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Protecting your Personnel: Working with Oncology Bio-safety Cabinets

Chemotherapy drugs, of which there are over 100 types, remain the primary treatment for cancer today. These chemical substances are also known as antineoplastic agents or cytotoxins, and, because of their cell-destroying nature, are extremely hazardous. While they may benefit cancer patients, they pose a serious occupational risk to pharmacists and other laboratory personnel who must handle them. Dealing with the toxicity of these medicines has been a challenge for oncology facilities for decades.

The standard safety protocol for the manipulation of chemotherapy drugs in oncology clinics and laboratories involves the use of a bio-safety cabinet (BSC), which tend to be Class II, either Type A or B. These have High Efficiency Particulate Air (HEPA) filters and may be exhausted outside. As long as the BSC is well maintained and functioning correctly, it provides personnel with a strong measure of protection against accidental exposure to the drugs, particularly in aerosol form; but the BSC alone is not sufficient and extra precautions are necessary. Correct and consistent use of Personal Protective Equipment (PPE) is vital.

 Potential routes of exposure to chemotherapy drugs are inhalation of vapours, skin contact, and accidental ingestion. Because drug preparation includes working with needles, syringes, vials and ampules, there is a risk of spillage and splattering, and dust has also been found to be a source of concern. Dust from the products may be found on work surfaces, including that of the BSC.

 Exposure to the cytotoxins can cause, among other problems, irritation of the skin, eyes, mouth and mucous membranes, as well as more serious acute damage like ulceration and tissue necrosis, and long-term effects on the nervous system and reproductive system. As a result, PPE is essential.

The most basic form of PPE instructs the use of laboratory coats and gloves. However, this is not considered satisfactory and staff need to take further precaution by employing fully comprehensive forms of PPE, which include:

  • Chemotherapy gowns, shoe covers, hair covers, masks and respirators. Gowns should be impermeable, closed at the front and tied at the back, long-sleeved with tight wrist cuffs, and disposable. They need to be discarded before leaving the dedicated laboratory workspace.
  • Gloves also need to be impermeable (commonly used materials include latex, nitrile, neoprene and polyurethane) and disposable, and two pairs should be worn at all times. They need to cover the cuff of the gown. They should be changed every half an hour, or whenever any tears or contamination are found. It is also imperative that workers wash their hands thoroughly with soap and water when changing gloves.
  • Masks should cover the face from the bridge of the nose to the chin, and respirators, which are not always necessary, but are required during cleaning or decontamination of the BSC, and when handling spills, should be checked for a tight fit. In addition, they must be kept clean and, along with other non-disposable PPE, stored carefully.
  • Facilities also need to have eyewash stations and emergency showers available, as well as spill kits containing all the necessary items to effectively manage an incident.

Use of the PPE listed above can protect technical personnel from accidental exposure to chemotherapy drugs and other hazardous substances. However, without appropriate training, it cannot be of much help. It is critical that workers understand the importance and correct usage techniques of all PPE. It is also important that they use it consistently – failing to adhere to PPE guidelines has been found to be a major cause of avoidable injury in oncology facilities.

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