Hazardous Drugs in the Veterinary Setting

Some of the same pharmaceutical and biological agents used in clinical care settings for humans are now available to treat animals. This opens up the range of therapeutic options for treating cancers and other severe conditions, which is great news for animal lovers. The use of these drugs, however, does not come without risks.

Understanding the risks of hazardous drugs in the veterinary setting is the first step toward protecting staff and keeping the premises safe for anyone present.

Veterinarians, vet techs, assistants, and other professionals need to protect themselves from exposure to agents that can have harmful short- or long-term effects.¹ Harmful exposure isn't just a matter of accidentally ingesting or injecting one of these drugs. It can occur through inhalation of powders or vapors, absorption through the skin, or accidentally touching your mouth, skin, or eyes with a contaminated glove or hand.

Without the proper protocols in place, you may not realize when a surface is contaminated or if there are potentially harmful particles in the air. If contamination occurs, it's not just dangerous for staff members, but for anyone who comes into the practice, including customers.

There are steps veterinary hospital managers and practice administrators can take to minimize these risks, like implementing drug handling protocols and the use of equipment such as closed system transfer devices (CSTDs).

CSTDs are essential in mitigating risks of exposure to hazardous drugs. Studies have shown that these systems vastly reduce the risk of contamination when used properly. Experts recommend using them any time hazardous drugs are being prepared or administered.

The most common hazardous drugs used in veterinary care are cancer-treating agents used in chemotherapy. These veterinary pharmaceuticals are sometimes referred to as cytotoxic drugs because they are toxic to cells. Killing cancer cells is the desired outcome, but unfortunately, they also are toxic to healthy cells. This is why cancer patients often experience undesired side effects such as hair loss or sickness.

Using these drugs in a veterinary care setting poses the same risks to veterinary personnel as health care workers face in clinical care settings for human patients. They may experience hair loss and other common chemotherapy side effects, or additional acute or chronic symptoms.

Exposure can cause short-term symptoms such as headaches, dizziness, sore throat, or cough. But they've also been linked to longer-term, more severe effects, such as impaired fertility, miscarriage, stillbirth, congenital disabilities, or even some types of cancer. While all medications used in a veterinary setting should be carefully monitored and handled, hazardous drugs pose even more serious risks.²

So it's imperative to take steps to mitigate these risks, so the staff can safely treat animals without putting themselves in danger. Tiny exposures can build up over time, so even the slightest risks should not be overlooked when establishing rules for handling hazardous drugs in a veterinary setting.

Working with animals can be unpredictable. The plan for mitigating risks for employees and customers shouldn't be. Consider potential points of exposure and know the procedure for addressing them before a dangerous situation arises.

Restricted Use

Hazardous drugs should be handled with extra care and only by people who are knowledgeable about them. Accidents are more likely to occur when someone unskilled tries to handle these drugs.

Leakage of vapors, liquid, or particles from the medication can be harmful to both clinical or non-clinical staff. So it's everyone's business to understand clearly who is authorized to handle these substances and who isn't and to respect those rules.

Careful Prep

Preparing medications is a key point of risk. Solutions that are aerosolized or inhaled and powders that need to be diluted raise the risk of air contamination. Liquids can spill as well, letting particles into the air. And needle sticks can occur when prepping syringes or IV sets.

Every surface, vial, container, or other piece of equipment is a potential source of contamination. The use of CSTDs can make these processes safer by blocking the release of any drug concentration

Safe Storage

Hazardous drugs should have their place -- specifically in a pharmacy area and in the treatment rooms. These areas should be clearly designated, and no eating or drinking should be allowed in them to help reduce risks of accidental ingestion. Keep a careful inventory of these medications and have specific guidelines for storing, labeling, and distributing them.

Working With Large Animals

Administering hazardous drugs in a veterinary setting can pose unique risks, especially when working with large animals because the doses can be high. There's a risk of contamination to anyone that comes into contact with these medications, as they can absorb through the skin and can vaporize into the air. They may inadvertently get on someone's hand, who then touches their face.

You also may come into contact with the animal's bodily fluids when administering medication. An animal taking hazardous drugs may shed some of the substance through fluids for a short time after.

PPE

Proper protective equipment, including gloves, gowns, protective eyewear and masks can help, but only if you know how to use them. Ensure staff members who handle hazardous drugs know how and when to use protective equipment, including proper removal and disposal.

Careful clean-up takes on a whole new meaning with hazardous drugs. Staff members should also don personal protective equipment while thoroughly disinfecting any surfaces or areas where contamination may have occurred. PPE is necessary when cleaning bedding or linens, as well as sanitizing any area where an animal who has taken hazardous drugs has soiled or excreted other bodily fluids. Establish specific protocols for disinfecting treatment areas. Additionally, syringes and other single-use items must be disposed of safely.

Accident Protocols

Have a plan for how to handle spills or other accidental exposures. Ensure employees know how to safely clean up spills, and have supplies on hand in any areas where spills might occur. Include protocols for documenting the incident and reporting it, if necessary. If someone was in the area when a spill or other incident occurred, and was not properly protected, make sure they get any necessary medical help.

These are just some suggestions for the types of protocols that should be in place for veterinary settings that use hazardous drugs. More specific guidelines will vary based on the specific hazardous drugs in use, how frequently they're administered, and even logistical factors, such as the layout and ventilation in your practice.

Educating both clinical and non-clinical staff on the dangers of hazardous drugs in the veterinary setting can help keep them invested in following protocols put in place for keeping them safe. Talk frequently about safety protocols and why they're so important. Discuss the therapeutic benefits of these drugs in addition to the risks so that it's clear why they are being used, despite the dangers.

Keep rules regarding safe handling of hazardous drugs posted where everyone can see them. Go over regular touchpoints, especially if new medications come into use in your practice or as new staff members join the team. An ongoing dialog and continued training will help ensure everyone stays engaged in your safety plan and will allow them to ask questions and offer feedback.

Make sure staff members are aware of the specific health risks, especially for women who are pregnant or may become pregnant. During pregnancy, the most vulnerable time is usually in the earliest stages, when many women may not yet realize they are carrying a child. So, women of childbearing age who work in veterinary settings need to be aware of these risks, even if they're not currently expecting.

In a veterinary setting, workers learn to expect the unexpected. But there's no room for surprises in managing hazardous drugs that could pose significant risks. Having secure, comprehensive protocols in place for managing these medications is critical to keeping veterinary employees safe.