Handling cytotoxic medicines in veterinary practice

Exposure to cytotoxic medicines in veterinary care

When treating and caring for animals, cytotoxic medicines and related waste might be handled by:

• veterinarians
• veterinary nurses
• animal attendants
• cleaners
• animal owners

In veterinary practice, exposure to cytotoxic medicines can occur when:

• preparing drugs
• administering drugs
• caring for treated animals

Exposure can occur through:

• skin contact with cytotoxic medicines or animal waste
• spills of cytotoxic medicines or animal waste
• inhalation of aerosols
• contact with sharps

To ensure that cytotoxic medicines and related waste is safely handled, employers should consider workplace design as a high-order control option. This includes the use of:

• cleanrooms
• drug safety cabinets
• other specially designed equipment

Employers must provide information, education, training and supervision to ensure that control measures and safe work practices are:

• developed
• understood
• used
• maintained

Employers should also consider the following controls as a priority:

• buying cytotoxic medicines in a ready-to-use form to eliminate drug preparation work
• referring animals who need cytotoxic medicine treatment and care to a veterinary practice equipped to provide the service
• using a diluted form of cytotoxic medicines where possible
• buying cytotoxic medicines in the safest form available
• reviewing health and safety information about cytotoxic medicines before deciding to buy them

Standard work procedures for administering cytotoxic medicines in veterinary practice should include:

• administering parenteral or oral cytotoxic medicines under the supervision of a registered veterinary practitioner
• using signs to identify animals receiving cytotoxic medicine treatment

Caring for animals receiving cytotoxic medicines

Employers should prevent environmental contamination. It is harder to contain contaminated animal excrement than that of human patients.

Setting up an animal care area

When setting up an animal care area, it is important to:

• allocate a secure area that only authorised employees can access
• allow enough room for employees to move
• provide secure waste storage
• establish a system for obtaining and keeping health and safety information, such as a Safety Data Sheet (SDS), in a place accessible to employees

Suitable equipment for animal care

Employers should provide the following equipment where possible:

• animal cages designed to contain and flush excreta directly into the sewerage system
• sealable, labelled bags to contain waste products (see Managing cytotoxic waste for more information)
• a spill kit (see Managing cytotoxic medicine spills for more information)
• absorbent pads for cleaning

How to safely handle cytotoxic medicines in veterinary practice

Employers should develop procedures for safely handling cytotoxic medicines in the workplace. They should include the following controls as appropriate:

• place a sign that says 'Receiving cytotoxic medicine therapy' on an animal's cage when the animal:
  • is being treated with cytotoxic medicine
  • could be excreting cytotoxic residues
• use proper equipment, including personal protective equipment (PPE)
• clean equipment immediately after use with a strong alkaline detergent with pH>10
• avoid skin contact with animal excreta and body fluids
• keep animal cages clean
• use cleaning techniques that:
  • avoid skin contact
  • contain waste
  • prevent the generation of aerosols
• immediately wash down animals if they become contaminated, being careful not to generate aerosols
• dispose of cytotoxic waste

Information for animal owners

An animal's owner might:

• administer cytotoxic medicines at home
• care for animals receiving cytotoxic medicine

Treating facilities should give the following written information to home carers:

• why it is necessary to be careful when handling cytotoxic medicines and related waste
• precautions to take when the treated animal interacts with people in the home, especially:
  • small children
  • the aged
  • women who are pregnant or breastfeeding
• equipment they might need to care for the animal at home
• the route of excretion of drugs and how to dispose of body waste
• how long the animal might excrete cytotoxic residues after drug administration
• how to store cytotoxic medicines at home
• how to dispose of cytotoxic medicines that are no longer needed
• spills and procedures for cleaning up
• laundering contaminated bedding
• emergency procedures for accidental exposure or ingestion of cytotoxic medicines