Cytotoxic Waste Disposal Guidelines
Every facility that handles or administers cytotoxic agents must be aware of not only definitions and terminology, but regulations for the handling, storage, and disposal of cytotoxic waste. Knowing the difference between a trace or a bulk cytotoxic waste can mean the difference between compliance and potential fines or penalties for noncompliance.
Federal guidelines throughout Canada must be followed, but every province and territory also has their own regulations regarding cytotoxic agents and their disposal. In addition, most hospitals, oncology medical centres, and outpatient treatment centres will also have their own standards and operating procedures for safe handling of cytotoxic drugs and bodily fluids.
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What is cytotoxic waste?
What exactly is cytotoxic waste? Cytotoxic drugs are those that can inhibit or prevent cell function within the body. Among the most commonly known forms of cytotoxic drugs are those that are called antineoplastic or chemotherapy agents. Drugs in this category are often used to treat conditions that are non-cancerous in nature, such as psoriasis or rheumatoid arthritis. However, because antineoplastic drugs can damage often fast-dividing cancerous cells, they are also effective in many cancer treatments.
While the primary function of cytotoxic or antineoplastic drugs is to interrupt or disrupt the function and growth of diseased cells, such drugs can also harm healthy cells. Patients treated with such drugs may experience toxic side effects, as can those who deliver treatments if they don’t maintain proper care in the handling, administration, and aftercare of patients receiving those drugs.
Cytotoxic drugs have the potential to be generally toxic, carcinogenic, genotoxic, and mutagenic in nature. A ‘general’ toxic substance has the potential to damage DNA and can contribute to malignant tumor growth. A carcinogenic drug can cause cancer. Genotoxic substances can cause mutations that contribute to the development of tumors in healthy cells. Mutagenic substances can alter the DNA, increasing the chances of mutations.
Where are regulations for cytotoxic waste found?
Regulations regarding the use of cytotoxic drugs are found in numerous locations. Turn to provincial or territorial government agencies for specifics in your region. Every province will have its own set of definitions and standards for cytotoxic waste disposal. For example, in Ontario, cytotoxic waste means a waste consisting of:
- A cytotoxic drug
- A medicinal drug
- A medicine chemical, or
A waste consisting of a waste listed in (a) or (b) including waste such as tubing, tissues, needles, gloves, vials, preparation materials, ampoules, cleaning materials and personal protective equipment
In Ontario, cytotoxic waste that is not commingled with sharps waste can be disposed of in a single-use container (not a reusable container). The label colour is red and marked with the cytotoxic label. A cytotoxic sharps waste can be disposed of in a compliant, single-use or reusable sharps container and marked with a red colour label and the cytotoxic symbol.
In the Northwest Territories, cytotoxic waste is not specifically classified as a biomedical waste, but is considered a hazardous material. In that region, cytotoxics are typically defined as those restricted to drugs or other medicinal chemicals that are used in patient diagnosis and treatment. Guidelines specify that segregation from other waste streams is important and that any item that comes into contact with a cytotoxic drug (any amount) “must be treated as cytotoxic waste and handled and disposed of by incineration or chemical neutralization.”
In addition, chemical deactivation can be used for some cytotoxic agents in cases where incineration is unavailable.
It is vital that every facility that handles, stores, administers, or disposes of cytotoxic waste be aware of the regulations of not only their own province or territory, but regulations of the department of transportation (Transport Canada). In addition to the regulations provided by the federal government and provincial or territorial governments, facilities that provide oncology care and who administer cytotoxic drug therapies may also have their own guidelines regarding disposal of cytotoxic/antineoplastic/chemotherapy agents.
For example, a pediatric oncology group in Ontario province requires that all syringes and needles must be discarded in compliant sharps containers that are leak-proof, puncture resistant, and have lids that securely seal, in addition to being properly labeled. Personal protective equipment (PPE) should be disposed of in appropriately labelled containers, and bags and solution administration sets are to be discarded intact in compliant and properly labelled red-sealed containers that are puncture proof and leak proof.
Research, laboratory, hospital, or other facilities that utilize cytotoxic drugs are also required to provide red-coloured sharps containers or bins or red-coloured biohazardous waste containers or bins with red-coloured waste bags for the disposal of cytotoxic drugs and bodily fluids, bio specimens, and wastes for those undergoing cytotoxic drug treatment.
Are all Cytotoxic Drugs Hazardous?
Cytotoxic drugs, by their very nature, are deemed hazardous in bulk quantities. As such, they should be handled, stored, and disposed of with care. Any healthcare provider or ancillary staff that handles either cytotoxic drugs or its byproducts created by their use (including housekeeping and maintenance staff) should receive adequate education and training in their handling. Proper handling and disposal of cytotoxic drugs and their waste byproducts are essential for the safety of healthcare personnel, ancillary staff, the public, and the environment.
Cytotoxic Waste Segregation: Trace vs. Bulk
Cytotoxic waste is its own medical waste stream and must be segregated, collected/bagged, and labelled appropriately. So what’s the difference between trace versus bulk waste? In many scenarios, any type of paraphernalia that is associated with antineoplastic or chemotherapy processes can be managed as a trace chemotherapy waste if it has potentially been exposed to chemotherapy/antineoplastic contamination.
Such items can include gloves, wipes, or gowns used in the handling, preparation, or administration of chemotherapy. It can also include “empty” vials, IV bags, tubing, and syringes.
A bulk chemotherapy waste is a material that has been saturated with antineoplastic or cytotoxic agents. Hazardous waste generators should seek guidance from provincial or local public health departments or agencies for their specific determination and definition of trace versus bulk when it comes to collection and disposal.
Disposing of Cytotoxic Waste
Guidelines for the disposal of cytotoxic waste are accessible from provincial and territorial governmental offices as well as public health resources. When it comes to disposal, all potentially cytotoxic contaminated materials should be placed into plastic bags that are 2 mm thick (if composed of polypropylene) or 4 mm thick (if polyethylene). Proper colour-coding and application of cytotoxic warning labels are also required.
Sharps are to be placed in puncture-proof sharps containers prior to bagging. Adequate and proper segregation of waste materials that are the result of cytotoxic drug preparation and administration should also be carefully assessed. Disposal processes must meet not only provincial, but federal regulations in regard to hazardous waste disposal processes. According to the Canadian Union of Public Employees (CUPE), plans “must meet or exceed the provincial regulations for hazardous waste disposal.”
Daniels Health Canada focuses on fully customizable and integrated cytotoxic waste management programs. We provide a variety of containers, educational resources, and customized services for collection and disposal processes. For more about our services, resources, and guidance, contact us today.