At Rpharmy, we pride ourselves on the relationships we've built with our clients over the years. These trusted partnerships often lead to eye-opening conversations—conversations that help us understand the real challenges healthcare teams face and how we can better support them. One such discussion recently centered on a deceptively simple but critical question.
The Client Question: What About Body Fluids?
A client reached out with this timely concern:
“How are other clients addressing patient care activities for body fluids?”
Their team wanted to know how to protect healthcare workers when a patient is on a complex drug regimen containing multiple drugs with different risk levels. Should the most hazardous drug determine the safety protocol? And if so, how do you identify which one that is?
This concern wasn’t limited to nurses. Environmental services (EVS), respiratory therapists, and even home healthcare providers could be exposed to hazardous materials through contact with patient waste. In these scenarios, knowledge and coordination are critical.
Understanding the Risk Window
Handling body fluids from patients on drug regimens that include multiple medications and at least one hazardous drug requires the same stringent safety protocols used to handle and dispose of the drugs themselves. This is especially critical in oncology clinics where cytotoxic and antineoplastic drugs are common.
While most hazardous drugs are excreted within 48 hours, some linger in the body for up to seven days or more. When multiple hazardous drugs are involved, excretion timelines can overlap, extending the period during which body fluids remain dangerous. It is imperative that safety protocols be made available to healthcare workers outside of pharmacy and even nursing to EVS, respiratory therapists, home healthcare and beyond.
In general, safe handling and disposal guidelines should be followed for at least 48 hours after drug administration. For drugs with longer half-lives, PPE use should extend to 4–5 times the drug’s half-life. According to the ONS 4th Edition Safe Handling of Hazardous Drugs (Olsen & Walton, 2024):
"Because some HDs and their active metabolites may have extended excretion times, which may lengthen risk of exposure, healthcare workers (HCWs) should know how to determine the length of time a patient will excrete a given HD. ... 94%–97% of a drug is eliminated after four to five half-lives ... This may be useful for alerting HCWs who may be handling body fluids but are not administering drugs (e.g., environmental services workers, nursing assistive personnel)."
Putting It Into Practice: Patient Care Activities in Action
How do healthcare systems decide on the right level of precaution? According to USP <800>, the answer is simple but critical:
Apply the most stringent safety protocols applicable to any of the drugs in the regimen.
These standards should apply not just to pharmacists and nurses, but to every healthcare worker who may come into contact with the patient or their body fluids.
Within Rpharmy’s Rhazdrugs hazardous drug safety solution, we also have the option to add a “Patient Care Activity” for body fluid that dictates the highest hazardous drug safety protocol. This provides a high level of safety when drug-specific safety protocols aren’t available.
Take a look at an example below of how this appears in Rhazdrugs for managing body fluids from patients on hazardous regimens:
These activities outline recommended personal protective equipment (PPE) and handling guidelines for everyone, from nurses to environmental services (EVS) staff. Even toileting protocols are addressed, including the use of plastic-backed absorbent pads or toilet lid closures to prevent the spread of hazardous residue.
Recent research published in the Clinical Journal of Oncology Nursing (CJON) confirms the importance of this step. The study supports the use of plastic-backed pads during flushing to reduce contamination in patient care areas.
Have a Question Like This? Let’s Talk.
If you’re like our client who had questions about how to protect healthcare workers from hazardous materials in body fluids, please ask! We take on any and all questions regarding medication safety, hazardous drugs, and USP <800>. And if we don’t have the answer, we’ll ask our amazing client community. Chances are, someone else has faced the same challenge.
📧 Email us at info@rpharmy.com. We’d love to hear from you.
