Difficulties encountered in implementing guidelines for handling antineoplastics in the physician??s office

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Abstract
The possible hazards associated with the occupational exposure to antineoplastic drugs have been acknowledged widely in recent years. Hospitals, several drug companies, and professional oncology organizations have responded by developing detailed guidelines and procedures for maximum protection for the worker involved. Standards for mixing, administering, handling, and disposing of these cytotoxic agents are the result of numerous research studies and their subsequent findings. Only a small percentage of chemotherapy, however, is given on an inpatient basis, or can be prepared for administration by a pharmacist in a protected area of a hospital pharmacy. In the oncologist's office, one or two nurses often must shoulder the responsibility of assisting with patients and securing and analyzing blood tests, as well as admixing and administering chemotherapy treatments. While guidelines approved for hospital and institutional use afford the worker optimal protection, they may be impractical and costly in a small oncology office. Specific steps can be taken regarding safe disposal of toxic waste, as well as safe techniques for mixing and administering chemotherapy, while maintaining a cost-conscious approach. Office nurses are encouraged to secure safety measures for their protection, including the acquisition of a vertical flow hood for optimal chemotherapy preparation.

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