Cytotoxic

Precautions

Stephanie Wilcox
 Objectives

 What are cytotoxic drugs?

 How to protect yourself and others

 How to handle cytotoxic waste

 What to do in the event of a cytotoxic spill

 Educational requirements for cytotoxics

What are cytotoxic drugs?

 Cytotoxic drugs

 Kills or slow the growth of cancer cells.

 Slow down an immune system.

Routes of Occupational Exposure

 Inhalation

 Ingestion

 Skin absorption

 Needlestick
 Side effects of cytotoxic drugs

 Alterations to normal blood cell count

 Fertility changes, Foetal loss & possible birth defects

 Abdominal pain, hair loss, nasal sores & vomiting

 Liver damage

 Contact dermatitis or local toxic reactions

 Allergic reaction that may result from direct

 Occupational exposure

 02 Cytotoxic Drugs - Occupational Exposure (R2) -

YouTube
 Personal Protective Equipment

 Must be worn when dealing with

Cytotoxic drugs & related waste

 PPE = mask, gown,

gloves & goggles
 Cytotoxic PPE requirements

Task Specific PPE Requirements

Procedure Personal Protective Equipment
Handling of body fluids Full PPE – Impermeable Gown, protective
goggles/face shield, chemoprotectant gloves (Nitrile,
long sleeves) and P2/N95 Mask.

Oral cytotoxic drugs – Capsules and Chemoprotectant gloves (Nitrile, long sleeves)
coated tablets

Oral cytotoxic drugs – Uncoated Full PPE – Impermeable Gown, protective

tablets and liquid formulations goggles/face shield, chemoprotectant gloves (Nitrile,
long sleeves) and P2/N95 Mask.

Injectable – intravenous, Full PPE – Impermeable Gown, protective

subcutaneous, intramuscular goggles/face shield, chemoprotectant gloves (Nitrile,
long sleeves) and P2/N95 Mask.
 MASK

 This should be a particulate respirator type

mask (not a surgical mask)

 Also known as a P2 or N95 mask rating

GOWN

 A long sleeved gown with

cuffed/elastic sleeves,
impermeable material
GLOVES - chemoprotectant

 They should be long PVC, surgical or

purpose manufactured gloves
 Purple colour denotes cytotoxic use
 Textured fingers for extra grip
 GOGGLES

 Must wear safety

spectacles with side
shields or goggles.
 CYTOTOXIC WASTE – WHAT IS IT

 Any equipment used for preparation

or administration of drug

 All body fluids are considered

cytotoxic for 7 days post treatment

 Double bagging prior to

disposal
DISPOSAL OF WASTE

 Wear PPE

 All sharps - dispose in cytotoxic sharps container

 All other equipment used in administration

dispose in purple otto bin

 Pans & urinals flushed twice or program “5”

immediately in sanitizer

 Emesis bags – seal & dispose in purple otto bin

Soiled Linen

 Dry uncontaminated - sheets

maybe discarded as usual

 If heavily soiled or wet linen -

dispose of linen entirely into
plastic bag & then purple otto
bin
 SPILLS

 Requires immediate attention

 Ask someone if you are not sure
 Know where your spill kits are
located
 Spill kits must accompany a
patient if transported whilst
cytotoxic therapy is in progress
or if considered cytotoxic
 Spill kits can be ordered
through pharmacy
 SPILL KIT

 Contains all equipment

required for a spill (up to
@ 1L)

 Has an instruction sheet

 Spills = vomitus, faeces,

urine, blood, & drugs
 What’s in the Kit

 Everything required to clean

up the initial spill is within the
kit

 Area affected by the spill

must be washed with
bleach after the initial spill

 Replace spill kit immediately

 Spills kit video

 https://www.youtube.com/watch?v=TWLpYvGXOVQ
Education Requirements
 AINs / ENs / All other clinical personnel

Antineoplastic drug administration for the non-cancer

setting

 Handling antineoplastic drugs and related waste safely

Only an ADAC facilitator can accredit staff

to become assessors in these skills.
 RN’s / RM’s/Medical Officers

Antineoplastic drug administration for the non-cancer setting

 Handling antineoplastic drugs and related waste safely

 Understanding antineoplastic drugs, assessing & educating patients
receiving antineoplastic drugs
 Administrating antineoplastic drugs

Must complete administration of Cytotoxic skills

6 monthly to maintain clinical currency
Only an ADAC facilitator can accredit staff
to become assessors in these skills.
 Key Contacts

 Stephanie Wilcox, Nurse Educator Cancer Services

 Stephanie.Wilcox1@health.nsw.gov.au
 0407 103 839, Extension: 54398, Pager 8675
 Carolyn Williams, Medical Oncology Clinical Nurse Educator
 Carolyn.Williams@health.nsw.gov.au
 Pager: 27890, Extension: 56913
 Melinda Bragg, Haematology/BMT Clinical Nurse Educator
 Melinda.Bragg@health.nsw.gov.au
 Pager: 27325, Extension 58634
STAYING SAFE……

 Safe Handling and Waste

Management of Hazardous Drugs
2016 (eviQ.org.au)

 Work Health and Safety Regulation

2017 (NSW)

 SafeWork NSW Guidelines (2017)

Questions…