All cytotoxic waste should be placed into compliant bags or containers that are appropriately identified. NZS 4304:2002 Management of healthcare waste specifies the following colours and symbol coding for cytotoxic waste:

Provide a spill kit to patients being treated at home or in a community care setting so they can safely manage spills of cytotoxic drugs and related waste. The kit should include easy-to-read instructions, a list of kit contents, and information about how to safely dispose of used items or how cytotoxic waste will be collected. See eviQ for more information about precautions patients should take at home: www.eviq.org.au(external link)

PPE is the last choice in the hierarchy. PPE should not be the first or only control considered. WorkSafe expects other controls to be used first, preferably those that protect multiple at-risk workers at once.

Cytotoxicity

Workers could be exposed to cytotoxic drugs and related waste through skin contact, skin absorption, inhalation of aerosols and drug particles, ingestion, and sharps (needle stick) injuries. Also think about other people who may be exposed, such as visitors to patients.

Hospitals are the obvious audience for this guide and the health and safety of nurses, pharmacists, orderlies, cleaners, and laundry workers have all been considered in the advice.

For detailed information about safely administering cytotoxic drugs in each of these ways, see: www.eviq.org.au(external link)

Cytotoxicdrugs mechanism of action

These requirements apply across the product’s entire lifecycle – from manufacture and construction, through to everyday use, decommissioning and disposal.

A supplier supplies plant, structures or substances that may be used in a workplace. A supplier has a duty, so far as is reasonably practicable:

A PCBU in the supply chain (upstream) also has a duty to ensure, so far as is reasonably practicable, that the work they do or the things they provide to other workplaces do not create health and safety risks.

More than one PCBU can have a duty in relation to the same matter. These PCBUs have overlapping duties – this means that the duties are shared between them.

PCBUs must ensure, so far as is reasonably practicable, that every worker who works with a substance that is capable of causing a risk in the workplace:

Control measures may introduce new risks that PCBUs will also need to manage. For example, wearing a full-face splash shield may reduce a worker’s peripheral vision.

Cytotoxic waste includes any residual cytotoxic drug following a patient’s treatment and the materials or equipment used to prepare, transport or administer the drugs.

The time it takes for the drugs to be fully eliminated from the body depends on the patient and the particular drug. WorkSafe recommends that workers wear appropriate PPE for the entire elimination period. This is generally seven days but may vary depending on the drug and route of excretion. Check the material safety data sheet or Medsafe data sheet for more information.

Should be cleaned at the end of shift or when contaminated. Clean with a detergent that is pH neutral and leave to air dry.

Should be cleaned at the end of shift or when contaminated. Clean with a detergent that is pH neutral and leave to air dry.

More than one type of control measure can be used at a time and the measures should be proportionate to the risk. Give preference to control measures that protect multiple at-risk workers at the same time.

If elimination is not possible, PCBUs must minimise the risks, so far as is reasonably practicable,3 by implementing control measures in the order below:

See standard 5 of the National Nursing Standards for Antineoplastic Drug Administration in New Zealand(external link) for information about training.

For more information, see our guidance: Health and safety duties for businesses that design products for workplaces [PDF, 40 KB]

PCBUs must try to eliminate risks at work, so far as is reasonably practicable, by removing the sources of harm. If elimination is not possible, the risks must be minimised, so far as is reasonably practicable.

Cytotoxicdrugs examples

This guide will also be useful for the waste management businesses that collect cytotoxic waste, and pharmaceutical businesses that prepare cytotoxic drugs but are not based at a hospital.

An installer/constructor builds and/or assembles and installs plant and structures that may be used at a workplace. A commissioner performs adjustments, tests and inspections on plant and structures before they are used for the first time in a workplace.

Involve workers – get their ideas, ask them what they think the risks are of their work and what procedures, equipment and facilities they think are needed to make it safe.

These requirements apply across the product’s entire lifecycle – from manufacture and construction, through to everyday use, decommissioning and disposal.

Cytotoxic drugs – also known as antineoplastic drugs or chemotherapy drugs2 - kill or slow down the growth of living They are used to treat cancer and other medical conditions such as rheumatoid arthritis and multiple sclerosis.

However a PCBU can make an agreement with another PCBU to fulfil specific duties. Even if this occurs, all PCBUs are still responsible for meeting their legal duties.

A designer creates or modifies a design for plant, substances or structures that are to be used or operated, or could be used or operated, in a workplace.

WorkSafe recommends workers use CSTDs when administering or compounding cytotoxic drugs.5 When used correctly, the device can minimise the risk of workers being exposed to the drugs. Workers should be trained to use CSTDs.

A PCBU must, so far as is reasonably practicable, consult, cooperate and coordinate activities with all other PCBUs they share duties with so that all PCBUs can meet their joint responsibilities.

Keep a spill kit in all areas where there is a risk of cytotoxic drugs and related waste spills. See Appendix 4 for spill kit contents.

All PCBUs that work with cytotoxic drugs and related waste must implement effective control measures to protect workers and other people.

Contaminated waste identification is essential to minimise the risk of exposure to cytotoxic materials and to ensure the safe and correct disposal of cytotoxic waste.

Cytotoxicdrugs classification

These requirements apply across the product’s entire lifecycle – from construction or assembly, through to everyday use, decommissioning and disposal.

For more information, see our guidance: Health and safety duties for businesses that supply products for workplaces [PDF, 39 KB]

These requirements apply across the product’s entire lifecycle – from construction or assembly, through to everyday use, decommissioning and disposal.

For more information, see our guidance: An additional health and safety duty for businesses that install, construct or commission plant or structures for workplaces [PDF, 39 KB]

A closed system transfer device is a drug transfer device that prevents the transfer of environmental contaminants into the system and the escape of the hazardous drug or vapour concentrations outside the system.4

Keep a record of reviews, including information such as the date, outcome, actions required (and who is responsible for these and by when).

