8/3/2019 Safe Handling of Cytotoxic Drugs

http://slidepdf.com/reader/full/safe-handling-of-cytotoxic-drugs 1/4

Safe handling of cytotoxic

drugs

Cytotoxic drugs are prescribed to treat cancers and other medical conditions.

There are no exposure limits set for cytotoxic drugs, however even low levels of exposure

should be avoided as much as possible and with necessary safety precautions taken.

Healthcare, veterinary and laboratory workers can be exposed or contaminated by cytotoxic

drugs through skin or eye contact, skin absorption, inhalation of aerosols and drug particles,

ingestion and needlestick injuries.

Exposure can be through drug preparation or administration, handling patient waste, transport

and waste disposal, and spills.

Where control measures are not adequate, adverse health effects may result from exposure

(eg abnormal formation of cells, alterations to normal blood cell count, foetal loss in pregnant

women, abdominal pain, hair loss, nasal sores and vomitting, liver damage, contact

dermatitis, local toxic or allergic reaction).

What is the solution to the problem? 

The risks of adverse health effects from handling cytotoxic drugs can be eliminated or

reduced by:

  outsourcing cytotoxic drug preparation work to a company that specialises in this field

  purchasing cytotoxic drugs in ready-to-use concentrates to eliminate pharmacy

preparation

  purchasing the drug in liquid rather than powder form, and in vials not ampoules

  ensuring the IV (pump) delivery system has an automatic backfill function

  establishing cleaning procedures for managing the contamination of surfaces (eg IV

bags and work/floor surfaces) using strong alkaline detergent with pH>10

  using a cytotoxic drug preparation area to restrict access to unauthorised persons  ensuring appropriate ventilation and air-filtering systems installed in drug preparation

areas

  using non-bevelled/wide-bore needles to transfer liquids from containers

  ensuring universal purple coloured cytotoxic equipment is used

  using labelled mops, buckets, trolleys and waste containers specifically for cytotoxic

drug use

  using proper hand washing technique

  identifying cytotoxic drugs used and stored at the workplace

8/3/2019 Safe Handling of Cytotoxic Drugs

http://slidepdf.com/reader/full/safe-handling-of-cytotoxic-drugs 2/4

  obtaining relevant material safety data sheets (MSDS) and educating workers about

this information

  establishing protocols and safe work procedures for handling and using cytotoxic

drugs and the disposal of related waste, in consultation with employees

  displaying universal cytotoxic drug signage when treatment in progress

  informing operating theatre and X-ray staff of patient undergoing therapy

  establishing and maintaining a cytotoxic drugs register

  evaluating the nature and risks of the work involving cytotoxic drugs

  establishing procedures for managing cytotoxic waste (eg identifying, containing and

segregating waste, transport of waste on and off site, ensuring secure waste storage

and waste treatment and disposal)

  providing mandatory induction and training to workers about the hazards, safe

handling/use of these drugs or any new drugs introduced and correct use of personal

protective equipment (PPE)

  following drug manufacturers' instructions for safe handling/use

  providing health monitoring to workers handling cytotoxic drugs, by a medical

practitioner, that meets current recommendations, and providing medical advice and

counselling as required

  ensuring cleaners, carers, patients and visitors are aware of precautions to avoid

contamination from the clean-up of body waste (eg vomitus), spills and soiled linen or

clothing

  wearing personal protective equipment such as overalls, gowns, head covering, closed

footwear, gloves, safety glasses/face shields and respiratory protective devices

  reviewing the condition of PPE and spill kit contents regularly

  ensuring equipment used for administering cytotoxic drugs is purpose designed, safe

to use and maintained

Procedures for managing workers exposed to cytotoxic drugs or patient body waste should

include first aid, counselling, health monitoring and reporting any incidents. Work practices

and risk controls should be reviewed and monitored on a regular basis.

While risk assesement is not mandatory, it is a useful step for controlling risks and

establishing protocols for workers handling and using cytotoxic drugs.

8/3/2019 Safe Handling of Cytotoxic Drugs

http://slidepdf.com/reader/full/safe-handling-of-cytotoxic-drugs 3/4

Spills and ContaminationStrategy for the Management of Spills and Contamination

In addition to adopting and following safe work practices which aim to prevent accidental

spills of cytotoxic drugs, a written strategy must be developed

and maintained for the management of the spills that may occur when preventative strategiesfail.

Spills and breakages must be cleaned up immediately by a properly protected

person trained in the appropriate procedures.

All personnel likely to be involved in a cytotoxic spill should be trained in:

  The correct procedures for handling cytotoxic drugs or waste in order

to prevent and minimise the risk of spills;

  The location of the spill kit in their area (see Appendix 3 for contents);

  The arrangements for the medical treatment of any affected personnel;

  The procedure for the containment of the spill and decontamination of 

personnel and the environment;

  The procedure for waste disposal according to the nature and extent of 

the spill; and

  The procedure for the safe handling of packages of cytotoxic drugs

which may be damaged or leaking.

A spill should be identified with a warning sign so that other persons in the

area will not be contaminated.

Incident Report Forms

The circumstances and handling of all spillages should be documented on an

incident report form. One copy should be kept on the departmental file for

the staff member(s) involved. Another copy of this form should be sent to the

person responsible for the occupational health of staff working within the

hospital.

Information recorded on this report form should include:

  Date and time of the incident;

  Location of the incident;

  Name of the drug involved;

  Form of the drug;

  Approximate concentration and quantity spilled;

  Names of personnel involved, including any person in the area who

might have been exposed;

  A description of any direct skin or eye contamination;

  Absorption may have occurred; and

  A description of what action was taken

8/3/2019 Safe Handling of Cytotoxic Drugs

http://slidepdf.com/reader/full/safe-handling-of-cytotoxic-drugs 4/4

Emergency Proceduresd

Small spills that occur on-site and during transportation should be managed

by the healthcare establishment. Procedures should specify under what

conditions emergency services should become involved.

Consideration should be given to the establishment of an emergency spill

management team which includes pharmacy and cleaning personnel. All

personnel likely to be involved in the handling of cytotoxic drugs and waste

should have training in spill management.