Cytotoxic Drugs and Related Wastes - Guidelines for the Safe Handling of
These guidelines have been prepared to provide practical guidance aimed at reducing the exposure of healthcare personnel, such as pharmacists, nurses and doctors, to cytotoxic drugs during reconstitution, preparation and disposal of related waste. While it is specific to healthcare establishments, it may be used by those involved in the handling of cytotoxic drugs and related waste in the community and other settings such as veterinary centres.
Table of Contents
1. Summary
2. Introduction
3. Scope and Application of these Guidelines
4. Responsibilities
4.1 Duties of Employers
4.2 Duties of Employees
5. Potential Effects of Exposure to Cytotoxic Drugs
5.1 Acute Effects
5.2 Chronic Effects
5.3 Employees who are Pregnant, Breast Feeding or Planning Parenthood
6. Procedures for Handling Cytotoxic Drugs and Related Wastes
6.1 Drug Preparation and Reconstitution
6.1.1 General
6.1.2 Minimising Exposure
6.1.3 Alternative Arrangements for Supply
6.1.4 Personal Protective Clothing and Equipment
6.1.5 Laundering of Contaminated Personal Protective Clothing
6.1.6 Storage of Cytotoxic Drugs
6.2 Drug Administration
6.2.1 General
6.2.2 Personal Protective Clothing
6.3 Care of Patients Receiving Cytotoxic Drugs
6.3.1 General
6.3.2 Personal Protective Clothing
6.3.3 Patient Wastes
6.3.4 Contaminated Linen
6.3.5 Care of Patients in the Home
6.4 Spills and Contamination
6.4.1 Strategy for the Management of Spills and Contamination
6.4.2 Incident Report Forms
6.4.3 Emergency Procedures
6.5 Waste Management and Disposal of Drugs and Contaminated Material
6.5.1 General
6.5.2 Personal Protective Clothing
6.5.3 Waste Identification, Segregation and Containment
6.5.4 Waste Storage
6.5.5 On-Site Waste Transport
6.5.6 Off-Site Waste Transport
6.5.7 Waste Disposal
6.6 Labelling, Packaging, and Transport of Cytotoxic Drugs
6.6.1 General
6.6.2 Labelling
6.6.3 Packaging and Transport of Cytotoxic Drugs within the Facility
6.6.4 Packaging and Transport to Other Facilities
6.7 Provision of Information, Training and Supervision
6.7.1 New and Existing Employees
6.7.2 Other Staff
7. Health Evaluation and Monitoring
7.1 General
7.2 Environmental Monitoring
7.3 Biological Monitoring
7.4 Biological Monitoring within New Zealand
7.5 National Register of Personnel involved in the Preparation and Administration of Cytotoxic Drugs
8. Appendices
Appendix 1: Glossary of Terms
Appendix 2: Symbols for Waste Classification
Appendix 3: Contents of Cytotoxic Drug Spill Kit
Appendix 4: Selected Reading and Bibliography
