OHS Catalogue of Cytostatics

Together with the other UMCs and employee organisations, your UMC has compiled an OHS catalogue. The OHS Catalogue describes measures for the main OHS risks at the UMCs, including cytostatics. The aim is to work in a safe and healthy manner. With the OHS catalogue, the UMCs implement the general regulations set by the government. If you want to know exactly whether a regulation on cytostatics, for example, is good practice or is informed by a statutory standard, you can find this in the formal OHS Catalogue text. The definitions of the different types of regulations are given in the Introduction to the OHS Catalogue.

Below you will find the full text of the OHS Catalogue of Cytostatics. You can also download the document as pdf.

Hospitals use cytostatics to treat patients. However, cytostatics are also dangerous substances because a number of them are also carcinogenic and reprotoxic. Cytostatics can be absorbed into the body through the skin, by ingestion and inhalation of aerosols. Research has shown that skin exposure is a very important route for exposure to cytostatics. Risk moments are:

• the preparation of cytostatics (pharmacy)
• the administration of cytostatics (nursing ward and outpatient clinics)
• patient care and handling excretion products1 (nursing ward, outpatient clinics)
• cleaning work.

The introduction of guidelines for working safely with cytostatics, the use of closed preparation and infusion systems and increased awareness have led to a significant reduction in job-related exposure to cytostatics.

Exposure to carcinogenic and mutagenic substances (such as cytostatics) is a serious risk due to the expected effect (malignancies or damage to offspring). Moreover, poor control of this risk can lead to serious reputational damage. Under normal operating conditions, the risk of exposure is small, but not negligible.

The 'cytostatics' guidelines in this OHS Catalogue apply especially to the UMCs' own and external workers and managers of the departments listed below:

• pharmacy
• nursing wards and outpatient clinics
• operating centre (HIPEC), MC, IC, Recovery
• logistics
• cleaning
• test animal centre.

This concerns the 'directly' exposed groups of workers and their managers.

With regard to groups of staff who are exposed 'indirectly', such as the radiotherapy and physiotherapy departments, the activities/duties for which risks exist and how the exposure can be managed are also outlined. 

A number of topics in these guidelines are also important for the support departments, such as the OHS and environmental service and the company emergency response organisation.

The Working Conditions Decree describes how to deal with dangerous substances in general and with carcinogenic and reprotoxic substances in particular. These provisions cover subjects such as:

• the duty of care of the employer (paying specific attention to the risk assessment)
• limits (to the extent that these are available, they are included in a ministerial regulation)
• the limitation of exposure by implementing preventive measures (in accordance with the state of scientific and technical knowledge and the occupational health strategy)
• hygiene measures
• specific groups of staff, e.g. pregnant women
• (medical) research
• information and training.

Until the publication of this OHS Catalogue, these statutory provisions for the subject of cytostatics have been further elaborated in policy rule 4.18-5.

The aim is to minimise exposure to cytostatics (ALARA principle, i.e. As Low As Reasonably Achievable).
Explanatory notes:
Cytostatics are dangerous substances because they are (mostly) carcinogenic and/or reprotoxic. This means that everyone who works with them must exercise caution. In the past, the government stated that it aimed to achieve zero exposure. In hospital settings, where the patient is also an important source of contamination and exposure, zero exposure is not feasible.
However, an UMC does have the duty to keep exposure to a minimum. To achieve this goal, this OHS Catalogue includes process and resource requirements and good practices. In accordance with the occupational hygiene strategy, the source approach is preferred; the use of personal protective equipment is a last resort.

The safest possible techniques, products and procedures are used for preparing cytostatics for administration, administration and the handling of excreta. The state of the art is the frame of reference.
Explanatory notes: A number of resource requirements are in place in order to realise this ambition.

The spread of a cytostatics infection is prevented as much as possible.
Explanatory notes: Process requirements are in place in order to realise this ambition.

All staff who (may) come into regular contact with cytostatics receive training and instruction in the recognition of cytostatics, the risks of cytostatics and the implementation of measures.
Explanatory notes:
Information and instructions are included in this OHS Catalogue as process requirements. The intention is that the various target groups (see description of target groups) are provided with bespoke training and instruction. The information in this OHS Catalogue can be used for this purpose. A proper safeguard of this information/instruction ensures that the knowledge and skills of the new and existing staff are always up to date. Departments with a high staff turnover in particular run an additional risk of a lack of knowledge and hence of unnecessary exposure and an undesirable spread of cytostatics. The cooperating organisations need to consult with one another with regard to external staff. Arrangements are made as to who will provide this training/instruction (including assurance).

The most important measures and resources with which to fulfil the ambitions and statutory target requirements are:

• Process requirements:
  • All UMCs have an up-to-date overview of the substances/cytostatics that are subject to specific (cytostatics) guidelines.
  • All UMCs have specific instructions for the training and instruction of (external) staff who (may) come into regular contact with cytostatics.
  • This is reported in the case of the transfer of patients to nursing homes, old people's homes and home care (VVT) during the risk period.
  • All UMCs perform regular wipe tests to check for the spread of cytostatics.
  • All UMCs use a (specific) cleaning protocol.
  • All UMCs use an emergency protocol
     
• Resource requirements:
• All UMCs include instructions in their cytostatics policy:
• the use of safety workbenches
• the use of certain packaging materials and systems in preparation and transport
• the use of locked/secured connections in the cytostatics administration system
• the delivery of cytostatics with an appropriate barrier
• the safe use of needles and syringes
• the use of bedpan washers with a reversing mechanism
• the use of personal protective equipment
• the use of specific hospital waste containers with pedals
• marking on rooms, laundry bags and transport cases.
   
• Good Practices:
  • UMCs continuously strive to reduce exposure through critical intercomparison of cytostatic policies, paying attention to such things as:
    • working safely with cytostatics
    • safe administration systems
    • the responsible use of personal protective equipment.

A detailed description, in accordance with the state of the art, is included in the working group document (see appendix).

More information

(Bijgevoegd wordt het integrale document dat werkgroep heeft opgesteld. Dit document valt onder de verantwoording van de werkgroep van deskundigen uit de UMC’s en maakt onlosmakelijk deel uit van dit hoofdstuk van de Arbocatalogus.

Aldus vastgesteld door het LOAZ.

Wat is een arbocatalogus

Arbocatalogus Cytostatica, incl bijlage