Gone are the days when chemotherapy meant slipping on a pair of latex gloves and administering intravenous vincristine (and I have seen this done off the needle all be it many years ago). Fortunately times have moved on and the safety of all involved with chemotherapy patients has to be of paramount importance. Iain Grant led last week’s webinar advising how to provide the safest possible environment for our staff and pet owners when performing chemotherapy. 

Iain advises using the ALARA concept (as low as reasonably achievable) in controlling risks associated with administering chemotherapy. This starts with limiting the use of chemotherapy and only using it on patients which are deemed appropriate. A dedicated room should be chosen to perform chemotherapy and the exposure to any individual should be limited by using a number of trained and knowledgeable staff rather than relying on one particular vet or nurse. Of course any pregnant personnel should never be involved in any part of the chemotherapy protocol and should never be present in the room where the drugs are to be administered. There should also be no eating or drinking in the dedicated room.

PPE (personal protective equipment) is an obvious must but a standard barrier nurse apron and a pair of latex gloves is no longer considered acceptable. Iain advises using impervious non-absorbent gowns along with nitrile non latex non powdered gloves. Double gloving should be performed and placed over the cuff of the gown. Wrap around goggles are also necessary along with a mask which should not be a surgical mask but a specialized mask for respiratory protection. 

Test kits are available to check surface contamination from chemotherapy agents and Iain advised drug residues are most commonly encountered in the areas where drugs are reconstituted. It is at these points as well as the stages when these drugs are administered which offers the greatest risk of exposure for participating individuals. The biological safety cabinet (BSC) offers the safest option for making up chemotherapy drugs but is extremely expensive to purchase and maintain within a practice environment. ‘Chemopet’ offers a service which makes up drugs within a BSC and sends out to practices within a closed system transfer device (CSTD). The CSTD has a closed connector, is needle free and very simple to use allowing the safe administration of drugs within a completely closed system. 

The safety of the owners and people handling patients after chemotherapy also has to be considered. In humans drug residues have been found in urine belonging to family members of patients having undergone chemotherapy. We know in dogs that vincristine stays in urine for 1-3 days post treatment and doxorubicin can be found in very low concentrations up to 21 days following chemotherapy. Iain advises to send owners home with a set of written instructions highlighting the importance of hand washing after handling their pet and to ensure dogs are walked in low traffic areas which are sunny, as sunshine helps to break down drug residues. It is also worth diluting any urine with water as again this will reduce the concentration of residues.

Owners should double glove to give oral chemotherapy products and wear gloves and gowns to clean up any accidents in the house. Owners should also avoid sleeping with their pets and pregnant women should avoid contact with any of their pet’s excretions/secretions including urine and saliva. 

Iain cited an investigation by the health and safety executive at Michigan University which was initiated after a complaint was received from a member of staff about lack of safety within their chemotherapy department. Lack of knowledge by staff about safety protocols was a significant issue according to the investigation. This demonstrates how important it is to discuss and educate staff about chemotherapy safety protocols and watching this veterinary webinar along with other staff members is an excellent place to start.