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How to Reprocess Surgical Instruments used in Chemotherapy or in contact with other Hazardous Drugs

[Over the years we have received a number of inquiries from the field regarding chemotherapy and instrument reprocessing best practices. The following guest article by Keicha Brock, CSPM, CFER, MBA, Founder & CEO of Eyes to See Management & Consulting seeks to introduce you to the foundational concepts to consider as you prepare your own policies, procedures, and processes. We hope you enjoy! * Beyond Clean]


There are precautions that must be adhered to when handling instruments that may have been exposed to chemotherapy or Hazardous Drugs (HD).

Education, training and communication is the best resource for staff that may come into contact with or be exposed to Chemotherapy/Hazardous Drugs contaminated instruments. Any facility that has hazardous drugs, must remember that it is vital that each person understand the fundamental practices and precautions that are needed to prevent harm and minimize exposure.

So what is Chemotherapy?

Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemo drugs can be grouped by how they work, their chemical structure, and their relationships to other drugs.

Some drugs work in more than one way and may belong to more than one group.

National Institute for Occupational Safety and Health (NIOSH) has a list of Hazardous Drugs and updates the list every two years. NIOSH cautions that new drugs enter the marketplace often and the listed on the website is not all-inclusive.

Each facility is responsible for maintaining and developing a comprehensive list of HDs used at their facility as well as an ongoing process for drug evaluation through safety data sheets, product information and current literature that is available.

Chemotherapy drugs are considered Hazardous Drugs (HDs) because they meet these characteristics

  • Carcinogenicity

  • Teratogenicity or other developmental toxicity

  • Reproductive toxicity

  • Organ toxicity at low doses

  • Genotoxicity

Complications that may come from exposure are rashes, nausea and vomiting, dizziness, abdominal pain, headache, nasal sores, and allergic reactions. Exposure over a long period of time can be associated with birth defects, reproductive losses, and cancer.

Reprocessing around Chemotherapy & other Hazardous Drugs (HD)

Anyone that works with instrumentation that encounters Chemotherapy/HDs must remember the possibility for potential contamination and exposure due to the three “S” splash, splatter, or spray. When handling Chemotherapy/HDs- contaminated instruments, personnel that handles instruments must wear Personal Protective Equipment (PPEs.) PPEs are a temporary barrier between hazardous drug contamination to prevent a health hazard. We must remember that all PPE’s are not created the equal. They are several companies on the market that provide PPEs for Chemotherapy/HDs exposure.

The PPEs consist of: Gloves Glove thickness does not determine dermal safety from hazardous drugs. Exam gloves made from polyvinyl chloride do not protect the wearer from drug exposure. Look for glove manufacturer test data for permeation resistance compared to hazardous drugs/ chemotherapy glove guidelines.

Gowns Disposable gowns that are tested for chemotherapy/HDs offer temporary and partial defense against hazardous drugs. These gowns are an indispensable part of protective gear. A lab coat and/or scrubs do not provide the same protection as a disposable gown rated for Chemotherapy/HDs.

Respiratory Protection Surgical masks are not enough to prevent chemotherapy/hazardous drug exposure on their own. An N95 respirator paired with a surgical mask may be allowed for certain chemotherapy hazardous drugs, as listed on the drug information sheet.

Eye and Face Shields Vapors, aerosols and splashes from chemotherapy/hazardous drugs cause irritation and potential long-term damage not only to the eyes but also to other organs. Glasses alone do not provide sufficient protection. Those who wear glasses should choose full-face shields and/or goggles to avoid the risk of hazardous drug exposure.

Sleeve, Hair, and Shoe Coverage When wearing sleeve, hair, and shoe covers, it is recommended to always check for holes or other manufacturing defects before entering a place that has instruments that are contaminated.

Disposal of PPE after contact with hazardous materials must be done properly to avoid contamination. Never wear disposable PPE more than once. Adhere to these safety guidelines regarding PPE disposal: