Safe administration and disposal of intravesical chemotherapy

1
Safe administration and disposal of intravesical
chemotherapy
Emerson R, Seoighe A Pharmacy Department, Mater
Misericordiae Hospital, Dublin.
Introduction
The provision of information on the safe handling
and disposal of drugs is one of the essential
roles of pharmacists. The cytotoxic agents,
epirubicin and mitomycin C are administered
intravesically for the treatment and prophylaxis
of transitional cell carcinoma (TCC) of the
bladder. This method of administration raises
difficulties in relation to the safe handling and
disposal of potentially hazardous drugs for
nursing staff and for patients alike. Recent
media coverage of mishandling of hazardous waste
has highlighted the need for clear guidelines to
be in place.

Objectives
The principle objective was to provide guidelines
for establishing best practice in the
administration and disposal of drugs and
equipment during and post-intravesical
administration of epirubicin and mitomycin C.

• Methodology
• A literature search was conducted to obtain the
  available information on the safe handling of
  these drugs.
• The relevant pharmaceutical companies were
  contacted and information was obtained regarding
  recommendations for the safe handling and
  disposal of these agents.
• Nursing staff on the relevant ward were consulted
  in order to examine current practice and
  ward-based protocols dealing with this area were
  obtained.
• Staff information sheets on the intravesical
  administration of these drugs were produced.
• Post-administration guidelines for the patient
  were compiled in the form of a patient
  information leaflet.

Administration of epirubicin via a Foley
catheter In addition to disposing of equipment
used during intravesical administration, it is
necessary to ensure that all of the drug that is
voided from the patient after administration is
disposed of in a appropriate manner. This is
often relevant even after the patient has been
discharged, as some of the drug may be present in
the urine for a further 24 hours or more
post-administration. As a result of this study,
there are now written guidelines available on
appropriate precautions and hygiene to be
followed post intravesical administration of
cytotoxic agents. These guidelines will decrease
the risk of unnecessary exposure to both the
patient and their relatives and help prevent
inappropriate disposal of potentially hazardous
waste. Safe Handling Intravesical
administration involves much manipulation of
these agents and therefore contamination is a
significant risk. Proper protective clothing and
vigilant adherence to protocols during
administration can minimise this risk. The
guidelines produced as a result of this study
will improve the current practice and protect
patients and staff from unnecessary exposure to
cytotoxic drugs.

• Results
• Easy to follow, step by step instructions for the
  intravesical administration of epirubicin and
  mitomycin C have been produced.
• The leaflets (one per drug) provide clear written
  guidelines on how to handle these agents during
  and after the procedure.
• Guidelines for the safe disposal of contaminated
  equipment are also provided.
• Patient information leaflets on the procedure
  were produced.
• Patients and staff were provided with information
  on how best to deal with contaminated excreta
  that is voided into the toilet bowl post
  intravesical administration of these agents.
• Discussion
• Safe Disposal
• The importance of appropriate disposal of
  hospital waste has recently been highlighted by
  findings of large amounts of clinical waste in
  illegal dumps surrounding the Dublin area. It is
  clear that there is a need for more stringent
  guidelines to prevent this occurring in the
  future.

Conclusions Written guidelines have now been
provided in order to ensure best practice in the
management of hazardous drugs in a specific area.
Such guidelines are also clearly needed in other
areas. Thus there is an opportunity for
pharmacists to make a significant impact on
hospital health and safety standards through the
provision of written information on the safe
handling and disposal of medicines.
References 1. Pharmorubicin , Summary of Product
Characteristics, IPHA Data Sheet and Summary of
Characteristics Compendium, 2001-2002. 2.
Pharmorubicin safety data sheet. Pharmacia and
Upjohn, 1997. 3. Safe Handling of Cytotoxic
Drugs, 2nd Ed, Oncology Nursing Press, Inc.
1997 4. Mitomycin C Kyowa, Summary of Product
Characteristics, Kyowa Hakko U.K. Ltd., 1995.