Safety Regulations and Handling Procedures when Compounding Chemotherapy Products

Procedures for Handling Chemotherapy Products

Chemotherapy products and all subsequent derivatives are in a class of some of the most hazardous drugs that are handled in healthcare settings. It is for this very reason that various upper-echelon apparatus such as the Compounding with Drugs Expert Panel (CDEP) and the more recent Compounding Expert Committee (CEC) were constituted to outline standards that ought to be maintained when handling these substances. According to Barton-Burke & Wilkes (2016), these standards form an integral part of the health care system and are meant to protect compounding professionals from the noxious effects of hazardous chemicals (45). Below is a comprehensive list of some special procedures that should be followed during the handling phase.

I) Personal Protective Equipment (PPE)

A typical compounding procedure often presents numerous high-risk opportunities with a probable likelihood of health care workers being exposed to risky cytotoxic drugs. This is why the USP Chapter 800 stipulates that all those involved in the preparation and administration of chemotherapy be afforded appropriate personal protective equipment as a necessary precautionary measure against contamination. Impervious examination gloves, disposable lint-free polypropylene and facial protection masks are therefore provided pursuant to these specifications and tested to ensure that they meet the liquid barrier performance criteria.

II) Disposal

Before starting any compounding procedure, practitioners must first and foremost make certain that waste disposal systems for anodyne removal of waste are in place and fully understood by all relevant staff. Here, handling procedures often require compounding administrators to be mindful of all empty containers, vials and syringes that may have been used to handle various chemotherapy drugs. These items are then subjected to a thorough trace waste collection system to rid the working area of any apparatus containing active metabolites of unchanged cytotoxic agents. 

III) Spill Clean Up

Spills are a regular occurrence when compounding chemotherapy drugs. Nevertheless, health care professionals have to ensure that they are always prepared for such eventualities with an appropriate clean up response to protect their personnel. In case of a spill, all activities must cease immediately and all persons escorted out of the premises in preparation for routine apposite response procedures. The contents are, then, subsequently handled by trained members of staff in protective gear using tools reserved in the hazardous spill kit. 

IV) Labeling

It is paramount that all chemotherapy preparations include warning labels that are identifiable by all those handling them directly so as to ensure that they are fully aware of their hazardous proclivity. All containers are, therefore, expected to bear labels clearly indicating their contents and potential to cause serious harm.  In addition to making the said contents easily discernible, labels also eliminate any margin of error that is all too common when dealing with medication that happen to sound alike. Also, labeling standards need to adhere to those contained in the Health Professions Act (HBA) to safeguard the well-being of both administrators and patients alike.

Risks Associated with Failing Safety Procedures Prescribed For Handling Chemotherapy Preparations

Failing to follow safety procedures when handling cytotoxic drugs is a serious affair that can result in grim health risk for compounding experts. As per the National Institute for Occupational Safety and Health (NIOSH), cytotoxic drugs fit the “hazardous substances” category owing to their capability to induce carcinogenicity, genotoxicity, teratogenicity and developmental toxicity (Tomlinson & Kline, 2010, p.76). They affect healthy human cells and tissues making, their handling a grave undertaking since persons may, inadvertently, end up being exposed to high concentrations of hazardous chemicals. Rules and regulations are thus put in place to minimize the risk of exposure to both personnel and patients in direct contact with the said drugs. USP 800 also invokes the contaminant primary engineering control (C-PEC) to prevent any form of cross-contamination that may pose an immediate threat to the health of all those involved.

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