|Title:||Safe handling of cytotoxic drugs|
|Document ID:||Operational Circular OP 1961/05|
|Date of issue:||Thursday, 16 June 2005|
|File number(s):||92-08854; 94-06061|
|Description:||Guide to hospitals on the appropriate and safe handling of drugs used in cancer treatment.|
|Applicable to:||Clinical and administrative staff of the Department of Health.|
|Period of effect:||from 10 June 2005|
|Authorised by:||Dr Andrew Robertson, Acting Group Director, Statewide Policy Division, 09-Jun-2005|
|Print version:||View print version|
Safe handling of cytotoxic drugs
Cytotoxic drugs are used primarily in the treatment of cancer. Risks of occupational exposure include topical irritation and necrosis, liver damage, mutagenesis, carcinogenesis, teratogenesis and risk of miscarriage.
Managers and employees must be aware of safe working practices that prevent uncontrolled exposure to cytotoxic drugs. This document provides an overview of occupational health and safety aspects of the handling and use of cytotoxic drugs and includes guidelines for inclusion in workplace-specific policies and procedures.
Hospitals and Health Services should ensure that local policies and procedures promote the safe handling of cytotoxic drugs and that employees involved in the handling and use of such drugs receive appropriate training and supervision. Policies and procedures should be reviewed and updated regularly.
Strategies to Minimise the Risk:
Safety cabinet and equipment
It is strongly recommended that cytotoxic drugs are prepared in cytotoxic drug safety cabinets meeting the requirements of Australia Standard (AS) 2567:2002 'Laminar flow cytotoxic drug safety cabinets' and AS 2639:1994 'Laminar flow cytotoxic drug safety cabinets - Installation and use'. Laminar flow cabinets provide protection from exposure to cytotoxic drugs, whilst ensuring that drugs are protected from contamination during their preparation. Cabinets should be located in a room designated for the preparation of cytotoxic drugs. Adequate equipment (syringes, intravenous sets and vials) and resources (designated, appropriately-designed work areas and fixtures) are required. These should be inspected regularly to ensure their continued appropriateness and effectiveness.
Access to areas where cytotoxic drugs are prepared or administered should be restricted to authorised personnel.
If a cytotoxic drug safety cabinet is unavailable, only pre-prepared, ready-to-administer cytotoxic drugs should be used by health services.
Personal protective equipment (PPE)
Appropriate protective clothing and equipment should be provided by the employer for use by staff involved in preparing, administering and handling cytotoxic waste, including spillage clean-up and cleaning or maintenance work in cytotoxic drug facilities. The following clothing and equipment is recommended:
Special laundering facilities are required for reusable protective garments. These garments should be placed in purple, colour-coded, sealed and labelled containers for transport to a laundry which is capable of conforming with the requirements of AS 2013.2:1989 'Cleanroom Garments - Processing and use'.
Non-disposable personal protective equipment should be decontaminated routinely after each use, stored away from sources of contamination and regularly maintained. Respirators should be selected, used and maintained in accordance with AS/NZS 1715:1994 'Selection, use and maintenance of respiratory protective devices'. Staff should be trained in the use of respiratory protection devices.
Transporting and packaging
All cytotoxic preparations must be placed in labelled, sealed, impervious containers capable of protecting from spillage, leakage or breakage during transport.
Emergency spillage procedure
A written procedure must be established for containing and decontaminating cytotoxic drug spillages.
In general the procedures should provide the following:
Health status checks are required for personnel before commencing and during periods of work with cytotoxic drugs (at least annually). Any examinations should take into account the potential adverse health effects of the specific cytotoxic drugs used and their clinical signs and symptoms. Routine screening of blood, urine or cytogenetic screening is not generally warranted as it has little or no predictive value.
The health surveillance program should be conducted by a suitably qualified medical practitioner.
Transport, labelling and disposal of waste
All cytotoxic waste, including contaminated sharps, must be placed in labelled, sealed, impervious containers capable of protecting from spillage, leakage or breakage during transport. Containers for cytotoxic waste can be obtained commercially from medical suppliers and should be clearly labelled with a purple label incorporating the symbol for cytotoxic waste, as attached, and the words: CYTOTOXIC WASTE - INCINERATE
Cytotoxic waste must be incinerated because it is highly toxic. It must be incinerated at 1100°C with a minimum retention time of one second for the flue gases at this temperature. Waste with low concentrations of cytotoxic drugs, such as urine, faeces and vomitus, may be disposed of safely by flushing into the sewage system.
Appropriate precautions must be taken when handling these materials, to ensure against skin and inhalation exposure. This includes the use of personal protective equipment described previously.
Exclusion from handling cytotoxic drugs
Pregnant or breastfeeding women should not handle cytotoxic agents or cytotoxic waste unless adequate exposure protection can be assured at all times. Male and female personnel planning pregnancy should be made aware of the potential risks and offered alternative duties, if necessary.
Health Care Units should maintain records of the following:
National Guidelines for Waste Management in the Health Industry. National Health and Medical Research Council. 1999
Standards of Practice for the Safe Handling of Cytotoxic Drugs in Pharmacy Departments March 1997, Aust J Hosp Pharm 1999; 29 (2): 108-16
Guide for Handling Cytotoxic (Anti neoplastic) Drugs and Related Waste. Queensland Workplace Health and Safety. 1997
Dr Andrew Robertson
This circular last updated: Thursday, 16 June 2005 at 10:21am