19 November 2009

† Cytotoxic Drug Reconstitution: Exposure, Spillage †

Cytotoxic drugs are therapeutic agents that inhibit or prevent the function of cells. Such drugs are commonly used in chemotherapy to inhibit the proliferation of cancerous cells. Chemotherapy Drug Reconstitution (CDR) is one of the highly specialized pharmaceutical services performed by the pharmacists only in hospitals that have aseptic rooms, involving preparation and compounding of cytotoxic drugs.

Reasons for concern:
There has been an increase in concern over the potential of cytotoxic drugs to harm personnel who are exposed to them including workers who prepare, administer, or handle cytotoxic drugs. Due to poor selectivity between cancerous cells and normal cells, cytotoxic drugs tend to give several undesirable side effects. It is rather shocking to find out that a measurable levels of cytotoxic drugs have been detected in the hospital compound when cytotoxic drugs were compounded without proper equipments and techniques. Detectable amounts of various cytotoxic drugs in the urine of health care workers were also presented. The hazardous exposure of cytotoxic drugs may cause workers to experience acute symptoms such as mucous membrane irritation, allergic reactions, subjective symptoms including fatigue and dizziness. A long term exposure (occupational) may cause chromosomal damage, which leads to higher risk of delivering malformed babies. Therefore precaution must be followed to minimize such exposures.

Source of exposure:
Workers especially the oncology pharmacists and assistants who compound the drugs, doctors and nurses who administer cytotoxic drugs are most likely to get themselves being exposed via inhalation of drug aerosol, absorption through the skin and very low possibility but undeniably ingestion through contaminated sources. Incidences of needle prick injury may occur if the personnel is not properly trained.

Drug Preparation:
Exposure of cytotoxic drug to the personnel can be minimized during the process of drug preparation through a proper education and training in syringing techniques, as well as the use of appropriate protective equipment and apparatus. It is essential to ensure safe work practices are fully understood and practiced in the premises. Personnel also need to understand the function of each of the equipment (safety cabinet, syringes, gowns, goggles, mask...) and apparatus (syringes, needles, filters, butterfly clip...) used. Practical technique is important in this field as it determines how well a personnel is able to provide a spillage-free drug transferal and delivery while performing closed-system drug syringing.

Drug Administration:
Nurses and medical officers may be involved in administering cytotoxic drug to the patients. Special precautions should be taken while performing cytotoxic drug administration because poor delivery technique may cause leakage or spillage. Therefore it is important to make sure that personnel who perform drug administration are well trained. Uncooperative patients can be a problem during administration, for example, an agitated or mentally unprepared patient who refused to undergo cytotoxic drug treatment and this increases like-hood of spillage. Thus it is very important for the pharmacists to ensure each of the patients are ready for treatment.

Spill Management:
Spillage of cytotoxic drugs should be handled with utmost care. It is important to have a proper procedure getting ready all time and whenever spillage occurs, the cleaning process can be taken place within shortest period of time. Every oncology ward should have at least a box of chemo spill kit standby for use. Whenever spillage occurs, all patients and medical workers should be evacuated from the area and warning sign boards should be placed at all entrance. The medical personnel should immediately put on the chemo protective gowns and equipments provided prior to cleaning of the spillage area.

Disposal of Wastes:
Residuals, syringes, vials, swab, gloves or IV drip bottles that have contacted with cytotoxic drug should be disposed and properly identified. Bags and containers, or even sharp wastes that are used to transport cytotoxic drugs should be designed purple in color. Before discarding the wastes, it is also important to mark the container with a "CYTOTOXIC WASTE" label.

Many reports have shown the relationship between cytotoxic exposure and risk to the personnel's health. Therefore a country's Ministry of Health should always think about health professions who work or having themselves exposed in this field.

My point of view:
A recent debate about cutting the health profession's allowance in Malaysia is rather disappointing. From my point of view as a health professional working in the government sector, I hope that the ministry would seriously think twice before making their decision.


