Cytotoxic Drug Safety

Definition
Refers to a drug or enzyme that is administered to plants, animals or humans for the specific purpose of altering the metabolic process or possessing a specific destructive action on cells. It may be genotoxic, oncogenic, mutagenic, and teratogenic and includes most anti-cancer drugs.

Exposure Control
Purpose and Responsibilities
It is the responsibility of the person (s) in whose care the drug falls that the drug will not be accessed during storage, administration or disposal by any other person than those specifically trained to use this product. This exposure control plan will require periodic review to ensure its relevance.

Risk identification, Assessment, Control
For each cytotoxic drug, it must be identified who is potentially at risk and what the routes of entry into the body might be expected. If the drug is an air contaminant. Exposure monitoring will take place to ensure that workers are not exposed during handling of the drug

Depending on the type of drug and the routes of entry into the body, control measures will be implemented using:

1. Engineering; dedicated fume hoods and exhaust systems that do not allow air to be recirculated back into the room; isolating or enclosing the materials in a suitable fashion so that untrained or unaware persons are not accidentally exposed to the drugs.
2. Substitution or elimination; other drugs or chemicals used to obtain the same or similar results with less hazard of exposure;
3. Administrative controls; including worker training, recognition of janitorial staff of the potential hazards involved. This may include protective reassignment for a worker who is pregnant or intends to conceive a child.
4. Personal Protective Equipment (PPE) to be used in conjunction with other control measure to limit exposure. PPE will include, but not be limited to:
   1. Gloves made of surgical latex or other materials which provides at least equal, or better protection.
   2. A moisture resistant, long sleeved gown with cuffs.
   3. If there is a risk of contact with aerosols, an approved respirator which has been fit tested (contact OH&S for fit testing.
   4. Chemical splash goggles and if necessary full-face protection.
   5. Gowns, gloves, lab coats etc. must not be used outside the area where the drug is stored or used.

Information to Workers
For any cytotoxic drugs used, stored or disposed of in the workplace, information on the drugs:

1. acute and chronic toxicity, including any reproductive hazard,
2. acute exposure treatment
3. safe handling
4. techniques and procedures for safe handling
5. proper use of protective equipment and materials
6. spill, waste and storage procedures
7. eating, drinking, smoking, application of cosmetics and storage of food or cosmetics cannot occur in a lab where cytotoxic drugs are used or stored.

will be available to the instructors, students and to the first aid attendants (Occupational Health Nurse). Training records must be kept by the person conducting the training (supervisor or instructor) for three years from the date that training occurred.

Labels
The container holding a cytotoxic drug as well as the storage area for that drug will be labeled with:

1. The name of the drug.
2. Statements regarding adverse health effects.
3. Where to go for more information.
4. What to do in the event of any emergency.

Signs
Warning signs indicating:

1. The type of cytotoxins stored.
2. Warnings regarding adverse health effects.
3. What to do in the event of an emergency.

Must be posted on prep room or lab room doors.

Records

1. The lab supervisor or instructor must keep records of any person handling a cytotoxic drug. These records must be kept for the duration of time that the person is working with the drug, plus ten years.
2. Training records must be kept for a minimum of three years. See Information to Workers for training, which should occur.

Waste Disposal
Cytotoxic materials should be held for disposal in leak proof waste disposal containers. Contact the Occupational Health and Safety Department for regarding disposal.

Spill Clean Up

1. A spill kit, suitable for the type of cytotoxic drug used must be available
2. Material Safety Data Sheet
3. Personal Protective Equipment
4. Containers for the storage and disposal of the material

Follow the instruction provided on the spill clean up kit or material safety data sheet for a particular drug. This material should be reviewed and understood prior to actually having to clean up a spill. Any person using cytotoxic drugs must be made aware of the correct procedure to follow.

Waste should be held for disposal in appropriate containers. Contact the Occupational Health and Safety Department for further information.