Table 2.

Recommendations for Health Care Providers

Parameter
Storage
Proper storage and handling of oral chemotherapeutic agents should be ensured by health care professionals in order to prevent accidental exposure and to ensure the integrity of these medications.
In health care institutions and pharmacies, cytotoxic agents should be stored in a designated area per the manufacturer's instructions, and separate from noncytotoxic agents.
Some agents are air-, moisture-, and/or light-sensitive; therefore, storage specifications should be followed.
Handling
Correct use of personal protective clothing and equipment should be instituted to minimize exposure and health risks.13,14,21
Oral chemotherapeutic agents should not be dispensed using automatic counting machines.
Disposable gloves should be used for dispensing. Hands must be washed before and after glove application.
Manipulations such as compounding, crushing, cutting, or splitting should be performed in a biological safety cabinet41 and should involve the use of personal protective equipment, which should be disposable to the extent possible.
Separate equipment should be used for cytotoxic and noncytotoxic agents.
The pharmacist (or other qualified professional) should attempt to limit additional handling of hazardous medications by other health care professionals. For oral chemotherapeutic agents in powder form, for instance, unit doses of the medications in the solution form (ie, reconstituted) should be prepared in the pharmacy and placed in an oral syringe, ready for administration.
Health care professionals who store and dispense oral chemotherapeutic agents must have a written emergency plan in the event of a spill or accidental exposure. It is recommended that annual spill simulation exercises be conducted.
An updated list of hazardous medications should be readily accessible to all health care personnel involved in handling of oral chemotherapeutic agents.
Disposal and cleaning of contaminated materials
All disposable protective clothing as well as any disposable materials used while handling oral chemotherapeutic agents should be disposed of as cytotoxic waste according to the local waste disposal regulatory guidelines.
All nondisposable materials exposed to chemotherapeutic agents including counting trays, tools, surfaces, etc should be washed or decontaminated* thoroughly after use.
Training and competencies for safe handling
Health care professionals should attend orientation programs and routine training courses specific to their roles, and should complete competencies associated with these training programs, along with an accompanying assessment for licensing qualification if applicable.35,36
A primary educator within a health care institution should be established as a source of referral and continued education on oral chemotherapy for health care professionals, allowing for consistent education, training, and monitoring across the multidisciplinary team.8,37
Health care workers involved in the handling of oral chemotherapeutic agents should be trained and competent to treat individuals accidently exposed to chemotherapeutic agents and on the disposal of cytotoxic medications.
All clinical staff who are likely to come in contact with oral chemotherapeutic agents or with waste from patients who have received these agents (eg, clerks, hygiene workers, and sanitation workers) should undergo appropriate training.

^*In some European countries, limited data support the use of cleaning agents that are validated for the removal of cytotoxic agents.³⁸