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Safe Handling of Parenteral Cytotoxics: Recommendations for Ontario

From the Oncology Nursing, Systemic Treatment, and Evidence-Based Care Programs, Cancer Care Ontario; Occupational Health and Safety Department, Toronto General Hospital, University Health Network, Toronto; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton; Pharmacy, Parkwood Hospital, St Joseph's Health Care, London; Division of Neurosurgery, Children's Hospital of Eastern Ontario; and Hematology Department, Ottawa Hospital, Ottawa, Ontario, Canada

Corresponding author: Esther Green,Cancer Care Ontario, 620 University Ave, Toronto, Ontario M5G 2L7 Canada; e-mail: Esther.Green{at}cancercare.on.ca.

Purpose: To develop a set of recommendations for the safe handling of parenteral cytotoxics in health care facilities in Ontario, Canada.

Methods: Systematic reviews were conducted to assemble evidence on risks to health care staff who prepare or administer cytotoxic drugs for cancer care and on closed systems for handling these drugs. Recent guidelines on safe handling of hazardous drugs were also reviewed. A multidisciplinary expert panel used an ethical framework to interpret this evidence and develop a set of recommendations to guide oncology practice in Ontario. Practitioners were surveyed and asked to provide input for the final set of recommendations.

Results: Available evidence on risks associated with handling cytotoxic drugs is of poor quality, but it suggests that health care workers exposed to cytotoxic agents may be at increased risk for miscarriages. There is general agreement across guideline development groups in North America, Europe, and Australia concerning recommendations related to policies and procedures for handling cytotoxic drugs, use of personal protective equipment, and standards for ventilated cabinets, syringes and intravenous sets, transport and labeling, and education and training of staff. Limited evidence from poor-quality studies suggests that closed systems may reduce surface contamination with hazardous drugs during preparation.

Conclusion: A set of recommendations was formulated by the expert panel and approved by practitioners surveyed across Ontario.

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