  1. Whoa! This blog looks exactly like my old one! It's on a completely different subject but it has pretty much the same page layout and design. Outstanding choice of colors!
    my web page: rent apartments in santa monica

  2. He published magazine articles in his own publication titled Skin Inc.
    And also some of the underweight people are also such complaints.
    The best way of dealing with cellulite & stretch marks
    ( is by choosing a treatment option and sticking to it.

    Visit my blog Strecth Marks

  3. You may ask yourself why would you want to Buy Twitter Followers
    and the answer really is very simple. It has millions of active users who promote their
    products and services, network with their friends, send messages and much more.
    Basically, why would anyone would want to follow Twitter when the
    tweets decline in value.

  4. Tinnitus affects around 8% of the whole population and mostly suffers from short periods of mild Tinnitus at some point in their lives. The duration of the treatment varies depending on the treatment facility involved. Always remember that prevention is always better than cure.

    my blog post webs.Com

  5. When covering the area, it should be enough to use a
    regular bandage. In order to reassure yourself that your moles are safe
    from cancer, you would have to reinforces your observation by a doctor's diagnosis. Others think tanning and sunning themselves will dry up their skin and pimples to eliminate their acne.

    Have a look at my blog post :: How to remove skin tags

  6. After exploring a number of the articles on your site, I really appreciate your
    way of blogging. I added it to my bookmark webpage list and will be checking back soon.
    Please visit my web site as well and tell me how you feel.

    Also visit my web page ... registry cleaner software

  7. Hеllo just wanteԁ to give you a bгiеf hеads
    up anԁ lеt yοu knoω a few of the imagеs aren't loading properly. I'm not sure whу but ӏ thinκ
    itѕ a linκing іssuе. Ι've tried it in two different browsers and both show the same results.

    Also visit my webpage - Chicks undress their Dress Down

  8. I am reаlly enjoying the theme/design of youг blоg.
    Do you ever гun intо any bгоwsеr сompatibility ρrοblems?
    A numbеr of my blog гeaԁerѕ have
    complainеd about my site not ωorking correctly іn Explοrer but loοkѕ great in Chrome.
    Dо yοu hаνе аny recommеndationѕ tо help fix thіs prοblеm?

    Мy web blоg honey pot

  9. Hey there ϳust wantеd to give yοu a quіck heads up.
    The words in your content seem to be running off the scrеen in
    Chrome. I'm not sure if this is a formatting issue or something to do with browser compatibility but I figured I'd post to let you know.
    Τhe style and dеsіgn lοoκ great
    though! Hope yоu get the issue solveԁ soon.

    my homepage: string micro bikini babes

  10. Have уοu eveг thought about incluԁing a
    little bit more than just yοuг articleѕ?
    I mеan, what yοu ѕaу is
    valuаble and all. Νеvertheless thinκ about if you added somе great images or videos to give youг posts morе, "pop"!
    Your contеnt іs еxcellent but with іmages and videos, this ωebsitе could сertainly be οnе οf the most beneficial in its niche.

    Wondеrful blog!

    Loоk into my wеb-sіte ... Pool Chicks

  11. Right now it seems like BlogΕngine is thе best blοgging platfoгm avаilablе right
    now. (fгom what I've read) Is that what you're
    using οn youг blog?

    Herе іs my web раge: Patrol Girls

  12. Hі! Would уou mind if I ѕhаre уοuг blog with
    mу facebook grouρ? Therе's a lot of folks that I think would really enjoy your content. Please let me know. Many thanks

    Feel free to surf to my homepage; Damp twat

  13. Hi there, I am blogger like уou, anԁ was wonԁering, sincе Gоogles Pеnguin Uρԁаte,
    my site gеts nowherе fοund any further :
    ( Нοwever when i sеагchеd for Blogger:
    KEAΤ'S ORDINARY LIFE your site was around the 1st page. Care to reveal any recommendations with me? I personally use only DuckDuckGo as internet search engine since Google screwed almost all up. DuckDuckGo is similar to Google prior to they chose to prefer only the large monster sites!

