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Suitable protective clothing when handling cytostatics
Cytostatics are highly potent drugs and pose a potential hazard to anyone who works with them.

Meaning of cytostatics

For the treatment of cancer, cytostatic drugs have been an indispensable group of drugs for many years. Dealing with cytostatics takes place in many hospitals, pharmacies, doctor's offices or outpatient facilities. Activities with cytostatics will continue to increase in the future, and this group of drugs will also be used in veterinary medicine.

Dangers for people and the environment

Cytostatics are highly potent drugs and pose a potential hazard to anyone who works with them. Many cytostatics have mutagenic, carcinogenic, fertility-endangering or teratogenic effects. Immediately after contact with the skin or mucous membranes, they can have an irritating, caustic and sensitising effect. At therapeutic doses, cytostatics primarily damage cells with a high rate of cell division such as bone marrow, intestinal mucosa, hair follicle cells and gonads as well as the body's own defences. As a rule, cytostatics are not biodegradable and endanger the environment.

Risk assessment

Before starting work and at regular intervals, the employer must assess the working conditions and hazards associated with activities with cytostatics and, if necessary, take measures to improve them. The technical rule TRGS 400 "Risk assessment for activities involving hazardous substances" as well as TRGS 401 (risks from skin contact) and TRGS 402 (risks from inhalation) provide explanations of the subsequent risk assessment. Expectant and nursing mothers must not be exposed to cytostatics; Young people only if necessary to achieve the training objective and their protection is guaranteed by the supervision of a specialist.

Personal protective equipment

The necessary protective equipment is regulated by TRGS 525. A distinction is made between the requirements for protective measures during preparation, administration, cleaning work in the safety workbench and in the event of an unintentional release.


A) Preparation of cytotoxic drugs

When preparing cytostatics at a safety workbench, the following personal protective equipment must be worn and changed immediately if it is contaminated or damaged:
1. Protective gloves (for example tight-fitting, non-slip nitrile gloves would be suitable),
2. High-necked smock with long sleeves and tight-fitting cuffs.


B) Administration of cytostatics

Different protective measures are required during administration, depending on the form of application. The following protective measures are required for application by means of oral administration (and connection / disconnection):

  1. Safety gloves.

  2. When administering via hyperthermal intraperitioneal chemo-perfusion, the following additional protective measures apply:

  3. Safety glasses with side protection

  4. Surgical gowns made of water-repellent material,

  5. Respiratory protection mask of at least protection level FFP3 according to the trade association rules for the use of respiratory protective devices (BGR 190).

In the case of special forms of application (bladder instillation or trans-arterial chemo-embolisation), the protective measures must be determined accordingly.

C) During cleaning work

Cleaning work in the safety workbench that goes beyond simply wiping the work surface must be carried out with the following personal protective equipment:

  1. Liquid-tight protective gown with long sleeves and tight-fitting cuffs,

  2. Safety glasses with side protection

  3. Safety gloves,

  4. Respiratory protection mask of at least protection level FFP3 according to the trade association rules for the use of respiratory protective devices (BGR 190).

D) In the event of accidental release

A minimum of the following must be available to remove unintentional contamination that occurs during preparation or application:

  1. Overshoes, liquid-tight protective gowns with long sleeves and tight-fitting cuffs, protective goggles and protective gloves,

  2. Respiratory protection mask of at least protection level FFP3 according to the trade association "Rules for the use of respiratory protective devices (BGR 190)

  3. Cut pulp in sufficient quantity,

  4.  reception and waste container, hand shovel.

Requirements and aspects when using gloves

Disposable gloves with long cuffs and, if necessary, rolled edges, which ensure a secure fit over the cuffs, should be used. For example, tight-fitting and non-slip gloves made of latex or nitrile would be suitable. From the point of view of occupational safety, the gloves must meet the quality requirements of the European standard DIN EN 374. The glove material should be coloured in order to identify defects, holes and tears more quickly and more reliably. In practice it has been proven to wear two pairs of gloves (double-gloving) made from different materials (e.g. latex and nitrile) to eliminate the residual risk. The length should be enough to reach over the sleeve cuffs of the protective gown. Investigations to determine the permeability indicate that gloves made of latex, nitrile rubber or neoprene are most likely to have sufficient thickness for handling cytostatics. Gloves must be changed immediately if damaged. Regardless of visible contamination or damage, the gloves should be changed at least every 30 minutes in order to avoid the absorption of invisible contamination or damage. The gloves should always be turned inside out to avoid contaminating unprotected hands.




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