Safe Handling of Cytotoxic Drugs

What is the problem?

Healthcare, veterinary and laboratory workers being exposed or contaminated by cytotoxic drugs when preparing, handling and administering these drugs.

What are the risks?

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
• 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 rish assesement is not mandatory, it is a useful step for controlling risks and establishing protocols for workers handling and using cytotoxic drugs.

"WorkSafe Victoria, A Health and Safety Solution, Healthcare, veterinary clinics and laboratories - Handling cytotoxic drugs, www.worksafe.vic.gov.au"

Pro-Val Chemoprene gloves offer outstanding permeation resistance to cytotoxic chemotherapy drugs. Chemoprene gloves offer truce comfort, quality and protection. Their superior formulation allows the glove to resemble the fit and feel of latex, while providing better elongation and tensile strength than nitrile.

• Tested under ASTM F 739-99a for permeation resistance to the following cytotoxic chemotherapy drug. No breakthrough was detected up to 120 minutes on: Cyclophosphamide, Doxorubicin, Hydrochloride, 5-Fluorouracil, Cisplatin, Etoposide, Paclitaxel, Thio-Tepa, Mitomycin C, Daunarubicin, HCI, Ifosfamide, Melphalan, Idarubicin HCI, Carboplatin, Bleomycin Sulfate, Mitoxantrone, Cytarabine HCI. Carmustine, breakthrough detection time was 55 minutes.

• Biocompatibility, Skin irritation and Dermal Sensitisation (ASTM F-719, 720 ISO 10993) Thiurams and mercaptobenzothiazoles free - reduces the risk of contact dermatitis
• Viral permeation for Resistance to Blood borne Pathogens (Phi X0174 Bacteriophage ASTM F 1671-97)
• Residual Accelerators using Gas Chromatography Mass Spectrometry Zinc dibutyldithiocarbamate (ZDBC) - Residual Concentration: Not Detectable Zinc diethyldithiocarbamate (ZDEC) - Residual Concentration: Not Detectable
• Chemical Permeation Resistance to Industrial Chemicals to EN 374-2, EN374-3 and ASTM F-739-99. No breakthrough was detected up to 480 minutes: 40% Sulphuric Acid, 10% Sodium Hydroxide, 50% Nitric Acid.

Other Features Include:

• Powder free ensures no loose particles from the glove
• Ambidextrous
• Latex free, ideal for latex allergy sufferers
• Outstanding chemical resistance, including higher resistance to Alcohols
• Medical and diagnostic gloves
• Higher resistance than latex gloves to Non-Polar solvents
• Colour green for easy recognition
• Substantially lower modulus than nitrile gloves for greater stretchability
• Higher elongation than nitrile gloves
• Textured fingertips provide extra grip for wet or dry situations
• Listed on the Register of Therapeutic Goods
• For single use, non sterile
• Meets Australian Standard AS/NZS 4011:1997 / Amdt 1.1998