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Handling of Cytotoxic Drugs

Cytotoxic drugs are toxic chemicals used to treat cancer that can pose health risks if exposed to personnel through various means like skin contact, inhalation or ingestion. Proper risk management is required including identifying hazards, assessing risks, implementing controls and training personnel. Key controls involve proper preparation using isolators, administration procedures, packaging/transport, protective equipment, waste disposal and spill management. Risks should be minimized for those handling cytotoxic drugs like nurses, pharmacists and cleaners through engineering and administrative controls along with health monitoring.

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930 views

Handling of Cytotoxic Drugs

Cytotoxic drugs are toxic chemicals used to treat cancer that can pose health risks if exposed to personnel through various means like skin contact, inhalation or ingestion. Proper risk management is required including identifying hazards, assessing risks, implementing controls and training personnel. Key controls involve proper preparation using isolators, administration procedures, packaging/transport, protective equipment, waste disposal and spill management. Risks should be minimized for those handling cytotoxic drugs like nurses, pharmacists and cleaners through engineering and administrative controls along with health monitoring.

Uploaded by

Mr Voralpen
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Handling of cytotoxic drugs

Roshan Kumar Chaurasiya


WHAT ARE CYTOTOXIC
DRUGS?

Cytotoxic drugs otherwise called as antineoplastics describe


a group of medicines that contain chemicals
which are toxic to cells preventing
their replication or growth and so
are used to treat cancer.

• Many have proved to be carcinogens, mutagens or


teratogens.
What is the risk?

Exposure may be through

Skin contact

skin absorption

inhalation of drug particles

Ingestion

needle stick injuries


Personnel likely to be involved in these activities include:

nurses and medical officers

pharmacists

laboratory staff, and

cleaning, maintenance and waste handling personnel


Management of accidental exposure to hazardous drugs

Type of exposure Immediate care

Skin exposure Remove contaminated clothing


Wash affected area thoroughly with soap and water
Consult MSDs for drug specific instructions

Eye exposure Flush eye(s) with clear water or isotonic eye wash for
15min
Consult MSDs for drug specific instructions

Exposure by inhalation or Acute symptoms may require emergency interventions


ingestion
Consult MSDs for drug specific instructions
Managing the risk

This outline that the risk management process


that employers should follow for identifying the
hazards and assessing then controlling the risk.
Building a risk assessment
step1:Hazard identification:
Identify which cytotoxic drugs are used and stored at the
workplace

step2:Risk assessment
A risk assessment determines whether there is a risk to
employer’s health from cytotoxic drugs.
This could be done by obtaining and reviewing information about
cytotoxic drugs used.
Evaluate the nature of drugs
step3:Risk control
 The employer's primary duty is to eliminate any risk to
health arising from the use of a hazardous substance.
Where elimination of risk is not practicable, employers
must reduce the risk, so far as is practicable.

step4:Develop a risk control plan


This is a strategy that details a logical series of activities
involving consultation, implementation and review.
A risk control plan sets out the actions required to implement
controls over time. It also provides a useful tool to effectively
manage this process.

Health Monitoring
A vital aspect of the risk management program is to monitor the
health of employees with the issues of employee health
monitoring, counseling, reporting and record keeping. Health
monitoring may include
Demographic data
Occupational and medical history
biological monitoring
Physical examination
Training
Training should occur:
o at induction, prior to commencement of duties where cytotoxic drugs and
related waste are involved
o when new equipment is introduced or procedures change
o on an ongoing basis, with a review of every two years
WHO SHOULD BE TRAINED?
 pharmacy personnel
 nursing and medical personnel
 laboratory staff
 veterinary surgeons and veterinary nurses
 ambulance officers
 supervisors and managers
 maintenance personnel, cleaners, waste handlers etc..
Preparing and dispensing drugs
a laminar-flow cytotoxic drug safety
cabinet or a pharmaceutical isolator for
drug preparation

access only through an anteroom and


pass-through hatch.

