Recommendations for handling cytotoxic drugs in hospitals

Recommended procedures for handling cytotoxic drugs in hospitals are presented. The recommended procedures are designed to reduce the number of opportunities for unnecessary contact with cytotoxic agents (CYTAs) by hospital personnel and to prevent contamination of the hospital environment and staff with cytotoxic agents. The recommendations incorporate elements of previously published and unpublished guidelines; they admittedly are based on informed judgment as well. Three sets of recommended procedures are presented, each offering a varying degree of protection. The number of cytotoxic drug doses prepared and administered is suggested as the determinant of which level of protection is followed. The cytotoxic workload index, defined as the number of CYTAs prepared or administered (or both) divided by the number of available staff hours, is proposed as a quantitative method of deciding which level of protection is required for a particular work station or work shift. The recommended procedures cover the following seven topic areas: general guidelines; apparel, equipment, and facilities; drug preparation; drug administration; housekeeping, waste disposal, and management of spills and contamination; medical surveillance of staff; and legal and personnel considerations. The recommended procedures and associated equipment are considered to be practical and to adequately protect hospital personnel from risks associated with handling cytotoxic agents.