Chemotherapy is known to be mutagenic, carcinogenic and teratogenic. It is beyond the scope of these guidelines to address all recommendations for safe handling and prevention of occupational exposure. The requirements for occupational handling of cytotoxic agents, targeted therapy and related waste are defined by regulations and guidance in each State.
The use of monoclonal antibodies as cancer therapy continues to expand. Recommendations on occupational health and safety precautions should be based on local regulations and consensus documents.
Occupational exposure may occur where control measures fail or are not in place. Exposure may be through a variety of modes resulting from activities including preparation, administration, handling patient waste, transport and waste disposal. There is little scientific evidence currently available relating to whether working with cytotoxic agents actually increases the risk of developing cancer or not. However, in the absence of such data, a strategy of avoidance is recommended.
Some medications that belong to the targeted therapy group have been identified as hazardous by the US National Institute for Occupational Safety and Health (NIOSH). Organisations should refer to the "NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2014", to identify such medications and establish appropriate handling and management guidelines.
The COSA position statement  and the "Australian Consensus Guidelines for the Safe Handling of Monoclonal Antibodies"  do not state that Closed System Transfer Devices (CSTDs) are required for the preparation and administration of MABs. It is however acknowledged in the consensus guidelines that these devices can reduce occupational exposure and product contamination particularly during the preparation phase if a safety cabinet is not available.
Healthcare professionals should refer to state based documents for detailed requirements for safe handling of cytotoxic and related cancer therapies. The eviQ resource document "Safe Handling and Waste Management of Hazardous Drugs" should be used as a reference document in the absence of local guidance (Cancer Institute NSW).
Organisations must keep up-to-date with current information and practices in relation to occupational health and safety precautions for chemotherapy and targeted therapies and implement appropriate control measures.
All staff expected to handle hazardous substances and related waste are to have equitable access to training.
All staff expected to wear Personal Protective Equipment (PPE) to handle hazardous substances and related waste are to have training in the PPE processes, including gowning and disposal.
Staff should have access to current, evidence-based best practice resources to guide practice in relation to occupational health and safety.
Organisations must develop clear, unambiguous local policies and procedures related to the handling of chemotherapy, monoclonal antibodies, targeted therapies and related waste to protect the worker, the patient and the environment.
New therapies for cancer are continuously introduced into clinical practice. A process must be place to ensure occupational health and safety precautions are implemented that reflect exposure risks associated with mode of action and adverse effects.
(Cancer Institute NSW, 2016)
- Clinical Oncology Society of Australia and Cancer Pharmacists Group of Australia. Position Statement: Safe handling of monoclonal antibodies in healthcare settings.; 2013 [cited 2016 Sep] Available from: https://www.cosa.org.au/media/173517/cosa-cpg-handling-mabs-position-statement_-november-2013_final.pdf.
- Alexander M, King J, Bajel A, Doecke C, Fox P, Lingaratnam S, et al. Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel. Intern Med J 2014 Oct;44(10):1018-26 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25302720.
- Worksafe Victoria. Handling Cytotoxic Drugs in the Workplace.; 2003 [cited 2016 Sep] Available from: http://www.worksafe.vic.gov.au/__data/assets/pdf_file/0010/12223/handling_cytotoxic.pdf.pdf.
- NIOSH. By Connor TH, MacKenzie BA, DeBord DG, Trout DB, O’Callaghan JP. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2014. Publication No. 2014-138 (Supersedes 2012-150). Cincinnati, OH: US Department of Health and Human Services (DHHS), Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH); 2014 [cited 2016 Sep] Available from: http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138.pdf.
- Cancer Institute NSW. eviQ Cancer Treatments Online. [homepage on the internet]; 2017 Nov 23 [cited 2016 Sep]. Available from: https://www.eviq.org.au.