drugs.
   3. Wash your hands before and after handling the hazardous drugs.
   4. Do not eat, drink, smoke, or apply makeup or lip balm while transporting hazardous drugs.
   5. Have a hazardous drug spill kit with you when transporting hazardous drugs.
      1. Check with your Clinic Pharmacist to determine what you need to include in your kit.
      2. Commercial kits are also available.  You should receive training on how to use the spill kit.
3. What happens if the drugs spill or leak when I am transporting them?
   1. For large spills, contact the fire department.
   2. For small spills, put on Personal Protective Equipment (PPE) from the spill kit and clean up any glass using a scoop and brush.  Remove any contaminated removable items (floor mats, seat covers, etc.) and wash them in a commercial washing machine with regular detergent.  If the contaminated items can not be removed (seat upholstery, flooring, etc.), dab at the surface with a disposable cloth and wipe up as much of the drug as possible.  Clean the surface using a wet vacuum or upholstery spray cleaner.  Remove PPE such as gloves carefully and dispose properly.  Double bag all waste in sealed plastic bags.
4. How do I handle a spill in the home?
   1. Wearing the PPE from the spill kit, clean up any glass using a scoop and brush.  Wipe up any liquid with paper towels.  Clean the contaminated area with soap and warm water twice.  Double bag all waste in sealed plastic bags.
5. How do I handle contaminated linen or clothing?
   1. Institute standard precautions when handling excreta or contaminated linen for 48 hours after drug administration.
   2. Do not touched soiled areas with your bare hands. Wash the contaminated linen and clothing in hot water with regular detergent separately from other laundry.  If clothing and linen is tolerable, add bleach to the wash.  Wash a second time.
   3. If the linen can or clothing can not be washed immediately, place them in a sealed plastic bag until they can be washed.
6. What if I spill hazardous drugs on me?
   1. Immediately remove the contaminated clothing and thoroughly wash the affected area with soap and water.
   2. If your clothing is contaminated, you can wash it with regular detergent in hot water.  If clothing and linen is tolerable, add bleach to the wash.  Repeat this process.
   3. eport the spill to your healthcare provider and report according to Tribal policies and procedures.  Also, notify the healthcare facility who prepared the drugs that a spill occurred.
7. Other tips regarding hazardous drugs:
   1. Store hazardous drugs out of the reach of children and pets.
   2. Diapers should be placed in zip-loc bags for disposal for two days after drug administration.