2017 December - Cytotoxic drug safety for you, your team and your clients Dr Sandra M Nguyen – Registered specialist in veterinary oncology
Veterinary clients are increasingly likely to choose to treat their animal for cancer and cancer chemotherapy is becoming more widely available. The SafeWork NSW guidelines have recently been updated so now is a good time to cover the important topic of chemotherapy safety.
Commonly used cytotoxic drugs include chlorambucil, vincristine, cyclosphosphamide, doxorubicin and carboplatin.
Veterinary practices using cytotoxic drugs have a duty to provide information, instruction and training to all those who handle these drugs and related waste. This includes veterinarians, veterinary nurses, animal attendants, receptionists, cleaners and animal carers/owners (clients).
There is not a known ‘safe’ dose for those that are administering chemotherapy to be exposed to, nor a safe dose of cytotoxics to be exposed to through contaminated wastes such as urine, saliva, blood and faeces. Because of this, the best approach is to minimise the exposure in the first instance through safe preparation, handling and administration methods and making sure the staff and clients handling chemotherapy and waste from patients are adequately informed and trained in the use of cytotoxics.
Our obligations when handling cytotoxic drugs are outlined in the Cytotoxic drugs and related risk management guide published by SafeWork NSW and updated in July 2017. These comprehensive guidelines should be read and used as the minimum standard. Chapter 12 is specific to veterinary medicine, and also refers the reader back to other sections of the document.
Here are a few points from the document that can be instituted in practice with relative expediency:
- Pregnant, breast feeding women and those planning parenthood should be informed of the reproductive risks and possible effects on foetal development. This includes the veterinary health care team and the client.
- A dedicated area and isolated place within the veterinary practice should be used for cytotoxic drug treatment. It should be a secure area that provides restricted access.
- Use signs on cages to identify animals receiving cytotoxic drug treatment.
- All cytotoxic medications dispensed to clients need to have child proof lids, appropriate labelling which should include ‘do not cut or crush’ on the label.
- Advise clients to administer the cytotoxic drug over a non-carpeted surface, that is also not the kitchen or bathroom. Written information also needs to be given to the client on the drug and what to do in the case of a spills.
In addition, the guideline covers risk management procedures, emergency procedures, and recommendations around administration and personal protective equipment.
You must be authorised by SafeWork NSW to use cyclophosphamide as previously notified in Boardtalk May 2014 article Are you storing, handling or using cyclophosphamide to treat patients?
Further information is also available from the article Safe Handling of Cytotoxic (or Antineoplastic) Drugs (Boardtalk April 2007).
The SafeWork NSW guide can be downloaded from http://www.safework.nsw.gov.au/__data/assets/pdf_file/0005/287042/SW08559-Cytotoxic-drugs-and-related-risk-management-guide.pdf