How to handle cytotoxic drugs at your veterinary practice
To that end, it's important that you take precautions when handling cytotoxic drugs (CDs). Staff exposure can occur at many points in the process—during preparation, administration, or cleanup.
When deciding on a method to control or eliminate any safety hazard, the Occupational Safety and Health Administration (OSHA) expects practice owners to rely on "engineering controls" before the use of procedural policies or personal protective equipment. The latter steps are necessary, but they don't negate the need for proper facility preparation.The most basic purpose of these physical safeguards is to control environmental exposure during procedures. Typically, this exposure comes in the form of splattering, spraying, or aerosol generation of the material. In that vein, environmental controls are designed to protect not only those team members immediately involved in the procedure, but also others in the area or who may use the area at a later time. Here are some of the most important issues to address when dealing with CDs:
Segregation: All CDs must be stored and prepared in one centralized area to minimize the risk of "extraneous" contamination throughout the facility. This means setting aside a room to be used exclusively for chemotherapy procedures. In specialty practices with oncology services, the room should be large enough to prepare and administer the drugs as well as segregate patients from common areas during hospitalization. The busy treatment area is the least suitable place for these procedures.
OSHA requires that a biological safety cabinet (BSC) be used for diluting, drawing up, and mixing all dangerous drugs. "Closed system" drug bottles are a good precaution, but OSHA still requires the use of a BSC.
Signage: You must post warning signs on the door to the chemotherapy area. The signs should identify the room as a CD preparation area and restrict entry to authorized persons. Spill cleanup procedures should be posted in the room, and you should place a spill response kit nearby.
Disposal: You must place a yellow sharps container inside the BSC and another in the administration area. A suitable waste collection container and segregated laundry container must be available in the room.
Emergency preparation: An appropriate eyewash device must be readily available. In this case, it's considered essential that the eyewash device be in the room where all procedures are performed.
Cleanup: You must take special care when cleaning the chemotherapy room. After each procedure or when cleaning patient cages, the precautions you've outlined for spill cleanup should be followed. At the end of each day, the entire area should be sprayed thoroughly with 70 percent alcohol.
Finally, make sure team members aren't smoking, drinking, eating, or applying cosmetics in the preparation area—these activities greatly increase the risk of exposure.
Phil Seibert, CVT, is an author, speaker, and consultant with SafetyVet in Calhoun, Tenn. Send questions or comments to firstname.lastname@example.org