CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2017; 38(02): 190-197
DOI: 10.4103/ijmpo.ijmpo_174_16
Review Article

Cytotoxic Drug Dispersal, Cytotoxic Safety, and Cytotoxic Waste Management: Practices and Proposed India‑specific Guidelines

Malini R Capoor
Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
,
Kumar Tapas Bhowmik
Department of Radiotherapy, Biomedical Waste Unit, VMMC and Safdarjung Hospital, New Delhi, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

This article deals with practices related to cytotoxic drug dispersal, cytotoxic safety, and cytotoxic waste management and attempts at India-specific guidelines for their dispersal and disposal. The articles related to cytotoxic drug dispersal, cytotoxic safety, and cytotoxic waste management were reviewed from PubMed and their applicability in Indian health-care facilities (HCFs) was also reviewed. All HCFs dealing with cytotoxic drugs should consider cytotoxic policy, patient safety and health-care worker safety, and environmental monitoring program as per the available international guidelines customized as per Indian conditions. Utmost care in handling cytotoxic waste is quintessential. The formation of India-specific cytotoxic guidelines requires the inputs from all stakeholders. Cytotoxic waste, cytotoxic safety, and cytotoxic waste management should be the subject of a national strategy with an infrastructure, cradle-to-grave legislation, competent regulatory authority, and trained personnel.



Publication History

Article published online:
06 July 2021

© 2017. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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  • References