High Efficiency Particulate Air (HEPA)


filters

means of communication between the


cleanroom and other areas

installation of a manometer alarm, in


case of inadequate pressure differentials
Further design considerations

provision of access for cleaning


 smooth and durable work surfaces and furniture
Proper lights
limitation of the number of surfaces and shelves
accessible emergency shower outside the anteroom
effective airlock between the cytotoxic suite and external
environment
change-room facilities for changing into personal
protective equipment
Administering Cytotoxic Drugs

SOP for cytotoxic drugs


follow the recommended procedures for the administration
of specific cytotoxic drugs
ensure the patient is involved in the process, and
encouraged to alert administration staff of any problems
maintain close supervision of the patient
use back-priming techniques
connect intravenous bags at waist level
avoid contact with drainage fluid from body cavities
following administration of cytotoxic drugs

.
use cytotoxic labels to identify all intravenous solution
flasks, syringes etc.
manage extravasation incidents promptly
dispose empty intravenous bags or flasks with the
administration set still attached
discard gloves, at the completion of administration, as
cytotoxic waste
wash hands following administration and disposal of
cytotoxic drugs and related waste
 return unused cytotoxic drugs to the pharmacy or to the
source of referral
PACKAGING AND TRANSPORTING CYTOTOXIC DRUGS
Drug packaging
Cytotoxic drugs should be packaged in a labelled, sealed, leak-
proof container, with outer bags
heat-sealed where possible, ensuring the container:
-offers protection from light where required
-protects the drugs from breakage in transit
-contains no leakage if breakage occurs
-has a childproof lid (if appropriate)
Drug transport

Containers used for transporting prepared cytotoxic drugs


should be:

 hard-walled and robust

 made from suitable packaging material capable of


protecting the product from a shock

 securely closed and labelled with cytotoxic warnings


PERSONAL PROTECTIVE EQUIPMENT
The following personal protective equipment should be
provided, in conjunction with other control measures, to
personnel who prepare cytotoxic drugs:
coverall or gown
head covering
closed footwear and overshoes
protective gloves long enough to cover the elasticised cuffs of
gowns or coveralls
protective eyewear
respiratory protective device (where an inhalation risk exists).
Patient Care
The following facilities should be provided in patient care area:
hand washing facilities

laundry facilities

access to a proper toilet

secure area for patients

secured area for waste storage.


.
Management of Cytotoxic waste
Relevant regulations concerning the disposal of cytotoxic waste must
be followed.
Equipment
 Disposable equipment contaminated with cytotoxic agents should be
disposed of in purple cytotoxic waste buckets
 Non disposable equipment should be washed with copious amounts
of hot soapy water.
Excess agents
 cytotoxic agents that have not been administered must be returned
intact to pharmacy for disposal
Unused portions of cytotoxic agents should be disposed of
in purple cytotoxic waste buckets.

Contaminated linen and clothing


 Wear personal protective equipment; gown and gloves,
when handling linen and clothing

 Place contaminated hospital linen in a alginate bag at the


point of contamination, then place in the regular linen skip
for subsequent laundering

 Contaminated personal linen and clothing must remain


separate from other items of clothing
Cytotoxic waste disposal
 wastes must be transported in sealed designated
containers and labelled as cytotoxic waste.
 Personnel engaged in the routine handling and
transport of cytotoxic waste should wear industrial
work-wear, industrial gloves and safety boots.
 waste should be segregated from other waste
streams..
Storage of cytotoxic drugs
designated areas for storing cytotoxic medicines
with clearly visible labels
easy to clean refrigerators.
Spill management
After spillage of cytotoxic drugs,
the contaminated area should be
isolated and cleaned immediately.

Spilled substances should be soaked


up with sufficient quantities of
absorbent material.

Contamination of shoes and clothing should be avoided

Area should be washed with copious amounts of alkaline


detergent
Area should be rinsed thoroughly with water and dried with
absorbent material.

The spill kit should be replaced immediately after use.

All wastes should be discarded into purple cytotoxic waste


container including personal protective equipment.

Hands should be washed thoroughly with soap and water.


Reference
Handling Cytotoxic Drugs In The Workplace (January
2003), Published by Worksafe Victoria.
THANK YOU FOR LISTENING !

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