When treating pets and other animals with CMR drugs (e.g. cytostatics), the same protective measures should be used for treating staff as applied in human medicine.
The risk assessment:
The vet / operator must first carry out a risk assessment.
The risk assessment is the central element of occupational safety and forms the basis of specific measures applied to safety at work issues.
Hereby, it needs to be considered that, the cytostatics have a toxic effect. Even very small amounts are extremely toxic, eg. micrograms (10-6 ) and nanograms (10-9 ). Based on the risk assessment, the employer has to provide suitable PPE for their staff, and the employee is required to wear this.
Suitable personal protective equipment:
In accordance with the EU-directive 89/686/EEC , when handling cytostatics only Personal Protective Equipment (PPE) of the highest category III must be used.
Suitable PPE are, first and foremost, protective gloves, as here the possibility of contamination of an employee via direct contact with vials, infusion bags and liquids is greatest.
Protective gloves vs. medical gloves:
Within the EU, protective gloves are always required to be tested to the standards EN 420, EN 388 and EN 374. For handling cytostatics special chemical protective gloves need to be worn, which have been tested on various cytotostatics. In contrast to medical gloves (tested to EN455), the test results for protective gloves have to be additionally approved by an external certification body. This can be recognised by a 4-digit number, which is shown together with the CE Mark (see example).
Example: CE-Mark without and with test number.
Suitable gloves are, for example, the cytostatic protective gloves made from nitrile, which offer top protection and at the same time, are very good value for money.
To protect the body of the employee against splashes and aerosols, protective gowns are the correct choice. In comparison to ordinary cotton gowns, cytostatic protective gowns are provided with a tested protective barrier. They offer optimum protection and keep cytostatic agents, even in case of splatter, for more than 8 hours.
Cytostatic prep mats:
Special work mats are very useful during the manufacturing and administration of drugs. These have an impermeable and non-slip lower layer, whereas the upper layer absorbs liquids and transports them to the inside. Using prep mats leads to a reduction of laborious and time-consuming cleaning measures. .
Occuring contaminations cannot simply be removed with water. Investigations of the German Institute of Energy and Environmental Technology (IUTA) e.V. have shown that a 2-step cleaning procedure with an alkaline cleaner (e.g. 0,1 mol sodium hydroxide and Isopropanol 70% in a 2-step cleaning proecess lead to the best cleaning results. Thee Berner ISYSOFT cleaning wipeswere shown to have the best cleaning results (> 99,97%).
Emergency sets, so-called Spillkits should always be close at hand, during cytostatic drug production as well as during transport or when adminstrating drugs. As far as unintentional contamination is concerned, all tools of the cytostatic contamination should be easy and fast to remove.
Overview of the safey measures for handling cytostatics:
Administration of patient-specific solutions:
- Small safety cabinet
- Cytostatic protective gloves
Administration of cytostatic substances:
- Cytostatic protective gloves