# Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids

Source: https://onco.cc/protocols/hazardous-drug-handling-in-clinical-areas/  
OnCo record `hazardous-drug-handling-in-clinical-areas` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Many cancer drugs harm the staff who handle them every day, even in tiny amounts. So nurses wear special gloves and gowns when giving them, use sealed connectors, and handle spills and waste in a set way. For a day or two after treatment some drug is in the patient's body fluids, so staff wear gloves for those too. The protection is for repeated exposure at work; you are not dangerous to be near.

## Summary

The US framework is NIOSH (the 2004 Alert and the 2024 hazardous drug list), USP chapter 800 and OSHA, which ASCO's consensus standards (2019) endorse; the UK framework is COSHH, applied by HSE, with a hierarchy of control: enclosed systems, control at source, then PPE. Employers should keep a facility-specific hazardous drug list, because the NIOSH list (2024, 25 drugs added and 7 removed since 2016) may not include newer drugs.

NIOSH (2004) asks for double chemotherapy-tested gloves, a disposable gown with a closed front and closed cuffs, and goggles for all administration activities, from opening the outer bag to disposal; preparation belongs in a ventilated cabinet, tubing is primed with a non-drug fluid, and closed-system transfer devices (CSTDs) supplement but do not replace the cabinet. ASCO (2019) reports that USP chapter 800 requires CSTDs for administration and recommends them for compounding, while a Cochrane review (2018, 24 observational studies) found the evidence of benefit very low in certainty and drew no firm conclusions. Linen and excreta from patients treated within 48 hours (sometimes 7 days) are handled with two pairs of gloves and a gown. Spills follow written procedures with spill kits nearby; large spills need trained staff and a respirator, as surgical masks do not protect. ASCO asks for an alternative-duty policy for staff who are trying to conceive, pregnant or breastfeeding, and finds routine medical surveillance unsupported by evidence; HSE says monitoring is normally needed under COSHH where carcinogens are handled.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: cytotoxic safe handling; chemotherapy PPE; chemo gloves; chemotherapy gown; USP 800; closed-system transfer device; CSTD; chemotherapy spill; cytotoxic spill kit; cytotoxic waste; hazardous drugs in healthcare; NIOSH hazardous drug list

## Connected records

- protocols: [Ambulatory chemotherapy pumps at home: set-up, checks, spills and disconnection](https://onco.cc/protocols/ambulatory-chemotherapy-pumps-at-home/), [Anticancer treatment administration checks at the chair: assessment, independent double checks and line tracing](https://onco.cc/protocols/sact-administration-checks-at-the-chair/), [Aseptic compounding of hazardous anticancer drugs in the pharmacy](https://onco.cc/protocols/aseptic-compounding-of-hazardous-anticancer-drugs/), [Oral anticancer medicines at home: prescribing, teaching, adherence, storage, handling and disposal](https://onco.cc/protocols/oral-anticancer-medicines-at-home/)
- technologies: [Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)](https://onco.cc/technologies/closed-system-transfer-devices/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Oncology pharmacy automation and compounding robots](https://onco.cc/technologies/pharmacy-automation/)
- drugs: [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Ifosfamide](https://onco.cc/drugs/ifosfamide/)
- ideas: [A trial of closed-system transfer devices that measures staff exposure properly, not only surface wipes](https://onco.cc/ideas/idea-upgrade-closed-system-transfer-device-outcome-trial/)

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