Respiratory Protection

Oncology nurses are at an increased risk of exposure to airborne hazards when they’re administering cytotoxic treatments and caring for immunosuppressed patients who are susceptible to resistant infections. Airborne transmission occurs through small particles or droplet nuclei that remain in the air for extended periods of time.

Healthcare organizations are expected to provide sufficient respiratory protection for workers potentially exposed to infectious organisms and hazardous agents (National Institute for Occupational Safety and Health [NIOSH], 2008; U.S. Food and Drug Administration, 2016).

Infectious Agents

Protection against infectious agents is addressed in the Occupational Safety and Health Administration (n.d.) standards related to bloodborne pathogens, personal protective equipment  and respiratory protection. Respiratory Protection for Healthcare Workers is a free online course consisting of two short modules with CNE credit available from the American Association
of Occupational Health Nurses (http://aaohn.org/page/ online-learning). The modules specifically focus on airborne precautions, providing an update related to emerging infections and the proper use of respirators in healthcare settings.

Hazardous Agents

During hazardous drug activities, the Centers for Disease Control and Prevention and NIOSH (2008) recommend to “select specific respirators based on an assessment of your potential exposure to hazardous drugs.” Guidance can be found in the Personal Protective Equipment for Use With Hazardous Drugs (ONS, n.d.).

Knowing when to use the proper protection and educating your colleagues on potential airborne dangers will help foster a culture of safety in your practice.

Respiratory Protection 2
  • The material safety data sheet for each hazardous drug can help you determine the appropriate respiratory protection to use. In general, respiratory protection is recommended during following hazardous drug activities.
  • When risk of exposure to hazardous aerosols or vapors exists
  • During intravesical administration
  • 
When one of these situations does not apply, voluntary use of
  • In hazardous drug preparation areas

When cleaning hazardous drug spills respirators and masks is always an option. When faced with the need or option to select a protective mask, consider the following (NIOSH, 2012).


  • A standard surgical mask provides no protection against gases and vapors and little protection against direct liquid splashes.
  • Fit-tested N-95 or N-100 particle masks are sufficient for intravesical administration and spills able to be contained by spill kit supplies.

  • Chemical cartridge-type respirators should be used when cleaning larger spills (such as infusion bag breaks or disconnected lines), when decontaminating preparation areas, and when unpacking hazardous drugs not packed in plastic.

Following proper respiratory procedures can protect you from hazardous drugs and airborne infections. Knowing when to use the proper protection and educating your colleagues on potential airborne dangers will help foster a culture of safety in your practice.

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