asia4safehandling

Is regular full blood profile useful for staff exposure monitoring?


Methods for Staff Monitoring:

•	Methods used for staff monitoring include:
	- - - -	cytogenetic methods (sister-chromatid exchange rates, micronuclei formation), analysis of drugs/ metabolites in blood, urine mutagenicity studies, and miscellaneous methods such as white blood cell counts

•	None of these methods are satisfactory for staff monitoring

•	Cytogenetic methods are not sufficiently sensitive or reproducible for staff monitoring. Furthermore, the prognostic significance of positive results is not known.

•	Analytical methods to directly determine the concentration of cytotoxic drugs or metabolites in blood and urine can be both sensitive and reliable. However, "safe or acceptable" concentrations of cytotoxic drugs in urine and blood are not known so the prognostic significance of levels reported in mainly cross-sectional studies is uncertain. Also, it is not practicable to simultaneously monitor for all drugs (which could number > 30) handled in a cytotoxic unit.

•	Miscellaneous methods such as white blood cell counts have no scientific basis for staff monitoring and should not be used.

Since most methods for staff monitoring are not suitable and produce results which are difficult to interpret, it should not be routinely undertaken.

Is the use of isolator better than class II cytotoxic drug cabinet for the preparation of cytotoxic drugs?

Both types of cabinets can be used safely to prepare cytotoxic drugs. It is how you use the cabinets that determine how safe they are. The decision is usually based on the type of lab set-up you have, how you choose to practice and what is your operating cost.

Should I use a negative pressure or a positive pressure isolator to prepare cytotoxic drugs?

A recent publication from Health & Safety Executive (UK) entitled “Handling cytotoxic drugs in isolators in NHS pharmacies” gives a balanced view on the application of negative pressure and positive pressure isolators in pharmacy.
The decision is yours!