Practice Standards

Guidelines for Safe Handling of Cytotoxic Drugs

Preparation Aspects
ScopeThis standard specifies recommendations and requirements for preparation of cytotoxic drugs by pharmacy personnel.
ObjectiveThe objective of this standard is to provide guidelines on safe handling of cytotoxic drugs during preparation.
Referenced documentsThe references are listed in appendix 4.
DefinitionsFor the purpose of this standard, the definitions below apply.
1.
Anteroom
A room attached to a clean room which provides access to the clean room for personnel, equipment and operating
components. It also provides facilities for scrubbing and gowning before entry into clean room.
2.

3.

4.

5.

6.

7.

Clean room
A specially constructed enclosed area environmentally controlled with respect to airborne particles, temperature,
humidity, air pressure, air flow patterns, air motion and lighting.
Biological safety cabinet
A vertical laminar airflow cabinet that provides a clean working environment and protection to operators.
Isolator
A self-contained enclosed cabinet that provides a clean working environment and protection to operators. Manipulation
within the work zone is performed through fitted glove ports.
Aseptic technique
The technique involving procedures designed to preclude contamination(of drugs, packaging, equipment or supplies) by
microorganisms during processing.
Critical surface
Any surface that comes into contact with previously sterilised products or containers. It is also surface of the work part to
be protected from particulate and microbial contamination
Negative pressure technique
A Method used to manipulate vials to ensure negative pressure in vial during preparation.

8. Luer-lock devices
Equipment (syringes) used to mix and administer drugs which are less prone to separate, and reduce risk of leakage or
spills.

Practice Standards
Guidelines for Safe Handling of Cytotoxic Drugs

Preparation Aspects
Personal protective equipment
Preparation must be carried out using equipment and facilities that ensure protection of product, personnel and
environment.
1.
Biological safety cabinet/Isolator
All preparation of cytotoxic drugs must be carried out in a biological safety cabinet or isolator that is suitable and
currently recommended for use in preparing sterile doses of hazardous drugs.
Cytotoxic preparation cabinet or isolator should be located in a clean room specially designated for this purpose. The
clean room should be maintained under negative pressure. Provision should be made to increase air exhaust in the clean
room in case of a spill.
If the cabinet is not operating continuously, allow it to operate for at least 5 minutes before use to purge air spaces. If the
cabinet is to be switched off at the end of work sessions, allow it to operate for at least 5 minutes to purge the work zone
of aerosols.

2.

Glove'
Two pairs of surgical latex gloves must be worn at all time during drug preparation. Because all gloves are permeable to
some extent and their permeability increase with time, they should be changed regularly or immediately if they are torn
or punctured.

3.
Protective garments
Coveralls made of lint-free, low permeability fabric with closed front, long sleeved, and elastic or knit-closed cuffs,
must be worn in clean room of class 10 000 or less. These may be disposable or launderable.

4. Boots or overshoes
These should be made of lint-free and low permeability fabric.
5.

6.

Head covering
Hooded coveralls or caps must be worn to contain hair and reduce contamination.

Masks
Surgical masks must be worn at all times during preparation. Masks offer protection against the inhalation of powder,
but not necessarily against breathing in of aerosols.

reparation Aspects
Preparation areas
All cytotoxic drugs preparation should be carried out in a centralised area. Warning signs designating the area,
which should not be entered by unauthorised staff, should be clearly posted. Eating and drinking in or near the
preparation area is not allowed.
Work practice in preparation
Cytotoxic drugs must be prepared by trained and validated pharmacy personnel. He/She must have an
understanding of the hazards associated with mishandling of cytotoxic drugs, and special precautions to be taken to
prevent ontamination of the operator, product and environment.1. Donning of protective clothing

2. Techniques and precaution

2.1.

Proper aseptic technique must be used to prepare cytotoxic drugs.

2.2. Surfaces of the cabinet should be cleaned using 70% alcohol and disposable
non-linting wipes before and after preparation. Discard wipes into designated
cytotoxic waste bin.
2.3.
Work in the cabinet must be carried out on a disposable, plastic-backed liner,
which should be changed after each shift or after a spill.
2.4. Any manipulation during preparation should not block critical sites from the
laminar flow sterile air.
2.5.
Cytotoxic aerosol generation must be minimised during preparation. This can
be achieved by using negative pressure technique or sterile 0.22 micron
hydrophobic filter/needle combination.
2.6.

