Making the circuit for cytotoxics safe, an unconvincing track record for the pharmaceutical laboratories

Protecting hospital staff from cytotoxic products counts among legislative requirements (BPP, section 7).

While the preparation and administration stages are kept safe continuously, the reception of these products in our In-house Pharmacies remains a black spot in the circuit even though the chemical contamination of vials of cytotoxics has been demonstrated.

We conducted a survey of packaging and identification practices for cytotoxics delivered by pharmaceutical laboratories. The goal was to evaluate the level of safeguards implemented for this stage and, according to the results, to adopt training measures to protect staff.

22 pharmaceutical laboratories liable to deliver cytotoxic medications to us were contacted. A questionnaire was sent out to them. It addresses 3 issues: delivery procedures, packaging and identification of the boxes. The accuracy of the responses given was checked through being present on reception of cytotoxics in our In-house Pharmacy.

86% of the laboratories contacted answered our questionnaire.

81% of them do not use a separate delivery circuit for cytotoxic products.

57% supply boxes that are not marked "cytotoxics" that nevertheless contain such products. A lack of harmonisation of the labelling was noted.

54% package cytotoxic medications and non-cytotoxic medications in the same box.

In most cases, the reception of cytotoxics fails to maintain safety and exposes the hospital staff to the toxicity of these products. The legislation applying to the industrialists remains unclear on the matter and open to varying interpretations. Systematically wearing gloves on reception of boxes and the order kept separately with specification by the pharmacist when signing for the presence of cytotoxic products remain the basic rules to be respected while awaiting more concrete rules from the authorities.