1. 8
Chemotherapy

2. Cancer Overview DNA is damaged & cells grow out of control
Most cancers produce tumors
Cancers behave differently, grow at different rates
Treatment is specific to cancer type
Early detection, treatment = better survival chances

3. Cancer Overview (cont’d)
Treatment includes
Surgical removal of tumor
Chemotherapy
Radiation

4. Cancer Overview (cont’d)
Viruses linked to cancer
Epstein-Barr virus
HIV
HPV
Chemotherapy also used to treat
Rheumatoid arthritis
Lupus
Psoriasis
Autoimmune diseases

5. Cytotoxic Agents Also known as antineoplastics
Used to treat patients with various forms of cancer
Specific drugs indicated for specific tumors/cells
Extremely toxic to cells
Drugs can’t distinguish between healthy & sick cells

6. Cytotoxic Agents (cont’d)
Many side effects (hair loss, etc.)
Two main types
Cycle-phase nonspecific
Cycle-phase specific

7. Risk-Related Characteristics of Chemotherapy Agents
Mutagenic: can cause cells to mutate
Carcinogenic: can cause cancer
Teratogenic: can cause birth defects
Immunosuppressive: lowers immunity

8. Biological Safety Cabinets
Vertical airflow, top to bottom
Protects personnel, product, & environment
ISO Class 5 environment

9. Biological Safety Cabinets (cont’d)
Classes
Class I: protects personnel & environment only
Class II: protects personnel, product, & environment
Class III: provides maximum protection

10. Compounding Aseptic Isolator
Glove box isolator: a contained unit
Restricts movement of contaminants
Operator slips hands into long glovelike parts
Highly favored by USP 797 for multitasking
Requires less space, has monitoring controls

11. Proper Use of the BSC Keep insides & tops clear
Turn off all UV lights when lab is occupied
Wash hands & arms with germicidal soap
Wear long-sleeved gown & gloves
Don’t eat, drink, apply makeup, smoke in lab
Dispose of sharps appropriately
Clean up spills immediately

12. Proper Use of the BSC (cont’d)
Dispose of all waste in biohazard containers
Disinfect surfaces with sterile water & alcohol

13. Preparing to Use the Hood
Turn off UV light upon entering room
Check flow alarm system audio & visual
Decontaminate surfaces & wait 10 min

14. Cleaning and Decontaminating the BSC
Dress in usual garb + chemo-specific gown
Wash hands & put on chemo & sterile gloves
Clean bar at top of hood
Clean back panel of hood
Clean side panels
Clean work surface area

15. Cleaning and Decontaminating the BSC (cont’d)
With blower on, scrub from top to bottom
Repeat steps 3-7 using 70% IPA
Leave moveable parts in hood

16. Shutting Down the BSC Decontaminate all items in interior area
Turn on UV light
Allow 5 min of operation to purge system
Turn off BSC blower, if it is facility’s procedure

17. Personnel Training Competency should be assessed Annually (at least)
Any time employee is not following protocol

18. Personnel Training (cont’d)
Training program
Should include certification course
Recertification required regularly (yearly)
Trainer: several years experience with chemo
Should cover chemo procurement, storage, safe handling procedures, prep & waste guidelines

19. Attire Guidelines Low-permeability, solid-front gown with ties in back
Disposable, high-cuff, latex chemo/nitrile gloves
Thickest gloves allowed by workplace
2 pairs of thinner gloves under outer gloves

20. Attire Guidelines (cont’d)
Disposable lab coat, closed & with sleeves tucked into gloves
Don’t wear lab coat outside the lab
Eye protection (goggles)

21. Withdrawing a Cytotoxic Agent
Gather all materials
Don’t block airflow
Swab rubber top with alcohol
Use only Luer-lock syringe; make sure it’s tight
Pull plunger back halfway from what is needed
Remove cap from needle & insert needle

22. Withdrawing a Cytotoxic Agent (cont’d)
Add air to vial, then withdraw drug
Remove needle, remove air bubbles
Recap syringe
Perform final check

23. Handling Hazardous Drugs
Ensure syringes/IV sets have Luer-to-Luer connection
Don’t fill syringe >3/4 full
Use venting devices with
0.2 micron hydrophobic filters
5 micron filter needles/straws
Dispense final products ready to administer

24. Handling Hazardous Drugs (cont’d)
Wipe outsides of containers, IV sets, IV ports
Label final products; put in zip-lock container

25. PhaSeal Closed system Reduces/eliminates human exposure to chemo
Set of disposable containment devices
Used in drug mixing & administering
Connect original drug vial, syringe & IV set
Sealed pathway

26. PhaSeal (cont’d) Has double membrane to prevent drug leakage
Expansion chamber equalizes pressure in system

27. Disposal of Cytotoxic Medications
Use yellow, puncture-resistant hazardous container
Chemo waste
Discarded gloves
Disposable gowns
Disposable goggles
IV bags/bottles, tubing, needles, syringes

28. Disposal of Cytotoxic Medications (cont’d)
Place all cytotoxic waste in sealed zip-lock bag
Don’t clip or cap needles & syringes

29. Chemo Spill Kit Chemical splash goggles
Low-permeability disposable gown & shoe covers
2 sheets of absorbent, plastic-backed material
250 mL & 1 L spill control pillows
Puncture-resistant sharps container
Small scoop to collect glass fragments

30. Chemo Spill Kit (cont’d)
2 large, labeled, sealable hazardous drug waste bags
Appropriate respirator

31. Chemo Spill Kit (cont’d)
FIGURE 8-14 Chemotherapy waste container

32. ASHP Guidelines for Safe Handling of Cytotoxic Drugs
Limit access
Identify & label all hazardous drugs
Educate patient & family of precautions
Have a written procedure & kit for chemo spills
Design facility to prevent easy spillage, breakage

33. ASHP Guidelines for Safe Handling of Cytotoxic Drugs (cont’d)
Have written policies/procedures for chemo prep
Conduct orientations & yearly process validations
Keep MSDS for each hazardous drug accessible
Require employees to wear appropriate apparel

34. A Final Caution Avoid compounding cytotoxic agents if pregnant
Most cytotoxic drugs target fast-growing cells (ovaries & sperm)
Some chemo drugs are mutagenic, which may increase risk of miscarriages & birth defects
Drug may get out of container & into air

35. A Final Caution (cont’d)
Drug may be inhaled, absorbed, ingested, or accidentally injected
Drug may cause cell damage