All materials needed for use to complete a preparation should be placed into
the cabinet before beginning work to avoid interruption of cabinet airflow.

2.7. Work in the cabinet should not be performed within three inches of the sides
near the front opening.
2.8.
Rapid movements of the hands in the cabinet should be avoided.

3. Needles

The use of large bore needles, 19 gauge or larger, is necessary to prevent the
generation of high pressure within the syringes. The length of needles should
preferably be not longer than the vial. The recommended length of the needle is
1/4 inches.
4. Syringes
Luer-lock syringes and fittings should be used to avoid spills due to disconnection.
For the purpose of maintaining negative pressure and expelling air from the
syringe, always use a syringe that will never be more than % fill when preparing
or containing a dose.
5. Handling vials
Diluent should be slowly added into vial by alternately injecting small amounts
and allowing displacement of air into the syringe. When all diluent has been
added, a small amount of additional air may be withdrawn to create negative
pressure in the vial.
To withdraw liquid from a vial, negative pressure technique must be used. Never
push in on the plunger as this creates positive pressure in the vial and may result in
leakage or spraying from the vial.

6. Handling ampoules
Before opening ampoules, care should be taken to ensure no liquid or powder
remains inside the tip of the ampoule. A sterile gauze pad may be wrapped around
the ampoule neck before the top is broken to protect against cuts and to catch
aerosolised material. Ampoules should be broken in a direction away from the
body.
If diluent is to be added, it should be injected slowly down the side wall of the
ampoule. The ampoule should be tilted slightly to ensure that all the powder is wet
before it is agitated to dissolve content.

7. Handling solid dosage form

Cytotoxic drugs in the form of tablets or capsules should be handled in a manner
which avoid skin contact and introduction of powdered drugs into the air.
Crushing of oral cytotoxic drugs is not recommended.

Hands should be washed before gowning of protective

clothing. Gown must not be worn outside preparation area and
it should be changed immediately when contaminated or
soiled.
For procedure of donning gown before entry into clean room,
refer to appendix 1.
For procedure of removing gown, refer to appendix 2.
reparation Aspects
Personal protective equipment
Preparation must be carried out using equipment and facilities that ensure protection of product, personnel and environment.

1. Biological safety cabinet/Isolator

All preparation of cytotoxic drugs must be carried out in a biological safety cabinet
or isolator that is suitable and currently recommended for use in preparing sterile
doses of hazardous drugs.
Cytotoxic preparation cabinet or isolator should be located in a clean room
specially designated for this purpose. The clean room should be maintained under
negative pressure. Provision should be made to increase air exhaust in the clean
room in case of a spill.
If the cabinet is not operating continuously, allow it to operate for at least 5 minutes
before use to purge air spaces. If the cabinet is to be switched off at the end of work
sessions, allow it to operate for at least 5 minutes to purge the work zone of
aerosols.
2. Glove'
Two pairs of surgical latex gloves must be worn at all time during drug preparation.
Because all gloves are permeable to some extent and their permeability increase
with time, they should be changed regularly or immediately if they are torn or
punctured.
3.

Protective garments
Coveralls made of lint-free, low permeability fabric with closed front, long sleeved,
and elastic or knit-closed cuffs, must be worn in clean room of class 10 000 or less.
These may be disposable or launderable.

4. Boots or overshoes
These should be made of lint-free and low permeability fabric.
5.

Head covering
Hooded coveralls or caps must be worn to contain hair and reduce contamination.

6. Masks
Surgical masks must be worn at all times during preparation. Masks offer protection
against the inhalation of powder, but not necessarily against breathing in of
aerosols.

Storage and Disposal Aspects

ScopeThis standard specifies recommendations and requirements for storage and disposal of cytotoxic drugs by pharmacy
personnel.
ObjectiveThe objective of this standard is to provide guidelines on storage and disposal of cytotoxic drugs.
Referenced documentsThe following articles were referred to in this guideline:

 ASHP Technical assistance bulletin on handling of cytotoxic and hazardous drugs.

