At the same time, the requirement for maintenance of aseptic conditions must be satisfied. This brochure reviews the routes through which exposure may occur and presents recommendations for the safe handling of parenteral cytotoxic drugs by pharmacists, nurses, physicians and other personnel who participate in the preparation and administration of these drugs to patients. These guidelines apply in any setting where cytotoxic drugs are prepared - including pharmacies, nursing units, clinics, physicians' offices and the home health care environment. The primary routes of exposure during the preparation and administration phases are through the inhalation of aerosolized drug or by direct skin contact. During drug preparation, a variety of manipulations are performed which may result in aerosol generation, spraying, and splattering.
Pharmaceutical practice calls for the use of aseptic techniques and a sterile environment.
Many pharmacies provide this sterile environment by using a horizontal laminar flow work bench. However, while this type of unit provides product protection, it may expose the operator and the other room occupants to aerosols generated during drug preparation procedures. It should be noted that the filters are not effective for volatile materials because they do not capture vapors and gases. Personnel should be familiar with the capabilities, limitations and proper utilization of the biological safety cabinet selected. During administration, clearing air from a syringe or infusion line and leakage at tubing, syringe, or stopcock connections should be avoided to prevent opportunities for accidental skin contact and aerosol generation.