Cytotoxic and Cytostatic medications are widely used in healthcare and in the community. They are used for the treatment of cancer and other diseases. Cancer treatments include Cytotoxic and Cytostatic drugs, which kill cells and inhibit cell growth. Due to the diverse nature of illnesses, there is a range of methods used to administer the medication including tablets, liquids, creams and aerosols.
Because of the drugs’ toxic nature, they possess a significant risk to those that handle them. Consequently, both the patient and person providing the medication need protection. It is vital that appropriate personal protective equipment (PPE) is used. These items include gloves, gowns and facemasks. There is also a wide range of specialist equipment needed to administer the medication safely. Once used all of these items are considered Cytotoxic and Cytostatic waste.
Cytotoxic and Cytostatic drugs are classified as hazardous substances as defined by the Control of Substances Hazardous to Health Regulations 2002 (COSHH) and as hazardous waste by the Hazardous Waste Regulations. Therefore, so are items used to store or administer the drugs and containers used in the storage of waste. In addition, for seven days after the administration of the medication, the patient’s excreta (vomit, urine, faeces) and items coming into contact with this excreta should also be treated as hazardous waste e.g. nappies or wipes.
Using the list of waste or EWC waste can be classified using pre-agreed codes and definitions. The codes used to describe cytotoxic and cytostatic waste are 18 01 08 for waste from human healthcare and 18 02 07 from veterinary activities.
Duty of Care
All waste producers have a responsibility to ensure their waste is stored, transported and disposed of in a safe and compliant manner.
Healthcare professionals’ key responsibilities under their duty of care include:
- prevent unauthorised or harmful deposit, treatment or disposal of waste
- prevent a breach (failure) by any other person to meet the requirement to have an environmental permit, or a breach of a permit condition
- ensure the waste doesn’t escape from your control
- ensure that any person you transfer the waste to has the correct authorisation
- when transferring the waste to another person the healthcare professional must describe the waste accurately
The Duty of Care extends to householders. This is particularly relevant when a member of the household is taking Cytotoxic and Cytostatic medication. Normally residential waste disposal is a simple matter of using the correct bin and leaving it out for the relevant scheduled collection. When disposing of contaminated sharps or hazardous clinical waste (such as nappies, wipes, gloves etc.) the use of a correctly marked container is mandatory and a specialist collection service has to be arranged with the local authority.
Healthcare professionals should use purple bags or lidded bins to store equipment contaminated with hormone and chemotherapy medicines. Any sharps waste, such as scalpels, syringes and needles should be disposed of in the correct type of container.
Collection & Transportation of Hazardous Waste
When a waste producer sends waste for treatment, they are responsible for completing a hazardous waste consignment note. The information needed includes:
- The collection address for the waste
- Name and address of the waste producer
- An accurate description of the waste and the corresponding EWC code
- The address details of where the waste processing will take place
Without this paperwork, the transportation company cannot legally make the collection.
In addition, all businesses that transport hazardous materials must use ADR trained drivers and ADR compliant vehicles. It also forms part a waste producer’s Duty of Care to ensure that their waste management company transports, stores and processes hazardous wastes legally.
Due to its hazardous nature, high temperature incineration is the only option to dispose of Cytotoxic and Cytostatic wastes.