Cleaning & waste management

While preventing contamination of surfaces and equipment with cytotoxic drugs and their residues is the best strategy to minimize worker exposure, the handling of cytotoxic drugs may inevitably result in surface contamination that must be minimized and eliminated to negate potential handling risks.

Effective cleaning procedures and practices to decontaminate the work area should be developed with

documented safe work procedures including following: establishment of regular scheduled cleaning routines for all work surfaces and equipment used where cytotoxic drugs are prepared or administered use of disposal cleaning materials where possible, that generate a low amount of particles; reusable cleaning materials should be decontaminated or discarded after those along with other cytotoxic waste

This is a general guide to cleaning agents refer to manufacturer’s instructions for the specific product being used and the relevant safety data sheet for safety instructions when dealing with undiluted product.

So, Surfactants such as liquid detergents diluted in warm water, followed by rinsing will clean water are generally recommended for cleaning of all surfaces potentially contaminated with cytotoxic drugs and related waste. Detergent agents combined with decontaminating agents are available commercially.

Another type of agents are Chlorine-bases. Sodium hypochlorite, or we call liquid bleach, of various concentrations has been found to be the most effective reagent for the chemical degradation of a variety of cytotoxic drugs and is often recommended for decontamination purposes. The high decontamination potential of sodium hypochlorite solution makes it useful for the cleaning of cytotoxic drug spills and decontamination of material potentially contaminated with infectious agents, however its corrosive nature on metals like stainless steel are a major drawback and manufacturers of biosafety cabinets and barrier isolators do not recommend the use of sodium hypochlorite.

It is also known that sodium hypochlorite can degrade cytotoxic agents to integrate to mutagenic residues so a minimum one hour time gap is recommended between the cleaning and preparation of cytotoxic drugs. This may not be feasible in pharmacy production routines in which case other cleaning agents should be used.

Work place monitoring The Regular and random monitoring of surfaces in areas where there is a risk of contamination from cytotoxic drugs, such as the pharmacy preparation and storage areas and patient administrations areas, is an important quality assurance measure to assess the effectiveness of the cleaning practices. This is known as environmental wipe sampling.

General cleaning staff who may be involved in cleaning areas where cytotoxic drugs are stored, prepared or administered, must be informed of the potential hazards associated with cytotoxic drugs and be trained in safe cleaning procedures.

They should also be educated on the importance of their role in elimination and decontamination through cleaning. A low risk training module incorporating this information must be provided to these low risk workers.

For Laundry The Body fluids from patients receiving cytotoxic drugs may contain traces of active cytotoxic drug or its metabolites. The excretion rates for cytotoxic drugs are variable, up to 7 days after treatment depending on the individual cytotoxic drug and route of excretion.

About the Contaminated bedding The Bed mattresses should be cleaned with a decontaminating solution. Consider use of vinyl covered and plastic backed mattresses, pillows and chairs for ease of cleaning where risk of contamination is greater.

Cytotoxic waste is waste contaminated with cytotoxic drugs or metabolites it includes any residual cytotoxic drug that remains following patient treatment and all materials that have come into contact with cytotoxic drugs during the reconstitution, preparation or administration of cytotoxic drug therapy.

Unused cytotoxic pharmaceuticals contaminated waste from preparation processes used and contaminated sharps and syringes, ampoules and vials contaminated intravenous infusion sets and containers packaging that has been in contact with cytotoxic drugs disposable drug administration and devices such as used medicine cups.

And also contaminated personal protective equipment such as gloves, gowns, shoe covers, respirators materials used to clean cytotoxic contaminated equipment or spills Contamination body substance receptacles such as disposable vomit bags contaminated dressings and bandages heavily contaminated linen that is unable to be cleaned contaminated patient body waste, which is excreta, following treatment of the patient with cytotoxic drugs contaminated specimens from the laboratory.

Procedures must describe requirements for the segregation and identification, collection, transport and storage of cytotoxic waste and should be developed in consultation with those who generate cytotoxic waste and those responsible for the provision of support, transport and disposal services.

Cytotoxic waste should be managed separately from other types of waste generated in a clinical setting that are not assessed or classified as hazardous waste. Key elements of waste management safe work procedures

include following items: designating a person with suitable experience and training to be responsible for ensuring an efficient waste disposal system Number two, a clear chain of responsibility, and involvement of all levels in procedure development and implementation The third one, the compliance with legal requirements The forth, use of a government authorized facility able to accept cytotoxic waste procedures and systems to avoid and minimize waste at the point of generation Situations with all those who may be exposed, including those generating the waste, waste handlers and waste disposal workers use of appropriate risk control measures regular monitoring and reviewing of procedures. These are the key elements of waste management safe work procedures

For Waste disposal and treatment Incineration around 1100°C is the only approved technology for treating cytotoxic waste. All incinerators used for the treatment of cytotoxic waste must be licensed with the EPA and meet the prescribed standards. Patient excreta such as urine, feces, vomit and the concentration of colostomy and urostomy bags may be disposed of in the normal sewage system. If using a contractor to dispose of cytotoxic drug waste, the contractor must be a licensed waste transporter authorized to collect and transport medical waste by the EPA and or a local council.

This is the conclusion. Cytotoxic drugs are known to be highly toxic to health and classified as hazardous chemicals. And the aim of risk management is to eliminate or minimize the risk of illness or injury labeled with work

And Not only the Persons conducting a business or undertaking but also all workers who handle cytotoxic drugs occupationally are required to participate. Thanks for your attention.