HAZARDOUS DRUG EXPOSURES IN HEALTHCARE

Environmental sampling is a relatively new approach used to determine the level of workplace contamination by antineoplastic agents. The procedure has been used extensively in other situations, especially for monitoring contamination by radioactive materials. Typically, work surfaces are sampled with a moistened wipe and the material is extracted and analyzed for specific antineoplastic agents. Currently, it is possible to identify and quantitate six to eight agents with this technique.

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Several reports have dealt with methods for the decontamination and/or deactivation of antineoplastic agents. Although bleach (hypochlorite) is often recommended for the decontamination purposes, it is not effective with all classes of agents. Therefore, it cannot be assumed that cleaning with bleach solutions will destroy all types of antineoplastic agents. Some antineoplastic drugs are listed by the US Environmental Protection Agency as Hazardous waste and must be disposed of accordingly (see 40 CFR 261.33).

• AIHA Healthcare Working Group Hazardous Drugs Project Team. Chemotherapy hood decommissioning for disposal or recycling. Fact sheet. Approved by AIHA Board: October 17, 2016. Falls Church, VA: American Industrial Hygiene Association (AIHA).
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The most often used type of protective equipment for handling antineoplastic agents is gloves. Typically latex and other materials have been employed for this use. However, with the concern over latex allergies, newer materials are being marketed and evaluated for use with these agents. Protective gowns are another piece of equipment that is commonly used in the handling of antineoplastic agents. This section also deals with biological safety cabinets and closed system devices used in the preparation of antineoplastic drugs.

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• Chen WH, Shen LJ, Guan RJ and Wu FL. Assessment of an automatic robotic arm for dispensing of chemotherapy in a 2500-bed medical center. J Formos Med Assoc. 2013; 112:193-200.
• Krämer I, Federici M, Kaiser V and Thiesen J. Media-fill simulation tests in manual and robotic aseptic preparation of injection solutions in syringes. J Oncol Pharm Practice. 2014 (Epub ahead of print). DOI: 10.1177/1078155214565123.
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NIOSH defines a closed system drug transfer device as: “A drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drug or vapor concentrations outside the system.” There are several CDTDs currently available from different manufacturers. CSTDs have been shown to reduce the levels of surface contamination present where antineoplastic drugs are handled and to reduce the percentage of wipe samples that have detectable amounts of antineoplastic drugs.

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Several approaches have been developed for evaluating work practice techniques for drug preparation and drug administration. These approaches typically rely on a non-toxic substitute for the drug that can be easily visualized by ultra violet light or other means. Some test kits are available for various manufacturers.

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