Am J Hosp Pharm 1990; 47: 1033-49
OSHA Work-practice guidelines for personnel dealing with cytotoxic
(antineoplastic) drugs. Am J Hosp Pharm 1986; 43:1193-1204
SHPA Guidelines for the safe handling of cytotoxic drugs in Pharmacy Departments.
Aust J Hosp Pharm 1990; 20(5): 391-4
SHPA Guidelines for the transportation and handling of cytotoxic drugs by lay
personnel. Aust J Hosp Pharm 1988; 18(5): 355-91

SHPA Guidelines for the packaging of cytotoxic agents. Aust J Hosp Pharm 1986;
16(3): 156
Storage
All cytotoxic drugs must be stored in designated areas. Access to storage areas should be restricted to authorised personnel.
Precaution must be taken in such facility to prevent accidental breakage. Spill kit should be made available in cytotoxic
storage areas.
Disposal
1. Equipment
Cytotoxic waste bag made of polyethylene or polypropylene, labelled with a cytotoxic hazard label and coloured
differently from other hospital trash bag, should be used.
Leak-proof and punctured-proof box or sharps bin, labelled with a cytotoxic hazard label and, if possible, coloured
differently from other hospital sharp bin, should be used for the disposal of sharp waste such as needles, syringes and
glass vials.
2. Handling
Personnel involved in the handling of cytotoxic waste should receive instruction on procedures for safe transport and
for spill management. These wastes must be handled separately from other hospital waste trash and disposed of in
accordance with applicable regulations.

Validation of Staff on Cytotoxic Preparation Techniques

ScopeThis standard specifies recommendations and requirements for validating pharmacy personnel in cytotoxic preparation technique.
ObjectivesThe objectives of this standard is to provide validation procedures for ensuring that processes consistently result in sterile
products of acceptable quality and for assessing the adequacy of staff on safe handling technique.
Referenced documentThe following articles were referred to in this guideline.
Competence Assessment Tools for Health-System Pharmacies. Lee B. Murdaugh
1998
Handling Cytotoxic Drugs in Health Care Establishments. New South Wales
Government 1995
ASHP Technical assistance bulletin on handling of cytotoxic and hazardous drugs.
Am J Hosp Pharm 1990; 47: 1033-49
SHPA Guidelines for the safe handling of cytotoxic drugs in Pharmacy Departments.

Aust J Hosp Pharm 1990; 20(5): 391-4

OSHA Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic)
drugs. Am J Hosp Pharm 1986; 43: 1193-1204
DefinitionsFor the purpose of this standard, the definitions below apply.
1. Aseptic technique
The technique involving procedures designed to preclude contamination
microorganism during processing.

(of drugs, packaging, equipment or supplies) by

2. Growth media
A substance used to support the growth of microorganism or any cells. The growth media selected should be capable of
supporting the growth of a broad spectrum of microorganism likely to be production- associated contaminants in the
pharmacy.
3. Positive control
A quality control check to ensure that the growth media used in the validation process is capable of supporting growth of
microorganisms. The growth promotion of media should be determined with a range of appropriate microorganisms. Media
must be able to support growth when inoculated with less than 100 colony-forming units of the challenged microorganisms.
4. Negative control
A quality control check to ensure that the growth media used in the validation process is sterile. The sterility of the growth
media is demonstrated with the use of a biological indicator. The biological indicator is introduced into a sample container
during the sterilisation cycle of the growth media.
5. Validation process
Planned testing, in accordance with the principles of good manufacturing practice, designed to demonstrate that
microorganisms will be effectively prevented from inadvertently being introduced by personnel or by process related
activities.
6. Examiner
An examiner is a person who invigilates the entire validation process.
7. Critical surface
Any surface that comes into contact with previously sterilised products or
protected from particulate and microbial contamination.

containers. It is also surface of the work part to be

8. Work area/zone
That part of the controlled work space where containers are opened and the product is exposed. Particulate and microbial
contamination in the area should be reduced to levels appropriate for the intended use.
9. Open window
Any opening that provides a direct pathway between a critical surface

and the laminar airflow directly from the HEPA filter.

10. HEPA filter

A high efficiency particulate air (HEPA) filter compose of pleats of filter
medium separated by rigid sheets of corrugated
paper or aluminum
foil that direct the flow of air through the filter in a uniform parallel
flow. HEPA filters remove 99.97%
of all air particles 0.3 um or larger.
11. No touch technique
A method of manipulation whereby operators avoid contact of critical

surfaces during the preparation of sterile products.

Validation of Staff on Cytotoxic Preparation Techniques

Growth media for validation process1. Type of growth media

Tryptone Soya Broth (TSB) is the media of choice.
2. Source of growth media
The media should be obtained from a reliable/reputable source.
from the microbiology laboratory of the respective hospitals.

