Work with cytostatica
Cytostatica damage or kill cancer cells by affecting a cell´s DNA. Since these compounds have an effect on all cells in active growth, they also influence normal cells and will often result in serious side-effects.
Definitions
| Cytostatica | Chemical compound that stops or inhibits cell growth. |
| Carcinogenic compounds | Cancer promoting agent. |
Risk to personnel
When handling cytostatica personnel are at greatest risk during preparation of material for injection/infusion. Skin contact and exposure to an aerosol can have an effect on bodily systems and must be avoided. Several cytostatics are in fact strong irritants and can damage unprotected skin.
In the doses commonly used, cytostatica can lead to the development of cancer, and damage a fetus. It is known that working with cytostatica, without taking adequate preventive measures, can result in DNA damage. The risk of injuring health, however, is minimal if workers protect themselves and their immediate working environment by avoiding contact with such compounds.
Prohibition from work with cytostatica
Pregnant women and workers issued with a health certificate by their GP forbidding short-term or permanent work with cytostatica, shall be transferred to a working situation where cytostatica are neither handled, nor there is a likelihood of being exposed to such compounds.
Regulations concerning the handling of cytostatica, §3, clearly state that an employer is required to provide necessary directives and guidance.
Work procedures and personal safety equipment
Preparation of a solution
Preparation of cytostatica in solution shall be performed in a special laboratory on the 6th floor (6C128gA). Here the ventilation system is separate from that of the rest of the building.
The working surface shall be covered with material having absorptive properties such that the cytostatica solution is prevented from coming into contact with the bench surface. The surface cover shall be replaced after each working operation, and is then placed in the receptacle for problem waste. One is advised to dissolve the entire content of the vial in order to avoid handling the material in powder form during weighing. Use a double layer of nitril gloves and a short or long lab coat with long sleeves and tightly-sitting cuffs. Special water-repellent arm-protectors can also be used. After use the gloves are removed inside-out and immediately placed in a disposal bag. The arm-protectors are disposed of and the lab. coat put aside for washing. Cytostatica solutions are transported to the Animal House or to a Cell Laboratory in tightly closed containers. Working operations (removal of aliquots from a standard solution, preparation of dilutions, etc.) shall be performed in a safety bench (LAF-bench), if this is possible. When performing operations outside a safety bench then additional use of safety glasses and a facemask (mask approved for use when working with powder or liquefied particles) is recommended. Operation masks do not provide sufficient protection! Gloves should be replaced at least once every half an hour.
Incubators where cytostatica are being used in experiments are to be clearly marked.
When cells that have been treated with cytostatica are to be observed in the microscope, then they must be contained in a tightly closed system.
Cytostatica in the animal facility
This includes work with cytostatica, tissue implants, carcinogenic substances and flora not desirable to be spread to other parts of the animal facility.
- Information must be given to all people involved in the particular room, including cleaning staff.
- The doors must be marked with a yellow room form and it must be specified if chemotherapy is used in the room.
- The doors must be locked when the rooms are not in use. The users borrow the key when needed.
- Access to the room requires coat, hair cover, mask and shoes (plastic shoe covers).
- Yellow plastic boxes for hazardous waste, suitable disinfectant as well as tubs/ boxes / spray bottles must be easily available in the room.
- When replacing wood chips in the animal cages use protective equipment (including respirators) in connection with this and the first 24 hours after. Replacement of wood chips in cages where animals are injected with cytostatic should be done first after 24 hours.
- Dirty wood chips must be emptied directly in the yellow plastic boxes for hazardous waste. Wipe each cage with a damp paper before disinfection. Dead animals are put into plastic bags before placed in plastic box for hazardous waste.
- Disinfect animal cages, lids and bottles in a bath of suitable disinfectant. Alternatively, wrap everything in autoclavable plastic and disinfect the "package" on the outside. Autoclave the package after disinfection (See MSDS which measures are best suited as neutralization in each case.)
- Used coats must be packed in white waste bags and disinfected. Hats, gloves and face masks must be placed in boxes for hazardous waste.
- When leaving the room, mark the door with injection date and time of cleaning of the cage. After 24 hours the air is expected to be clean again.
- After 24 hours, one can retrieve and further handle the disinfected material.
Users, who need animals or have to work in this room, have to be in close contact with the animal facility so that the 24 hour rule are followed without major complications. Fixed times to various tasks can often be a simple and straightforward way to solve this. Users have to relate to the same rules as the staff in this room.
Guidelines following a spill of cytostatica
Spill on the skin: Wash immediately with large volumes of water, or soap and water.
Spatter of drops into the eyes:
Wash immediately with large volumes of water, or with a solution of sodium chloride, 9 mg/ml. Contact an eye-clinic.
Spill on the floor, bench etc.:
Wipe up immediately using disposable swabs. Then wash with soap and water. The swabs are treated as problem waste (yellow waste boxes). Use thick gloves, or two disposable gloves, the second outside the first. Plastic gloves are not to be used.
Cytostatica waste
Cytostatica-waste is regarded as remains of a medical preparation, and includes all equipment that has been used in preparation and administration of cytostatica. When handling such waste a double layer of nitril gloves must be used. Remains of standard solutions in vials are to be returned to the chemist (pharmacy). Use appropriate containers. Other types of waste are to be placed in either needle receptor containers or strong plastic bags, e.g. large ziplock bags that can be pressure sealed. Air is not to be pressed out of the bag until it is to be sealed. All waste of this type is to be collected in yellow plastic boxes that are to be clearly labelled "Cytostatika avfall" and handled as problem waste (sealed and sent for destruction at high temperature (>800°)). Waste material should be removed as soon as possible from the work place. Small amounts of remains, such as infusion sets, empty bags, gloves, empty medicine tubes and needle receptor containers, are to be packed in plastic and further treated as problem waste.
Disinfection of laboratory equipment
Disinfectant; surface alcohol disinfectant (or other suitable disinfectant) Application: with cloth or bath (reduced effect by spraying)
All equipment leaving an infected room must be disinfected, this is done in the front room.The disinfectant should work the time recommended for each disinfectant. All infected equipment must be "cleaned” with a cloth and/or water in advance of disinfection.
The content from dirty animal cages must be emptied in problematic waste cartons and brushed clean. They are further packed into biohazard bags, taped closed and moved to the front room for disinfection with alcohol. Disinfected bags are then transported to the washing room. The bags are lowered into large wash tubes with hot water and opened under water. Leave the bag in water for a half hour and then wash everything in the dishwasher. The same procedure can be applied to other parts of the cage.
For more information about waste see Waste Management.