Glossary

cytotoxic agent

• a substance that is potentially genotoxic, oncogenic, mutagenic, teratogenic or in any way hazardous to cells; used commonly in referring to antineoplastic drugs that selectively damage or destroy dividing cells.

cytotoxic antineoplastic drug

• any agent used to treat cancer that may be genotoxic, oncogenic, mutagenic, teratogenic or harardous in any way.

cytotoxic spill, contained

• cytotoxic agent in an unintended location but which is confined in such a manner that it cannot spread or be dispersed (example: liquid cytotoxic agent absorbed into bed linen).

cytotoxic spill, uncontained

• cytotoxic agent in an unintended location, not confined in a container or absorbent material and which exists in a manner which can be spread or dispersed (examples: liquid cytotoxic agent on a non-absorbent surface; solid or powdered cytotoxic agent on any open surface).

cytotoxic waste, disposable

• cytotoxic agent, or equipment or material contaminated with a cytotoxic agent, which is intended for single use only (examples: excess or unused drug slutions, cytotoxic agent which is no longer required, intravenous tubing that was used to administer a cytotoxic agent, absorbent towels used to clean up an uncontained cytotoxic spill).

cytotoxic waste, non-disposable

• equipment or material contaminated with a cytotoxic agent but which can be successfully decontaminated for re-use (examples: bed linens used for patients being treated with cytotoxic agents, expensive devices used to prepare or administer drug solutions).

exposure/contact

• direct contact with a cytotoxic agent or equpment or material contaminated with a cytotoxic agent, in any form via skin contact, inhalation, injection (e.g. needle stick) or ingestion.

genotoxic

• possessing ability to damage DNA, thereby causing mutations or cancer.

handling

• contact with a cytotoxic antineoplastic drug or its waste during any stage of its transport (within or from the Agency), preparation, administration, disposal or clean-up.

mutagenic

• possessing ability to induce or increase permanent genetic changes by causing changes in DNA.

oncogenic

• possessing ability to cause benign or malignant tumours.

public

• includes visitors to the Agency and any Agency or non-Agency personnel (eg, delivery or waste disposal employees) who may contact cytotoxic antineoplastic drugs/wastes.

teratogenic

• possessing ability to cause birth defects in a developing fetus.

wastes

• unused drug;     
• equipment and materials used during the preparation, administration or handling; or     
• body fluids/wastes of patients receiving cytotoxic drugs within the previous 48 hours.

References

1. American Society of Hospital Pharmacists. "ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs". Am J Hosp Pharm 1990; 47:1033-49.     
2. B.C. Cancer Agency, Division of Pharmacy. "Aseptic and Safe Preparation of Cytotoxic Drugs: Procedures and Checklists". B.C. Cancer Agency, Vancouver, B.C., 1995.     
3. B.C. Cancer Agency, Cytotoxic Handling Ad Hoc Task Force, Vancouver, B.C., 1992:   
   • Policy VA-140: "Recommended health surveillance for employees handling cytotoxic antineoplastic drugs/wastes."   
   • Policy VA-150: "Accidental contact with cytotoxic antineoplastic drugs/wastes." 
   • Policy VA-160: "Recommended handling of cytotoxic antineoplastic drugs/wastes by employees who are pregnant, breast feeding or attempting to reproduce." 
   • Policy VA-170: "Safe handling of cytotoxic antineoplastic drugs/wastes." 
   • Policy VA-180: "Spill management of cytotoxic antineoplastic drugs/wastes." 
4. Canadian Association of Nurses in Oncology. "Standards for Nursing Practice and Education Related to the Administration of Cancer Chemotherapy". Toronto, 1995.     
5. Canadian Society of Hospital Pharmacists. "Guidelines for the handling and disposal of hazardous pharmaceuticals (including cytotoxic drugs)". January 1991.     
6. Canadian Society of Hospital Pharmacists. "Guidelines for Preparation of Sterile Products in Pharmacies". August 1994.     
7. Laidlaw JL, Connor TH, Theis JC, et al. "Permeability of latex and polyvinal chloride gloves to twenty antineoplastic drugs". AM J Hosp Pharm 1984;41:2618-23.     
8. McDiarmid M. "Medical surveillance for antineoplastic drug handlers". Am J Hosp Pharm 1991;47:1061-6.     
9. Occupational Safety & Health Administration (OSHA), US Dept of Labour. "Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs". Am J Hosp Pharm 1986;43:1193-1204.     
10. Occupational Safety & Health Administration. "Hazardous Drug Handling". CPL 2-2.20B CH-4, 20 Sept. 1993.     
11. Oncology Nursing Society. "Cancer Chemotherapy Guidelines and Recommendations for Practice". Pittsburgh, PA, 1996.     
12. Power L, Anderson R, Cortopassi R, et al. "Update on safe handling of hazardous drugs: the advice of experts". Am J Hosp Pharm 1990;47:1050-60.     
13. University Hospital - UBC Site, Nursing Administration. "Antineoplastic Agents". University Hospital, December 1993.     
14. Vancouver General Hospital, Nursing Administration. "Handling of Cytotoxic (Antineoplastic) Agents". Vancouver General Hospital, 1993.     
15. Workers' Compensation Board of BC. "Final report of the Occupational Hygiene Subcommittee - Antineoplastics. WCB, 1994".