Reply To: N95 vs. PAPR (Respiratory Protection for HDs)

  • Heather Hartlage

    March 9, 2020 at 2:33 pm

    Do you have any information on if N95 is recommended even if using CSTD?  Looking for any evidence to demonstrate necessity of n95 to my employer.

    Heather Hartlage, MSN,RN,CPON
    Clinical Nurse Education
    Addison Jo Blair Cancer Care and Renal Center
    Norton Children’s Hospital
    Louisville, KY United States
    Original Message:
    Sent: 03-28-2019 08:47 AM
    From: Mary Lynn Rae
    Subject: N95 vs. PAPR (Respiratory Protection for HDs)

    Hello All:


    I want to clarify respiratory protection when it comes to HDs.  On slide 28 in Safe Handling (2019 Chemo/Bio Provider course) it says on the slide and in the notes that respiratory protection is not recommended during administration of HDs.  A N95 or PAPR is required for clean-up of spills/per the below.   


    Here is some wording for vapors in USP<800>

    • However, N95 respirators offer no protection against gases and vapors and little protection against direct liquid splashes
    • An appropriate full-facepiece, chemical cartridge-type respirator or powered air purifying respirator (PAPR)should be worn when there is a risk of respiratory exposure to HDs, including when: attending to HD spills larger than what can be contained with a spill kit, deactivating, decontaminating, and cleaning underneath the work surface of a C-PEC, and there is a known or suspected airborne exposure to powders or vapors


    But, USP<800> is not specific in which drugs cause vaporization, hence the new chapter in the book which is on page 153 that lists out the drugs

    Limited research has been done on HD vaporization because studies are difficult to conduct. Identified agents that have the potential to cause vaporization include the follow ing (Connor, Shults, & Fraser, 2000; Eisenberg, 2017; Kiffmeyer et al., 2002):

    • carmustine (BiCNU)
    • cisplatin (Platinol)
    • cyclophosphamide (Cytoxan)
    • etoposide (Toposar)
    • fluorouracil (Adrucil)
    • ifosfamide (Ifex)
    • nitrogen mustard (Mustargen)
    • thiotepa (Thioplex)


    The easiest article to understand is from Seth Eisenberg; other ones very technical…..


    • Connor, T. H., Shults, M., & Fraser, M. P. (2000). Determination of the vaporization of solutions of mutagenic antineoplastic agents at 23 and 37C using a desiccator technique. Mutation Research, 470, 85–92. doi:10.1016/S1383-5718(00)00105-4
    • Eisenberg, S. (2017). Hazardous drugs and USP <800>: Implications for nurses. Clinical Journal of Oncology Nursing, 21(2), 179–187. doi:10.1188/17.CJON.179-187
    • Kiffmeyer, T. K., Kube, C., Opiolka, S., Schmidt, K. G., Schöppe, G., & Sessink, P. J. (2002). Vapour pressures, evaporation behavior and airborne concentrations of hazardous drugs: Implications for occupational safety. Pharmaceutical Journal, 268, 331–337.



    Mary Lynn

    Mary Lynn Rae, MSN, RN, CPHON

    NPD Practitioner/Clinical Educator Hem/Onc/SCT

    Ann & Robert H. Lurie Children’s Hospital of Chicago

    T 312.227.4224 | |

    Mary Lynn Rae, MSN, RN, CPHON
    NPD Practitioner/Clinical Educator Hem/Onc/SCT
    Ann & Robert H. Lurie Children’s Hospital of Chicago
    225 East Chicago Avenue,
    Chicago, Illinois 60611-2991