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Hazardous therapy
Veterinary workplace exposure to chemotherapeutic agents creates health risks, could have regulatory implications


DVM360 MAGAZINE


Safeguards

Yet veterinarians like Ogilvie downplay contamination risks when the right protocols are put in place. He considers it a mistake to focus only on drugs used to treat oncology cases and not the safe handling of all hazardous agents.

"I've never seen anyone get sick from dealing with chemotherapy," he says. "But I do know of a veterinarian who died from developing a severe allergy to penicillin after repeatedly handling it. There have been many drugs that have been misused for ages, not by willful neglect, but by ignorance. We have an amazing profession that wants to help patients and clients. Regulations are only as good as their enforcement. The greatest weapon that veterinary medicine has is education."

That's Wendy Minor's contention, as the registered veterinary technician heads to Seattle this month to speak at the Veterinary Technician Cancer Society's annual meeting on the safe handling of chemotherapy agents.

"In the human field, you have to be in a pressurized room. Who's going to be able to afford that in veterinary medicine?" she asks. "More than half of your veterinary hospitals that are mixing these drugs don't even have a safety hood. When I see people like my sister, who's pretty sick from all the chemo she's been administering, I just want to educate people the right way about this."

Board-certified oncologist Dr. Sue Downing, of the Veterinary Cancer Group of Los Angeles, enforces a handling training program that can take more than a year for technicians to complete. Staff members learn about the drugs, restraint and injection techniques as well as calculations before they ever draw a medication. The next step is diluting and preparing drugs for administration, starting with those that have the lowest safety risk.

"Anyone with a veterinary degree can order these drugs, and any unlicensed veterinary technician can administer them under the order of a DVM." she says. "I think some of the scariest stories come from practices where there aren't many safety protocols in place, because we all have accidents. There have been well-documented cases where an animal coming into contact with these drugs has resulted in amputation of a limb. That's why we have antidotes for some of these more aggressive chemicals right on the shelf. Human error is something you can't get away from entirely."

USP 797

Downing predicts that any change in the law to mandate and enforce safeguards would have to come through state boards or federal legislation. But Cordes, the veterinarian who beat thyroid cancer, says a strict law that governs pharmacists also applies to veterinarians.

It's called USP 797. The guidelines ( http://www.usp.org/products/797Guidebook/), developed by U.S. Pharmacopeoia and revised last year, sets the nation's first standards for sterile and safe pharmaceutical compounding and, by definition, that includes drawing chemotherapy drugs from a vial. While it's meant to govern pharmacists, veterinarians mixing chemotherapy drugs also fall under these standards, he says, which are enforceable by state pharmacy boards in at least a dozen states and the Food and Drug Administration.

"797 applies to anybody handling chemotherapy, period," Cordes contends. "We fall through the cracks because we're so small; human oncology is 500 times larger. But these guidelines mandate certain behaviors when handling and mixing chemotherapy drugs. Veterinarians just don't realize they're subject to the same standards of practice as pharmacists when they're doing stuff like this."

Sections of 797 call for the installation of clean rooms, biological safety cabinets and non-shedding coats and gowns to be applied in a "gowning sequence," to name a few of its stipulations. Veterinary pharmacist Davidson says that while this is on the human and pharmacy radar, that's not the case for veterinary medicine.

"There is no veterinary practice exemption in this law, so if FDA starts enforcing it, veterinarians will be in for a rude awakening," she predicts. "Of course, there will have to be some human harm proven before FDA does anything. Right now, I don't think many veterinarians think the risks are real, but there are going to be some lawsuits, because there are going to be more Brett Cordes out there."

Fiala is a freelance writer based in Cleveland. She spent eight years with DVM Newsmagazine as senior editor and now also works with the Veterinary Information Network.


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Source: DVM360 MAGAZINE,
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