CONTENTS
Corporate Statement………………………. 1
Section 1 Handling Cytotoxic Drugs 2
What are cytotoxic drugs?……………………2
Potential health effects of cytotoxic drugs……… 3
Risk control ……………………………… 4
What are the legal issues?………………….. 4
Integrating health and safety law into the workplace. . 5
The risk management approach……………… 5
The need for consultation…………………… 6
Section 2 Managing the Risk 7
Building a risk assessment …………………. 7
Section 3 Health Monitoring
What is health monitoring?…………………..13
The conundrum of ‘biological monitoring’……… 13
What type of health monitoring should
be provided?…………………………….. 14
Emergency procedures…………………….. 15
Reporting and keeping records………………. 15
Section 4 Training 16
Who should be trained?…………………….. 16
Identify training requirements……………….. 16
Evaluate the training program……………….. 17
Keep training records………………………. 17
Section 5 Preparing and Dispensing Drugs 18
Alternative supply arrangements…………….. 18
Establishing a cytotoxic preparation facility…….. 18
Preparing cytotoxic drugs…………………… 20
Standard operating procedures for preparing
cytotoxic drugs…………………………….. 20
Packaging and transporting cytotoxic drugs……. 20
Personal protective equipment………………. 21
Maintaining controls……………………….. 21
Section 6 Administering drugs 22
Establishing a drug administration area……….. 22
Drug Administration Equipment……………… 22
Standard Operating Procedures……………… 23
Personal Protective Equipment……………… 23
Section 7 Patient Care 25
Caring for patients………………………… 25
Transporting patients………………………. 26
Caring for patients at home or in
community settings…………………………26
Section 8 Drug Treatment in
Veterinary Practice 29
Animal care………………………………. 29
Animal care at home………………………. 30
Section 9 Spill Management 32
Standard operating procedures………………. 32
Reporting procedures……………………….32
Section 10 Waste Management 34
Establishing a waste management strategy……..34
Identifying, containing and segregating waste……34
On-site waste transport…………………….. 35
Waste storage……………………………..35
Off-site waste transport……………………..36
Waste treatment and disposal……………….. 36
Personal protective equipment………………. 37
Laundering………………………………. 37
Appendix 1 – Glossary of Terms……………………… 38
Appendix 2 – Legislative Requirements……………… 40
Appendix 3 – Information Sources…………………… 41
Appendix 4 – List of commonly used cytotoxic drugs….. 43
Appendix 5 – Example of a Material Safety
Data Sheet (MSDS)…………………….. 45
Appendix 6 – Cytotoxic Drugs Register………………..47
Appendix 7 – Risk Assessment Template
for Cytotoxic Drugs……………………..48
Appendix 8 – Guidelines for medical practitioners in
health monitoring for cytotoxic drugs…… 49
Appendix 9 – Personal Protective Equipment…………. 51
Appendix 10 – Procedure for dealing with spills……….. 52
Appendix 11 – Procedure for dealing with contamination
of employees………………………….. 54
Acknowledgments……………………………………. 55