# Hazardous drugs (chemotherapy) safety

Source: [[../policies/POL-CW-04-chemo-safety.md|POL-CW-04]] v4.0 (19 Nov 2025) · Owner: Pharmacy + Nursing · Ages **0–21**

Teaching copy. Not KHCC policy. Not for real patients.

## The rules as written

- Closed-system transfer device for all parenteral hazardous drugs.
- PPE: chemo gown, double gloves, eye protection if splash. Surgical mask enough.
- Pregnant staff: may not mix; may administer if a second nurse spikes the bag.
- Hold myelosuppressive cycles if ANC **≤ 1000**, unless the protocol says otherwise.
- Fever during an infusion: stop the bag, call the registrar, and if the child is well **contact the day unit the next morning**. Night fever is not an ER path.
- Extravasation: vinca → warm + hyaluronidase. Anthracyclines (doxorubicin) → **warm compress**.
- Spill kit: **Room 12 clean utility**, top shelf, yellow, seal checked Mondays. Not in dirty utility. No plants in chemo rooms.

## Linked notes

- [[febrile-neutropenia]] — FN says same-evening ER, no waiting until morning.
- [[visitor-isolation]] — spill kit location disagrees (dirty utility cupboard B).
- [[discharge-fever]] — both tell a well-looking febrile child to wait; both disagree with POL-CW-01.

## Open questions

- Warm compress for doxorubicin is the reverse of the usual cold-for-anthracycline rule. Flag as an error.
- Age band 0–21 does not match 0–18 (FN, isolation) or under-16 (lines).
- Isolation gowns and chemo spill kit are told not to share a cupboard, but POL-CW-03 already put gowns in dirty utility next to a spill kit.