Abstract
ObjectiveTo review the scientific literature related to the safe handling of hazardous drugs (HDs).MethodCritical analysis of works retrieved from MEDLINE, the Cochrane Library, Scopus, CINHAL, Web of Science and LILACS using the terms "Hazardous Substances", "Antineoplastic Agents" and "Cytostatic Agents", applying "Humans" and "Guidelines" as filters. Date of search: January 2017.ResultsIn total, 1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about HDs; 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances (monoclonal antibodies, gene medicine and other chemical and biological agents). In 14 (23.3%) guides, all the stages in the manipulation process involving a risk due to exposure were considered. Only one guide addressed all stages of the handling process of HDs (including stages with and without the risk of exposure). The most described stages were drug preparation (41 guides, 67.2%), staff training and/or patient education (38 guides, 62.3%), and administration (37 guides, 60.7%). No standardized informatics system was found that ensured quality management, traceability and minimization of the risks associated with these drugs.ConclusionsMost of the analysed guidelines limit their recommendations to the manipulation of antineoplastics. The most frequently described activities were preparation, training, and administration. It would be convenient to apply ICTs (Information and Communications Technologies) to manage processes involving HDs in a more complete and simpler fashion.
Highlights
1100 references were retrieved, and from those, 61 documents were selected based on the inclusion and exclusion criteria: 24 (39.3%) documents related to recommendations about hazardous drugs (HDs); 27 (44.3%) about antineoplastic agents, and 10 (33.3%) about other types of substances
One guide addressed all stages of the handling process of HDs
The toxic properties of cytostatic drugs have been well known since the 1940s when they began to be used in the oncological field [1]
Summary
The toxic properties of cytostatic drugs have been well known since the 1940s when they began to be used in the oncological field [1]. The concept of a "hazardous drug" (HD), which until was exclusively associated with cytostatic drugs, was introduced in 1990 by the American Society of Hospital Pharmacists (ASHP) [10] and adopted in 2004 by the National Institute for Occupational Safety and Health (NIOSH). This led to the current and internationally accepted definition: any medicinal product that presents in humans one or more of the following hazard criteria: carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, low dose organ toxicity, genotoxicity or drugs with a similar structure or toxicity profile to other dangerous drugs [11]
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