PCBUs must also ensure workers are adequately trained in the safe use of substances that they use or handle, or that they may be required to use or handle, and all protective personal equipment (PPE) that they are or may be required to wear or use.

If it is not reasonably practicable for PCBUs to eliminate the risks to health and safety of cytotoxic drugs and related waste, they must:

Importation is another word for importing. Importation refers to the arrival of goods in New Zealand from a point outside New Zealand. These goods can arrive in any manner.

WorkSafe’s research so far has found that the general consensus is that there is currently no form of health monitoring which is sufficiently specific to adequately measure the effects of exposure to cytotoxic drugs or related waste.

Section 36 of HSWA deals with the ‘Primary duty of care’ of a PCBU to ensure, so far as is reasonably practicable, the health and safety of workers and other people is not put at risk from the work conducted as part of the PCBU’s business or undertaking.

CSTDs should not be the only control measure put in place – they should be just one in a range of control measures to minimise the risks of cytotoxic drugs to workers.

HSRs and Health and Safety Committees (HSCs) are two well-established methods of participation and representation. If workers are represented by an HSR, worker engagement must also involve that representative.

Some examples of workers who may be at risk of exposure to cytotoxic drugs and related waste are below. This is not a complete list:

This good practice guide is for persons conducting a business or undertaking to help keep workers safe when handling cytotoxic drugs and related waste.

A worker using a badly designed or poorly manufactured saw may be at risk of injury. This risk should have been eliminated or minimised, so far as was reasonably practicable, by the designer or manufacturer.

Upstream businesses are in a strong position to eliminate or minimise risk. They can influence and sometimes eliminate health and safety risks through designing, manufacturing, importing or supplying products that are safe for the end user.

This guidance uses ‘must’ and ‘should’ to indicate whether an action is required by law or is a recommended practice or approach.

Should be cleaned at the end of shift or when contaminated. Clean with a detergent that is pH neutral and leave to air dry.

5. National Nursing Standards for Antineoplastic Drug Administration in New Zealand 2016, Cancer Nurses College New Zealand

An installer, constructor or commissioner has a duty, so far as is reasonably practicable, to make sure that the way the plant or structure is installed, constructed or commissioned does not create health and safety risks to the people that come into contact with it across the product’s entire lifecycle – from construction or assembly, through to everyday use, decommissioning and disposal.

If PCBUs are not sure what control measures are appropriate, WorkSafe recommends getting advice from a suitably qualified and experienced health and safety professional.

For more information, see our guidance: Health and safety duties for businesses that manufacture products for workplaces

cytotoxicity发音

Isolating the hazard giving rise to the risk to prevent any person coming into contact with it (for example, by separating people from the hazard/preventing people being exposed to the hazard). Isolation focuses on boxing in the hazard or boxing in people to keep them away from the hazard.

Using safe methods of work, processes or procedures designed to minimise risk. It does not include an engineering control; or the wearing or use of personal protective equipment.

For more information, see our guidance: Health and safety duties for businesses that import products for workplaces [PDF, 41 KB]

cytotoxic中文

While PCBUs should check if there are widely used control measures for that risk (such as industry standards), they should always keep their specific circumstances in mind. A common industry practice might not be the most effective or appropriate control measure to use.

Cytotoxicdrugs uses

A local hotel contracts out housekeeping services to an agency. The hotel and agency both have a duty to ensure the health and safety of the housekeeping workers, so far as is reasonably practicable. This includes the duty to provide first aid facilities.

Certain PCBU duties (the section 36–43(external link) duties including the primary duty of care) must be carried out ‘so far as is reasonably practicable’.

Provide ongoing training as needed, including refresher training so that skills and knowledge are kept up to date. See our website for more information.

Cytotoxictherapy

Also think about other people who may be exposed, such as hospital visitors and home carers of patients being treated with cytotoxic drugs.

It is good practice to have written policies describing requirements for the segregation, packaging, collection, transport, and storage of cytotoxic waste.

The agency reaches an agreement with the hotel – if their workers need first aid while working at the hotel they can use the hotel’s first aid facilities.

1. A ‘person conducting a business or undertaking’. PCBUs have duties under the Health and Safety at Work Act 2015 (HSWA). See Appendix 5

PCBUs must, so far as is reasonably practicable, engage with workers on health and safety matters that directly affect them. This includes when identifying and managing the risks of cytotoxic drugs and related waste.

2. The range of cancer treatments includes conjugated monoclonal antibodies (MABs) – antibodies that are joined to a cytotoxic agent. Conjugated MABs are considered hazardous and should be handled according to accepted cytotoxic safe handling procedures.

Cytotoxic drugs are hazardous to human health. While little is known of the specific, long-term effects of occupational exposure to cytotoxic drugs and related waste, there is sufficient evidence to indicate they may cause adverse health effects such as those shown in Figure 1 below.

Workers can be represented by a Health and Safety Representative (HSR), a union representing workers, or a person that workers authorise to represent them (for example, a community or church leader, or another trusted member of the community).

PCBUs should also refer to their own health and safety policies and guidance regarding preparing and reconstituting cytotoxic drugs.

PCBUs should also refer to their own health and safety policies and guidance about handling cytotoxic-contaminated linen and clothing.

PCBUs must, so far as is reasonably practicable, engage with workers when making decisions about the provision of health and safety information and training.

Workers who are pregnant, breastfeeding, or planning to become pregnant and who prepare, administer or otherwise handle cytotoxic drugs and/or related waste, are at risk.

The purpose of this guide is to help PCBUs1 that work with cytotoxic drugs and related waste identify and control the health and safety risks of their work, and keep workers and other people, such as visitors to the workplace, safe.