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Exposure to hazardous drugs in healthcare: an issue that will not go away.

Davis-J; McLauchlan-R; Connor-TH
J Oncol Pharm Pract 2011 Mar; 17(1):9-13
The authors conclude that dermal and oral uptake is unlikely in the occupational setting. It is felt that pharmaceutical agents with molecular weights greater than 500 Daltons are not able to be taken up by the dermal route and oral ingestion of proteanous agents would result in degradation in the GI tract. Therefore, Halsen and Kramer suggest that pulmonary uptake is possible, but is limited and absorption is low. However, they advise that there is a potential for occupational exposure by inhalation, especially from droplets and aerosolized drug. Unlike almost all other treatments for illness, cancer drug treatment is truly individualized. Doses of drugs are not only generally based on patient's height and weight but on their laboratory parameters (e.g., neutrophil count and platelet count) on the day of treatment. Thus, a patient may be on one treatment yet receive different doses at different visits. This individuality is required because of the anti-cancer drugs' toxicity and their low therapeutic index. Additionally, since many individually prepared doses have a short 'shelf-life' either due to stability or sterility issues, doses must be prepared in a timely fashion, generally on the actual day of treatment. This is the basis for in-house preparation of anti-cancer treatments. Government authorities in charge of reducing risk in the workplace say that the first level of risk control is to eliminate the hazard. This can be interpreted to mean do not manipulate anti-cancer drugs. In fact, hospitals and institutions with a small workload should heed this advice and outsource the preparation of their doses. However, while patients continue to require individually prepared treatments, oncology pharmacists and technicians will continue to prepare them. We certainly do not want to stop this activity - after all we might be on the receiving end one day. But we must improve the conditions these professionals work under, to bring to a minimum their likelihood of harm while they are working to provide treatment for others. In the last few decades, we have made big improvements in handling hazardous drugs. However, we have not eliminated surface nor biological contamination entirely. The increasing number and variety of available drugs to treat cancer, that can cause harm to those handling them, behoves us to remain vigilant in seeking and following optimum safe handling conditions.
Health-care-facilities; Health-care; Health-care-personnel; Pharmaceuticals; Antineoplastic-agents; Drug-therapy; Drugs; Medicinal-chemicals; Therapeutic-agents
Jill Davis, Research Ethics Unit, Austin Health, Melbourne, Australia
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Healthcare and Social Assistance
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Journal of Oncology Pharmacy Practice