Risks of work with cytotoxic drugs

Abstract

Background. Cytotoxic drugs (CTD) are widely used in medicine for the treatment of tumors and other diseases. According to the definition, CTD are the drugs, which are toxic for cells, that is, interrupt their replication or growth. Effects of CTD are not targeted, that’s why when they get into the organism, they can harm not only target cells, but any other cells, and not only the patient, but also the other people who contact with them, especially, the healthcare workers (HCW). Objective. To define the risks of work with CTD. Materials and methods. Analysis of the literature data on this topic. Results and discussion. In case of breaking the safety rules, HCW may contact CTD. They can be exposed via skin contact, inhalation of aerosols or swallowing of the particles of CTD, via needle injuries. Actions and procedures, which can be accompanied by the contact of HCW with CTD, include drug preparation and administration, handling of drug containers and waste materials, handling the biological liquids of CTD-treated patient, cleaning of the spills or items, polluted by biological liquids. Exposure to CTD can result in the abdominal pain, hair loss, vomiting, liver injury, nasal sores, contact dermatitis and allergic reactions, miscarriages and fetal malformations (in pregnant women), changes in total blood analysis, mutations appearance. It is not proven that long occupational exposure to CTD leads to cancer, despite it is known that the majority of CTD have genotoxic, cancerogenic and mutagenic effects. Tactics of risk minimization in work with CTD includes definition of risk groups (pregnant women, newbies), assessment of the potential harms of used drugs, written fixation and often reassessment of risk estimation, HCW education. The latter must include methods of CTD preparation, peculiarities of CTD usage and waste handling, correct usage of individual protective equipment (IPE) etc. CTD must be prepared exclusively by the HCW, who underwent the adequate training, and in the specialized settings (HEPA-filtered exhaust systems, negative pressure rooms, absorbing surface covers). IPE must include vinyl or nitrile gloves, waterproof long-sleeved robe or overall with elastic cuffs, goggles or face shield, respirator, shoe covers. Potentially polluted by CTD waste must be collected into the polypropylene or polyethylene bags with the appropriate labeling. Conclusions. 1. CTD may harm not only target cells, but also the other cells, and not only patients, but all the other exposed people. 2. CTD exposure may lead to the abdominal pain, hair loss, vomiting, contact dermatitis, miscarriages and fetal malformations, etc. 3. There is a spectrum of protective measures to protect HCW from CTD exposure (IPE, equipment of specialized working places for CTD solutions’ preparation, correct waste handling).