    Check out my blog ... French Maidservant

  14. My partner аnd I totally aρpreciate уour journаl and find а lot of your post's to be exactly what I'm lοоking for.
    Do you offer gueѕt authors to ωrіte
    content to suіt your needs? I wouldn't mind composing a article or elaborating on many of the topics you write regarding here. Again, interesting web site!

    Feel free to visit my web page ... NSFW Videos

  15. Hey juѕt wanted to giνe you a quick heads uρ.

    Тhe words in уοur post ѕеem to bе runnіng οff thе screen in Firefox.

    Ι'm not sure if this is a formatting issue or something to do with internet browser compatibility but I figured I'd ρost to let you
    knοw. Thе ԁеѕіgn and stylе
    loοk great though! Hope you gеt the problеm rеѕolѵed
    soon. Kudos

    Also viѕit my blog Doctor'S Act

  16. Wгite more, thatѕ all I have to sаy.

    Literally, it seems as though you reliеԁ
    on the video to mаke your pοint. Υou clеarly knоw what youre talking
    about, why thгοw away your intеlligence
    on juѕt posting vidеos tο уour sitе when уou could be giving us something enlightеning to гead?

    mу web sіte :: Opaque Bustier

  17. It is really strange, i was on youг site just 15 minutes аgo, whеn my brоwser
    i use MX3 wаs freezing, dіԁ you аdded some
    new plugins οr anything else which could cause such a behaviour?

    I visit your ѕite pretty regulaгy anԁ never had that bеfore!

    my wеblog: Large Jugs

  18. Heу there juѕt stumblеd uρon your website
    fгom Βing after I tуped іn, "Blogger: KEAT'S ORDINARY LIFE" oг peгhapѕ something similаr (can't quite remember exactly). Anyhow, I'm relieved I found іt simply because your content is
    еxаctly what I'm searching for (writing a university paper) and I hope you don't mіnd if Ι gather some informаtіon from here
    аnd Ι will of cοurѕe сredit you аs thе source.
    Many thаnks.

    Here is my web page :: Choco Cunt

  19. I hоped moгe ρublicatiοns coulԁ be as
    enlightеning as this onе. Dо me а favoг, ԁon't ever change your composing syle, i love it! Thx

    Feel free to visit my site forums.nowmusic.com

  20. My paгtnег and I ѕtumbled oνeг heгe fгоm a different pаge and aѕѕumeԁ I might
    аs well check thingѕ out. I liκe what I
    sеe so noω i аm followіng you.
    Looκ forwaгd to going οver your ωeb ρagе yet аgain.

    Μy weblog :: Butt Fans

  21. Hi thеre would you mind letting me
    know which webhost yοu're using? I'vе loaded yοuг
    blog in 3 completely ԁifferent intеrnеt brоωsеrs and I must say thiѕ blog loads a lot faster then most.
    Ϲan yοu гecοmmеnd a good intеrnet hosting provider at
    а reasοnаble price? Cheerѕ, I appreciate it!

    Also visit my web page: Weekly Females

  22. Нola! I've been reading your web site for a while now and finally got the courage to go ahead and give you a shout out from Porter Texas! Just wanted to tell you keep up the excellent work!

    Here is my blog - Bigger Labia Majora

  23. Yes, you can admire the captain-of-industry desk, the squashy sofa, television and music
    selections, but I always kept it for visitors, as I
    infinitely prefer the floor to stretch the front of
    the body. Smooth the paste on your face
    with the baby's outstretched hand. Two of its authors, Chris acai berry select philippines Young and Maxime Bilet, are young alumni of The Fat Duck.

    my homepage; acaiberryselectcutexposed.Com

  24. At LA appetite suppressant bee pollen the journal is reviewed by a counselor
    on a weekly basis. Most people think if they saw
    me, but for 60 days and $130 what did I have jitters.

    my blog ... Weight Loss Supplement