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KAZUKI KUSHIDA, MASAYOSHI HIROHARA, KEN YAMAMOTO – SHOWA PHARMACEUTICAL SCIENCES CLEANING GUIDELINES


Preventing exposure to anti-cancer agents


This paper reports on the results of an investigation into information concerning appropriate cleaning and the washing measures found in guidelines on the prevention of exposure to anti-cancer agents.


The number of patients with cancer in Japan was predicted to have reached 1,010,200 in 2016, exceeding one million for the first time. The projected number of deaths was 374,000.1


The number of


cancer patients is continuing to rise and many kinds of treatment are provided of which chemotherapy is one. Recently, the spread of outpatient chemotherapy has allowed patients who have been given anti-cancer agents to live at home. However, as these therapeutic agents are well known for their acute and chronic toxicity,2


there are risks that


incidental exposure to these agents may harm people’s health. Medical institutions have their own policies to avoid exposure to and contamination from chemotherapy agents during much of the process: for example, the preparation of anti-cancer agents, the dosage in the sickroom, the handling of the patient’s bodily waste and the disposal of catheters. Many institutions outsource the cleaning of contaminated toilet facilities and the collection and cleaning of linen, meaning that appropriate practices are not always shared with the contractors. To prevent exposure to anti-cancer drugs, all materials must be handled appropriately, regardless of whether this is by internal or external staff, and information sharing about the prevention of exposure to anti-cancer agents is vital.


Methods The authors searched for research articles on the appropriate handling of anti-cancer agents and looked at guidelines issued by the scientific committee of the Japanese Society of Hospital Pharmacists, the American Society of Health System Pharmacists (ASHP), Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH) and the Oncology Nursing Society (ONS). They then compiled the information included on the prevention of exposure to anti-cancer agents during cleaning and washing.


82


been recommended when handling anti- cancer agents. In 1979, the detection of mutagenic


material in the urine of a nurse who had handled anti-cancer agents was reported.6 In his report, Falk warned not only of acute toxicity, but also of cytotoxicity. Later, it was reported that wearing gloves and a mask and using a safety cabinet could prevent exposure. Once it became clear that there was


a cytotoxic risk from anti-cancer agents, each country began to compile guidelines. Sweden was the first to respond with antineoplastic handling guidelines in 1978, which recommended that people should wear personal protection equipment (PPE) and use a safety cabinet. Guidelines were issued by the


Results Information on occupational exposure to anti-cancer agents has been reported since the 1960s, but many of the early reports were of local acute toxicity affecting the skin or eyes. The earliest reports of exposure influencing health were of dermatitis and unnatural pigmentation.3 In addition to corneal damage caused by vinblastine splashes,4


skin symptoms


caused by carmustine were reported.5 Since that time, the use of gloves has


Directorate of Labor Inspection in Norway,7


Australia,8


of Hospital Pharmacists,9 and Safety Executive,10 Nursing Society11 of Labor.12


the Canadian Society the UK Health


the US Oncology and the US Department In Japan, guidelines on handling


anti-cancer agents were issued in 1991. The content of the guidelines differs from one country to another, but the use of PPE and safety cabinets to prevent exposure are a common feature. From the early 1990s, contamination of the working environment came to be


Professor PhD, Laboratory of Pharmacy Innovation, Showa Pharmaceutical Sciences.


Kazuki Kushida Masayoshi Hirohara Ken Yamamoto Professor PhD, Center for


Education and Research on Clinical Pharmacy, Showa Pharmaceutical Sciences.


Assistant Professor PhD, Center for Education and Research on Clinical Pharmacy, Showa Pharmaceutical Sciences.


IFHE DIGEST 2018


©LoloStock/stock.adobe.com


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