  • 1 Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R, et al., editors. Safe Management of Wastes from Health-Care Activities' WHO Blue Book. 2nd ed. Malta: World Health Organization; 2014.
  • 2 NIOSH Publications. Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Publication Number 2004-165. Cincinnati, OH: NIOSH Publications; 2004. Available from: http://www.cdc.gov/niosh. [Last assessed on 2017 Apr 25].
  • 3 Cytotoxic Drugs and Their Waste: Risk Management Guide for South Australian Health Services; 2015. Available from: http://www.sahealth.sa.gov.su. [Last assessed on 2017 Apr 25].
  • 4 IARC (International Agency for Research on Cancer). Laboratory Decontamination and Destruction of Carcinogens in Laboratory Waste: Some Hydrazines. IARC Scientific Publications No. 54. Lyon: International Agency for Research on Cancer; 1983.
  • 5 IARC. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. List of IARC Evaluations. Lyon: International Agency for Research on Cancer; 1994.
  • 6 IARC. Laboratory Decontamination and Destruction of Carcinogens in Laboratory Waste: Some Antineoplastic Agents. IARC Scientific Publications No. 73. Lyon: International Agency for Research on Cancer; 1985.
  • 7 Hansel S, Castegnaro M, Sportouch MH, De Méo M, Milhavet JC, Laget M, et al. Chemical degradation of wastes of antineoplastic agents: Cyclophosphamide, ifosfamide and melphalan. Int Arch Occup Environ Health 1997;69:109-14.
  • 8 Castegnaro M, De Méo M, Laget M, Michelon J, Garren L, Sportouch MH, et al. Chemical degradation of wastes of antineoplastic agents 2: Six anthracyclines: Idarubicin, doxorubicin, epirubicin, pirarubicin, aclarubicin, and daunorubicin. Int Arch Occup Environ Health 1997;70:378-84.
  • 9 Easty AC, Coakley N, Cheng R, Cividino M, Savage P, Tozer R, et al. Safe handling of cytotoxics: Guideline recommendations. Curr Oncol 2015;22:e27-37.
  • 10 United States, Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Health & Safety. Workplace Safety and Health Topics: Engineering Controls. Atlanta, GA: CDC; 2014. Available from: http://www.cdc.gov/niosh/topics/engcontrols/. [Last cited on 2014 May 08].
  • 11 Service Ontario, e-Laws. Occupational Health and Safety Act. Ontario Regulation 67/93: Health Care and Residential Facilities. Toronto, ON: Government of Ontario; 2013. Available from: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_930067_e.htm. [Last cited on 2014 May 08].
  • 12 Bio-Medical Waste Management Rules, 2016. Published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-section (i), Government of India Ministry of Environment, Forest and Climate Change. Notification; New Delhi; the 28t h March, 2016.
  • 13 Service Ontario, e-Laws. Occupational Health and Safety Act. RSO 1990, Ch. 1. Toronto, ON: Government of Ontario; 2011. Available from: http://www.elaws.gov.on.ca/html/statutes/english/elaws_statutes_90o01_e.htm. [Last cited on 2013 Jul 31].
  • 14 ASTM International. ASTM D6978-05: Standard Practice for Assessment of Resistance of Medical Gloves to Permeation by Chemotherapy Drugs. West Conshohocken, PA: ASTM International; 2013.
  • 15 Ontario Agency for Health Protection and Promotion, Provincial Infectious Diseases Advisory Committee. Routine Practices and Additional Precautions. 3rd ed. Toronto, ON: Queen's Printer for Ontario; 2012. Available from: http://www.publichealthontario.ca/en/eRepository/RPAP_All_HealthCare_Settings_Eng2012.pdf. [Last cited on 2014 May 08].
  • 16 ASTM International. ASTM F739-12 Standard Test Method for Permeation of Liquids and Gases through Protective Clothing Materials under Conditions of Continuous Contact. West Conshohocken, PA: ASTM International; 2012. p. 13.
  • 17 Accreditation Canada. Medication Management Standards: For Surveys Starting After: January 01. Ver. 8. Ottawa, ON: Accreditation Canada; 2013.
  • 18 CSA Group. Canadian Health Care Facilities. CSA Z8000-11. Toronto, ON: CSA Group; 2011.
  • 19 Public Health Agency of Canada (PHAC). Laboratory Biosafety Guidelines. 3rd ed. Ottawa, ON: PHAC; 2004.
  • 20 Service Ontario, e-Laws. Occupational Health and Safety Act. Ontario Regulation 474/07: Needle Safety. Toronto, ON: Government of Ontario; 2010. Available from: http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_070474_e.htm. [Last cited on 2013 Jul 31].
  • 21 Ontario, Ministry of the Environment. Guideline C-4: The Management of Biomedical Waste in Ontario. Toronto, ON: Government of Ontario; 2009. Available from: https://www.dr6j45jk9xcmk.cloudfront.net/documents/1761/197-bio medical-waste-en.pdf. [Last cited on 2013 Jul 30].
  • 22 Transport Canada. Transportation of Dangerous Goods. Ottawa, ON: Transport Canada; 2014. Acts and Regulations can be Searched. Available from: http://www.tc.gc.ca/eng/tdg/safety-menu.htm. [Last cited 2014 May 08].
  • 23 International Society of Oncology Pharmacy Practicioners Standards Committee. ISOPP standards of practice. Safe handling of cytotoxics. J Oncol Pharm Pract 2007;13 (Suppl 1):1-81.
  • 24 Roos I, Makela T. Human resource issues in cytotoxic drug dispensing. J Oncol Pharm Pract 1997;3:200-18.
  • 25 Canadian Association of Pharmacy in Oncology (CAPHO). Standards of Practice for Oncology Pharmacy in Canada. Ver. 2. North Vancouver, BC: CAPHO; 2009.
  • 26 NSF International. Biosafety Cabinetry: Design, Construction, Performance, and Field Certification. NSF/ANSI 49-2008. Ann Arbor, MI: NSF International; 2008. Available from: http://www.standards.nsf.org/apps/group_public/download.php/3604/NSF_49–08e-rep-watermarked.pdf. [Last cited on 2014 May 08].
  • 27 Lawson CC, Rocheleau CM, Whelan EA, Lividoti Hibert EN, Grajewski B, Spiegelman D, et al. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol 2012;206:327.e1-8.