Audit of the practices of handling anticancer agents

Institutional procedures govern the handling of anticancer drugs to ensure quality and safety of the preparations for the patient and staff. An institutional audit was conducted to assess compliance with these procedures, and to link non-conformities to the chemical contaminations of the environment and staff found through the assessment carried out in parallel by INRS.

The audit covers the procedures of preparation in the centralized units of the pharmacy by the pharmacy technicians and in some wards where nurses still ensure the preparation of anticancer agents. The grid is divided into observational criteria and open questions on the individual and collective protection, handling of cytotoxic drugs, cleaning and waste management.

The procedures are globally respected for 54 % of the criteria. 93 % of the criteria are met by the pharmacy technicians and 48 % by the nurses, noting that those who attended the training on anticancer agents get better compliance than their colleagues (74% against 54 and 48%). The least respected criteria are the ones concerning personal protection, cleaning procedures and handling techniques.

The results of the analyses of the INRS show the contamination of all the personnel and certain surface areas, despite the high conformity rate for the pharmacy technicians during the audit. Areas for improvement should focus on, for the pharmacy technicians, the annual re-evaluation of the techniques of handling cytotoxic agents, removal of the flip-off in the equipment, and for the nurses, a mandatory institutional training.