Safe Handling of Hazardous Chemotherapy Drugs in Limited-Resource Settings
Abstract
[Background]. T he toxic effects of antineoplastic drugs used for cancer treatment have been well known
since their introduction in the 1940s. However, beyond the patient safety concerns arising
from the necessary therapeutic use of these drugs, the occupational risks to health care
workers handling these drugs in the course of their duties still need to be fully addressed.
Worldwide, more than 11 million new cases of cancer are diagnosed each year, and that number
is expected to rise to 16 million by 2020 (WHO 2005). Treatment for many of these cases relies
principally upon antineoplastic chemotherapy (Chabner et al. 1996). With approximately 100
different antineoplastic drugs now in use (NIOSH 2004, 2012) and many more under development,
chemotherapy has opened new avenues, providing remission from the disease and the possibility
of a cure in some cases. Addressing the formidable toxicity of these drugs, however, has been an
ongoing challenge for clinicians and, more recently, for the occupational health community...In low-resource countries, where the more costly engineering solutions such as biologic safety
cabinets may be prohibitively expensive, there is necessarily an overreliance on the other elements of
the hazard control hierarchy. Identifying dedicated areas for hazardous chemotherapy drug storage
and compounding, restriction of personnel access to these areas, meticulous adherence to work
practices that minimize drug aerosol production and work environment contamination, together
with painstaking attention to worker training and skills assessment are the most reasonable set of
alternatives to the internationally recognized best-practices approach described above.
This monograph describes in detail the rationale for and approaches to implementation of these
alternative approaches to safe handling of hazardous chemotherapy drugs in low-resource settings.
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