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Cytotoxic Drug HCW Precautions

Q: I have a OSHA question that I need some help with and wanted to see if you could point me in the right direction or provide me with some information on a question that I have in our office. We are a private OB/GYN office, and have a very small amount of a drug called Methotrexate in our office for any patients with ectopic pregancies. (Injectable) Because this is a cancer drug, what are the minimum OSHA standards for associate use and disposal?

A: You pose a good question about Methotrexate, which is considered a cytotoxic drug (CD), a class of drugs also called antineoplastics. The only safe level of worker exposure to these substances is NO exposure, so you will
definitely want to make sure you have adequate precautions in place at your facility.

If you have the Quality America OSHA Safety Program Manual, procedures for handling cytotoxic drugs are located on pages 9-1 through 9-6. If you do not have Quality America's manual, guidance directly from OSHA may be found at: http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#app_vi:2_1.

The CDC has also published guidance for working safely with antineoplastics in a NIOSH (National Institute for Occupational Safety and Health) Alert. The full NIOSH report, as well as a condensed 3-page "Summary of
Worker/Employer Recommendations" may be found here: http://www.cdc.gov/niosh/docs/2004-165/.

Worker exposure to cytotoxic drugs may occur through splattering, spraying, and aerosolization. Exposures have been noted during withdrawal of needles from drug vials, transferring drugs using syringes and needles or filter
straws, breaking open ampules, and during expulsion of air from drug-filled syringes. PPE (as outlined in the CDC/NIOSH link above) and Biological Safety Cabinets are needed during preparation of Methotrexate.

Regarding disposal, empty syringes/vials should be disposed of as chemotherapy trace waste, most likely in a yellow sharps container. Speak with your medical waste pickup service regarding state laws on chemotherapy
trace (also known as RCRA* empty) waste. Most likely this waste will need to be incinerated at an appropriately permitted facility. Full vials/syringes of unused expired medication should be disposed of as RCRA regulated
hazardous waste (some facilities are now using a black sharps container for this type of waste). Again, your medical waste provider can tell you if they are licensed to pick up this type of waste. Hopefully, you are able to
manage you inventory such that unused expired meds are not an issue.

More on state specific disposal laws can be found by clicking your state on the map at this link: http://www.epa.gov/epaoswer/osw/stateweb.htm

* RCRA stands for the EPA's Resource Conservation and Recovery Act.

Need help with OSHA compliance? Browse our helpful online store containing OSHA manuals & compliance programs.

Posted by Quality America on November 10, 2006 | Comments (4)


Do we need to double glove with 2 pairs of chemo specific gloves, or can they wear regular latex gloves under one pair of the chemotherapy gloves?

I know that they should wear a disposable gown with long sleeves and make sure all of their arms are covered and pull the second pair of gloves over their gown. After you are finished with your procedure or injection, please clarify disposal procedures for me.

We have purchased the yellow specific containers for disposal. Do we have to bag items that were used,(used gowns, gloves, meds, syringe, etc)prior to putting in the special container. If we have to use special bags for this purpose, can you tell me what kind needs to be used? If you have any sample policies or information on this topic, I would certainly appreciate the help.

Posted by: Tina Smith at January 25, 2007 11:43 AM

Double gloving with chemotherapy specific gloves is recommended by NIOSH. Check out the link to their recommendations in blog post above or click here:


We do offer policies and procedures, including details on how to remove and dispose of used PPE, when working with Cytotoxic Drugs in Tab 9 of the Quality America OSHA Safety Program Manual. Check it out here:


Posted by: Sarah Alholm at January 25, 2007 11:45 AM

What about having a hood for Methotrexate used in OB/GYN practices? We only use it about once every six months.

Posted by: Lisa at February 19, 2007 02:17 PM

Both MSDS for Methotrexate that we checked were quite clear regarding the use of a Biological Safety Cabinet (BSC), "ENGINEERING CONTROLS: Use only in a chemical fume hood."

Since the MSDS clearly calls for this control, a fume hood (Biological Safety Cabinet) is necessary even for infrequent use.

Posted by: Sarah Alholm at February 19, 2007 02:18 PM

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