Suggested sources may include commercial product or

Validation process
1. Personnel
All personnel involved in cytotoxic reconstitution process must undergo this validation process and achieve no growth
in all the tested growth media before embarking on any preparation of cytotoxic nature.
2. Protocol
A written protocol should be established for the validation process. Each centre should establish their own protocol to
simulate as closely as possible their routine aseptic process. Refer to appendix 1 for suggested protocol.
3. Checklist
A standard checklist should be used during the validation process by

the examiner for:

a) assessing the competency of the trainee

b) minimising inter-examiner validation in assessment
Refer to appendix 2 for suggested checklist.
4. Frequency of re-validation
The suggested frequency of re-validation is once every 2 years.
Examiner
The examiner should preferably be the pharmacist-in-charge or any other pharmacist as designated by the pharmacist-incharge. The examiner must have been previously validated in cytotoxic preparation technique.

Quality Assurance for Premise and Equipment

ScopeThis standard specifies recommendations and requirements for quality assurance of premise and equipment used for the
preparation of cytotoxic drugs.
ObjectivesThe objectives of this standard is to standardise quality assurance methods for premise and equipment used during cytotoxic
preparation so as to ensure that end-product consistently result in sterile products of acceptable quality and the adequacy of staff
safety when handling these cytotoxic products
Referenced documentThe following articles were referred to in this guideline.

Competence Assessment Tools for Health-System Pharmacies. Lee B. Murdaugh

1998

Handling Cytotoxic Drugs in Health Care Establishments. New South Wales

Government 1995
ASHP Technical assistance bulletin on handling of cytotoxic and hazardous drugs.
Am J Hosp Pharm 1990; 47: 1033-49
SHPA Guidelines for the safe handling of cytotoxic drugs in Pharmacy Departments.
Aust J Hosp Pharm 1990; 20(5): 391-4
OSHA Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic)
drugs. Am J Hosp Pharm 1986; 43: 1193-1204
Australian Standard. Laminar flow cytotoxic drug safety cabinets -Installation and
use. AS 2639-1994. Published by Standards Australia (Standards Association of
Australia). Second Edition 1994.
Australian Standard. Design, installation and use of pharmaceutical isolators. AS
4273-1999. Published by Standards Australia (Standards Association of Australia).
1999.

DefinitionsFor the purpose of this standard, the definitions below apply.

1 Type 2 Isolator
An isolator designed both to protect the cytotoxic/hazardous drug from process-generated and external factors that would
compromise its quality and to protect the operator and background environment from hazards associated with the drug. It
operates at a negative pressure relative to its environment.
2 Class II Biological Safety Cabinet
A vertical laminar airflow cabinet that provides a clean working

environment and protection to operators.

Quality Assurance for Premise and Equipment

Maintenance of Premise
1 Validation tests for clean rooms
(Class 10, 000 or 100, 000) should be performed at least once a year
various tests.
2 These tests include the following:

a)
b)
c)
d)
e)
f)
g)
h)

Particle Count Test

Bacteriological Test
HEPA Filter Patency Test
Temperature Test
Humidity Gradient Test
Lighting Level Test
Sound Test
Vibration Level test

and results should pass standards specified in the

Maintenance of Equipment
1 Maintenance of Type 2 Isolator
1.1 Validation tests should be routinely performed to ensure safety of the patient,
the operator and the environment as well as the sterility of the
cytotoxic/hazardous drug.
1.2 Tests should also be performed in the following situations:
I On site, before commissioning of the isolator
II After any electrical or mechanical maintenance
III After filter replacement
IV After relocation
V Suspicion of unsafe isolator operation
1.3 HEP A filters and Pre-filters
HEPA filters should be tested for their integrity at six (6) monthly intervals and
changed when necessary.
Pre-filters should be changed monthly for high cabinet utilization, otherwise
change as required.
1.4 Airflow rate
Airflow rate should be tested at six (6) monthly intervals and could be checked
simultaneously with filter integrity.
1.5 Particle count
Particle count should be checked at six (6) monthly intervals and could be
done simultaneously with filter integrity.
1.6 Gloves
Integrity of the glove should be checked before each operation session and
when a new glove is fitted. Glove should be changed immediately when torn
or pierced.
1.7 Sleeves
Integrity of the sleeves should be checked before each operation session and
when new sleeves are fitted.
Sleeves should be changed as required.
1.8 Isolator integrity
Leak detection of isolator should be done after installation, major service
calibration or repair.
2 Maintenance of Class II Biological Safety Cabinet (BSC)
2.1 Validation tests should be routinely performed to ensure safety of the patient,
the operator and the environment as well as the sterility of the
cytotoxic/hazardous drug.
2.2 Tests should also be performed in the following situations:
I On site, before commissioning of the BSC
II After any electrical or mechanical maintenance
III After filter replacement
IV After relocation
V Suspicion of unsafe BSC operation
2.3

Inspection and testing should be conducted at least every six (6) months.

