Cytotoxic drugs (CDs) are life-saving for patients with cancer but they can be very dangerous for the staff members who must handle and administer them. In order to maintain the highest safety standards for patients, clients and staff members, these procedures are instituted.

Storage:
CDs must be stored inside of closed containers to prevent accidental breakage.
CD storage containers must be labeled appropriately.

Spills:
A chemotherapy spill kit shall be assembled and maintained near the site where CDs are mixed or administered. ________________________ (fill in the name of the person responsible) shall ensure the spill kit is prepared and replenished when necessary.

If the spill is outside of the Biological Safety Cabinet (BSC), remove non-essential personnel from the area. Spills shall be cleaned up by absorbing the spilled liquid with absorbent pads while wearing gloves, gown and mask. The contaminated materials shall be placed in the yellow "Chemo" bag located in the preparation or administration area. The contaminated area shall be cleaned with water and detergent (NOT disinfectant). For any large spill (greater than 5 ml of CD), _________________ and the Safety Director shall be notified and an accident report filed.

Personnel Contamination
If during preparation or administration of a CD, your protective clothing or body is contaminated with the drug, immediately stop the procedure and remove the contaminated gloves or clothing. Wash the affected area with detergent (NOT disinfecting) soap and water. If your eyes are contaminated, immediately call out for assistance from other workers; flush your eyes at the eye wash station for at least 15 minutes. Notify __________________________________ and the Safety Director of the incident and seek medical attention if warranted.

Preparation: All CDs shall be drawn up, reconstituted or prepared inside of the Biological Safety Cabinet (BSC) located in the treatment area. Only staff members who have been trained and authorized by______________________________ shall attempt to mix, prepare or administer CDs. All drugs shall be handled in accordance with the manufacturer's instructions and the following procedures:

a. Assemble all reagents on an absorbent liner within the BSC.
b. Turn on the hood at the switch and remove non-essential people from the area.
c. Wash your hands with normal detergent soap but not disinfectant soap.
d. Put on an impervious, lint-free gown with elastic cuffs. This "cover" should only be worn in the CD prep/administration area.
e. Put on a pair of unpowdered chemo gloves with the glove over the cuff of the gown or smock. For extended procedures, double gloving is suggested. Gloves should be changed every 30 minutes.
f. Attach injection pins to drug bottles.
g. Select a leur-lock syringe based on estimated volumes (syringe should never be more than half to two-thirds full of solution.)
h. Attach the syringe to an appropriate needle.
i. Draw up the required amount of diluent.
j. Stick the needle into the drug container and draw out a small amount of air. Inject a small amount of diluent. Repeat this process until the entire amount if diluent is injected into the drug vial. The goal of this step is to never have the drug in a "pressurized" container to decrease the likelihood of spraying or aerosolization.
k. With the needle still in the vial, mix the solution by gently swirling until all particulates are dissolved.
l. Invert the vial and withdraw the solution in small amounts. Inject an equal amount of air back into the vial. Repeat this process until all the drug is drawn up into the syringe.
m. Aspirate slightly on the plunger to remove all drug from the needle and hub then remove the needle from the syringe.
n. Wipe the syringe with an alcohol gauze and replace the cap on the needle using the one-handed technique.
o. Label a zip-lock bag and the syringe with the patient's name, the date and the appropriate sticker.
p. Place the syringe in a zip-lock bag for transport to the patient administration area.
q. Place all disposable supplies from the hood in the yellow receptacle marked "Chemo" located next to the BSC. Do not recap remaining needles - dispose of them directly in the sharps container inside of the BSC. When the sharps container is full, seal it and place it inside of a yellow "Chemo" bag and place it in the normal collection box for sharps containers.
r. Remove your gown and gloves without touching the outside and dispose of them in the yellow "Chemo" bag next to the BSC.
s. Wash your hands with normal detergent soap but not disinfectant soap.

When CDs are being prepared or administered, the area shall be clearly identified with the appropriate sign and non-essential personnel kept at least 5 feet away.

Eating, drinking, smoking and chewing gum, applying cosmetics and food storage are prohibited in the CD preparation and administration area. These activities are also prohibited in any areas where patients treated with CDs are hospitalized or when handling these patients.

Administration:
Only properly trained staff members authorized by ____________________________ shall administer CDs or assist in the procedure. Administration of CDs shall only be performed in the designated area and non-essential personnel must be kept at least 5 feet away from the procedure area. All staff members must wear protective gowns, powder-free latex gloves and eye protection for the duration of the procedure. The drug manufacturer's directions shall be followed for administration.

The administration area (5 feet surrounding the table) shall be cleaned with water and detergent (not disinfectant) soap when the procedure is completed.

Patient Care:
Patients who have received CD treatments must be identified with a cage card. Only authorized and trained staff members shall care for CD patients.

Excretions from CD patients may be hazardous. The chart on the following page should be used as a guide for determining the risk of exposure. Potentially hazardous materials must be collected using appropriate protective equipment and disposed of properly: liquid waste in the sanitary sewer and solid waste in a yellow "Chemo" bag.

___________________________ is responsible for implementation of this plan.

Chemotherapeutic Drug Clearing Times and Routes

Although there is no conclusive data available on the pharmacokinetics of most of these drugs in animals, this information has been extrapolated from the data available for humans. Table courtesy of Dr. Sarah Sheafor of Southpaws Veterinary Referral Center, Springfield, VA.