NURSING 515 Guidelines for Cytotoxic Waste Disposal

CYTOTOXIC WASTE DISPOSAL 2 Guidelines for Cytotoxic Waste Disposal The following evidence-based practice guidelines were developed to address issues in the handling of cytotoxic drugs, including the use of oral cytotoxic agents; the selection and use of personal protective equipment; and treatment in varied, diverse settings, including the home and hospital setting. These recommendations represent a practical and reasonable set of procedures that the intended users of these guidelines should implement to minimize opportunities for accidental exposure. They cover the entire chain of cytotoxic handling and not limited to the just point of care. The primary objective of these recommendations is to reduce the likelihood of accidental exposure to cytotoxic agents within the medication circuit. Keywords: Cytotoxic drugs, hazardous waste, cytotoxic drug administration, personal protective equipment, cytotoxic drug preparation CYTOTOXIC WASTE DISPOSAL 3 INTRODUCTION The objective of these guideline was to update and address any issues in the handling of cytotoxic that have developed since release of the previous guideline on this topic from the Program in Evidence-Based Care, including the use of oral cytotoxic; the selection and use of personal protective equipment; and treatment in diverse settings, including the home setting. Recommendations 1. Identification and Safety Each institution should maintain a list of cytotoxic drugs. Cytotoxic drugs and their waste should be properly identified with the capital “C” symbol and, under it, the words “cytotoxic/cytotoxique” in capital letters. All cytotoxic waste under the Ministry of Environment regulation (guideline C4) should include bilingual wording, and both the words and the symbol should appear on a dark grey rectangle. FIGURE 1 2. Spills Kit CYTOTOXIC WASTE DISPOSAL 4 A spill management kit should be available in all areas where cytotoxic drugs are stored, transported, handled, and administered (SR). Standard label for cytotoxic drugs or their waste. 3. Personal and Protective Equipment Workers should work in compliance with the Occupational Health and Safety Act and regulations and use or wear the equipment, protective devices, or clothing that the employer requires to be used. The appropriate for the task should be worn throughout the medication circuit. It is the employer’s responsibility to provide the necessary and training on how to use the equipment. 4. Respiratory Protection Apparatus Fit-tested respirators such as those certified N95 or N100 by the U.S. National Institute for Occupational Health and Safety should be used when there is a risk that an airborne powder or aerosol will be generated. Respirators should be used in accordance with a respiratory protection program such as that outlined in csa. 5. Handling Delivery Containers of Cytotoxic Drugs All receiving-dock workers should receive training in the proper handling of cytotoxic drugs. The receiving-dock workers should check the integrity of the external packaging upon receipt; in the event of breakage or a damaged parcel likely to cause a spill, apply the Spill Protocol from your institution. Delivery containers should be taken immediately to the pharmacy department by the receiving-dock workers or the distributor. The receiving-dock or storeroom workers should not open the delivery containers. The delivery containers should be handled with care to avoid breakage of the cytotoxic drug containers and not be left unattended in a corridor. Only trained workers (for example, pharmacy technicians) are to CYTOTOXIC WASTE DISPOSAL 5 proceed with the unpacking and subsequent steps. 6. Damaged Containers or Spills Damaged containers should be handled as if they were spills. The manufacturer or distributor should be notified if a container is received in a damaged state. To limit exposure, a damaged container should never be returned to the manufacturer or distributor. Notify the pharmacy if any damaged containers are suspected. 7. Drug Preparation The following recommendations apply to the preparation of all cytotoxic medications, parenteral, oral, and topical, and both sterile and non-sterile. Policies and procedures should include appropriate ppe; equipment for preparation, including appropriate ventilation; other automated equipment for packaging; and a dedicated work area.