2.4 These tests include the following:

a) HEPA Filter Patency Test

b) Air barrier containment

c) Work zone integrity
d) Air velocity and uniformity in work zone
e) Air distribution
f) Alarm operational check
Failure of test
If any of the results above failed the standards, a re-testing should be conducted within 2 weeks and the premise/equipment
should not be used until the problem is rectified and the result pass the specified standard.
Documentation
All validation tests, cleaning, maintenance, installation and service activities should be documented and kept for reference.
The reports should be filed and kept for 2 years in the Cancer Centre Pharmacy Office.
Procedure for donning protective clothing for preparation of chemotherapy drugs
A. Scope.
This appendix defines standard procedure for gowning for the preparation of chemotherapy drugs.
B. Procedure.
The procedure should be as follows:
1. Remove watches and jewellery before gowning
2. Wash hands with povidine iodine
3. Put on hair cover, tucking all hair inside
4. Put on surgical mask
5. Put on gown and shoe cover
6. Push up the sleeves. Wash and dry hands thoroughly. Pull sleeves back
down to your wrists
7. Choose two pair of surgical latex gloves that will fit snugly but not impair
movement
8.
9.

Put on the first pair of gloves. Tuck the glove cuffs under the gown cuffs
Put on a second pair of gloves. Pull the glove cuffs over the gown cuffs

10. If powder-free gloves are not used, wash gloves with povidone- iodine and
dry with air blower

Appendix
Preparation Aspects

Procedure for removing protective clothing after preparation of chemotherapy drugs

A. Scope.
This appendix defines standard procedure for removing protective
B. Procedure.
The procedure should be as follows:

clothing after preparation of chemotherapy drugs.

1. Remove outer gloves before leaving the clean room

2. Remove gown and place it in a cytotoxic waste bag
3. Remove hair cap and mask and place them in a cytotoxic waste bag
4. Remove inner gloves and place them in a cytotoxic waste bag
5. Wash hands with soap before leaving the anteroom

Procedure for managing cytotoxic spill

A. Scope.
This appendix defines standard procedure for managing spill.
B. Procedure for managing spill in the cabinet.
The procedure should be as follows:
1.
2.
3.

Ensure that the cabinet remains operating

Absorb liquid spill with absorbent pads and dispose them into a sealable bag
Absorb powder spill with wet towels and dispose them into a sealable bag

4.

Wash the entire area with detergent solution

5.

Rinse well with clean water

6.
7.
8.
9.
10.

Repeat washing and rinsing until all of the drug has been removed
Discard all contaminated items into a sealable waste bag.
Remove outer pair of gloves and dispose them into a sealable waste bag
Discard all sealed waste bags and contaminated items into a cytotoxic waste
bag or bin
Remove protective clothing and discard into cytotoxic disposal waste bag

11. Wash hands thoroughly

12. Fill up the incident report form as required by your work place

C. Procedure for managing spill outside the cabinet.

The procedure should be as follows:
1.

Call for assistance if necessary. Do not leave the area unattended.

2. Don protective clothing:

- Gown
- Shoe cover
- Gloves
- Respirator
- Chemical safety glasses
- Chemotherapy gloves

3.
4.
5.

Remove glass particles and other debris using the absorbent pads. Place them in the appropriate sharps container
Absorb liquid spill with absorbent pads and dispose them into a sealable bag
Absorb powder spill with wet towels and dispose them into a sealable bag

6. Wash the entire area with detergent solution

7. Rinse well with clean water
8.

Repeat washing and rinsing until all of the drug has been removed

9. Discard all contaminated items into a sealable waste bag.

10
.

Remove outer pair of gloves and dispose them into a sealable waste bag

11.
Discard all sealed waste bags and contaminated items into a cytotoxic waste bag or bin
12
.
13
.
14
.

Remove remaining protective clothing and discard into cytotoxic disposal waste bag
Wash hands thoroughly
Fill up the incident report form as required by your work place

Pharmacy Department
Aseptic Skill Validation Exercises
A pass in aseptic skill validation requires all 10 bags and all 16 syringes to show no growth at the end of incubation
period.
Exercise 1
1. Using a 50ml syringe, withdraw and remove 100ml of saline from soft

bag provided.

2. Inject the following into the soft bag:a.

b.
c.
d.
e.

Drug A (conc.10mg/ml), 800mg

Drug B (conc. 20mg/ml), 600mg
Drug C (conc. 25mg/ml), 60mg
Drug D (conc. 5mg/ml), 30mg
Drug E (conc. 1mg/ml), 50mg

3. Repeat step 1 and 2 for another 9 soft bags.

4. Label the bags according to institution standards.
Exercise 2

= _____________ml
= _____________ml
= _____________ml
= _____________ml
= _____________ml

1. Using appropriate syringes, prepare the following bolus injections from

a.
b.
c.
d.
e.
f.
g.
h.

350mg
500mg
600mg
650mg
700mg
800mg
1000mg
1200mg

Drug X (conc. 50mg/ml) :-

= _____________ml
= _____________ml
= _____________ml
= _____________ml
= _____________ml
= _____________ml
= _____________ml
= _____________ml

2. Label the syringes according to practice standards.

3. Repeat step 1 and 2 for 1 more time.
Appendix
Validation of Staff on Cytotoxic Preparation Techniques

Aseptic Skill Validation Checklist

Name of Staff: ___________________________________ Date: ________
Name of Examiner: _____________________________________________

KNOWLEDGE AND SKILLS

1.

Demonstrates proper infection control (removes jewelry; ties

long hair back; washes to elbow with bacteriocidal soap; rewashes or uses alcohol if contaminated)

2. Demonstrates proper growing procedure (hair cover, mask,

lab coat, gloves, shoe covers)
3. Demonstrates understanding that the most important part of
preparation cabinet is the HEPA filter.
4. Demonstrates understanding that cabinet should be serviced
and certified by a qualified technician every 6 months and

YES

NO

when they are moved, repaired, or if the HEPA filter is

contaminated by a spill.

5. Demonstrates understanding that cabinet must run for a

specified period, depending on the type of cabinet, before it
can be used.
6. Demonstrates understanding that cabinet must be cleaned
after a spill with water and detergent, followed by a
thorough rinsing.
7. Demonstrates proper cabinet cleaning (uses 70% isopropyl
alcohol, cleans back to front; documents cleaning; cleans
spills quickly).
8.

Demonstrates understanding that cytotoxic and other

hazardous medications must not be prepared in a cabinet
utilised for preparation of other sterile products.

9. Correctly performs all calculations prior to admixture

preparation.
10. Correct medications, solutions, and supplies placed in hood
appropriately to prevent blocking air flow. Keep nonessential items outside hood.
11. Check labels both prior to and after compounding to ensure
medications and solutions used agree.
12. Demonstrates understanding of air-flow in cabinet,
maintains flow of clean air over objects in hood, does not
interrupt air flow, works well within hood.
13. Places hands within the most effective work zone during
preparation.
14. Performs all work on plastic-backed paper mat placed on the
work surface.
15.

Demonstrates proper technique in swabbing, entering, and

withdrawing fluid from vials, ampoules, and bags. Does not
touch or contaminate components that must remain sterile.

16. Minimises positive pressure in vials during reconstitution or

withdrawal of medication. Does not aspirate at any time.

17.

Demonstrates correct use of appropriate transfer devices

(filter needles, vented needles, dispensing pins, and etc).

18. Demonstrates proper closure technique for syringes and

infusion bag.
19. Uses correct amounts of solutions and additives in
compounding. Verifies type and amount of each additive
prior to injecting into container.
20. Inspects final admixture for incompatibilities and particulate
matter.
21. Demonstrates proper labeling, initialing, etc. of bags
/syringes /bottles.
22.

Demonstrates proper knowledge of expiration dates and

storage requirements, (or can show where to obtain data).

23. Affixes appropriate labels to medication container including

auxiliary and chemotherapy hazard labels.
24. Seals preparation in zip-lock bag before leaving the
pharmacy.
25. Disposes of all used equipment and waste in appropriate
hazardous waste disposal containers.
26.

Washes hand after completion of operations in clean room.