Cytotoxic Drugs And Related Waste - Risk Management

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CYTOTOXIC DRUGSAND RELATED WASTE –RISK MANAGEMENTJULY 2017

DisclaimerThis publication may contain information about the regulation and enforcement of work health and safety in NSW. It mayinclude some of your obligations under some of the legislation that SafeWork NSW administers. To ensure you comply withyour legal obligations you must refer to the appropriate legislation.Information on the latest laws can be checked by visiting the NSW legislation website www.legislation.nsw.gov.auThis publication does not represent a comprehensive statement of the law as it applies to particular problems or to individualsor as a substitute for legal advice. You should seek independent legal advice if you need assistance on the application of thelaw to your situation.This material may be displayed, printed and reproduced without amendment for personal, in-house or non-commercial use.Catalogue No. SW08559SafeWork NSW, 92–100 Donnison Street, Gosford, NSW 2250Locked Bag 2906, Lisarow, NSW 2252 Customer Experience 13 10 50Website www.safework.nsw.gov.au Copyright SafeWork NSW 0917

ACKNOWLEDGEMENTSThis guide was prepared by the cytotoxic drugsworking party and first published in 2008. Itprovides a practical health and safety standardfor the health care industry in workplaces wherecytotoxic drugs and related waste are handled.Members of the working party representeda range of stakeholders and health carepractitioners who are dedicated to improvinghealth and safety in the health care industry.Without their participation, this project wouldnot have been possible. Members of the originalworking party were:WorkCover NSWDr Usha St GeorgeMr Ted SzafraniecDr Bhoopathy SankaranNew South Wales Nurses’ AssociationMs Trish ButrejMs Mary McLeodCancer Nurses Society of Australia – SydneyMs Vivienne FreemanHealth Services UnionMr Mark HanlonClinical Oncology Society of Australia (COSA)Prof Bernard W StewartSociety of Hospital Pharmacists of AustraliaMs Johneen TierneyNSW HealthMs Frances WatersMs Lyndall DavisIn addition to working party members, variousother health care industry groups and individualshad provided their input. Their assistance ishighly appreciated.In 2016, this guide was updated for therequirements of current Work Health andSafety Regulation 2011 (WHS Regulation) byDr Bhoopathy Sankaran and Dr Vivian Fung ofSafeWork NSW and was circulated to membersof the 2008 cytotoxic drugs working party. Theirgenerous feedback in updating this guide isgreatly appreciated.We also thank the Ministry of Health (WorkplaceRelations Unit) for providing commentson the revised Guide and especially AngieStanojevic – Senior Policy Advisor; Dr Ian Cheng– Occupational Physician, Royal North ShoreHospital and Leslie Gibbs – Professional Officer,NSW Nurses and Midwives’ Association, AustralianNursing and Midwifery Federation, NSW Branch.The following publications provided invaluablereference during the preparation of this guide: Handling cytotoxic drugs in the workplace,January 2003, WorkSafe Victoria Guide for handling cytotoxic (anti neoplastic)drugs and related waste, 2005, QueenslandDepartment of Industrial Relations Guidelines for handling cytotoxic drugs andrelated waste in health care establishments,2nd edition, 1995, WorkCover NSW.This guide is neither definitive nor ‘set in concrete’.Practices change over time and commentson how this document can be improved arewelcome. Please contact SafeWork NSW.Vivienne Freeman and the Royal North ShoreHospital are gratefully acknowledged for theprovision of the forms and instructions relating tothe Cytotoxic drug precautions alert in Appendix11 and Your continuous infusion device pump andChemotherapy spill at home in Appendix 12.

CONTENTS1.Introduction 91.1Purpose 91.2Scope 91.3 What are cytotoxic drugs? 91.4 Potential adverse health effects 101.5Risk control 112. Legislative requirements 122.1 Work Health and Safety Act 2011 122.2 W ork Health and Safety Regulation 2011 122.2.112Managing risks 2.2.2Hazardous chemicals 132.2.3 Duties of manufacturers, importers and suppliers of hazardous chemicals 132.2.4Labelling 132.2.5Safety Data Sheets 162.2.6 D uty of supplier supplying carcinogenic chemicals 162.2.7 S ummary of duties of PCBUs who use hazardous chemicals 162.2.817Plant and equipment 2.3 O ther NSW legislation and standards 172.418Integrating health and safety into the workplace 2.5 The risk management approach 2.619Consultation 193. Managing risks to health and safety 213.1 Identify hazards of cytotoxic drugs used and stored at the workplace 213.2Assess the risks 223.3Record, review and revise the risk assessment 253.4Control the risk 253.5Hierarchy of control 253.5.1Eliminate the risk 263.5.2 Personal protective equipment 273.6 M ake the workplace safer 273.7Develop a risk control plan 283.8Maintain risk controls 283.9Review control measures 294. Personnel management 304.1General 304.2 What is health monitoring? 304.3Biological monitoring 304.4 What type of health monitoring should be provided? 30

4.5 Planning parenthood, pregnancy and lactation 334.6Emergency procedures 344.7 Reporting and keeping records 345. Information, instruction and training 355.1Who should be trained? 355.2 Identify what information and training is needed 355.3 Evaluate the training program 365.4Keep training records 366. Preparing and dispensing cytotoxic drugs 6.1Control measures 37376.2 A lternative supply arrangements 376.3 S etting up a cytotoxic drug preparation facility 386.3.138Drug preparation facilities 6.3.2 Work organisation layout and design 386.3.3Drug storage 396.4 D rug preparation equipment 396.539 Standard operating procedures for preparing cytotoxic drugs 6.5.1Parenteral preparations 6.5.26.6 Non-parenteral preparations (extemporaneous) 3940Labelling 406.7 P ersonal protective equipment 406.8 P ackaging and transporting cytotoxic drugs 406.8.140Drug packaging 6.8.2 D rug transport inside and outside the hospital 416.9 Maintaining controls 416.9.1 P erformance testing and inspection of facilities and equipment 416.9.2Equipment maintenance 416.9.3 Cleaning drug preparation facilities 416.10Summary of control measures 7. Administering cytotoxic drugs 42437.1 Key risk control measures 437.2 S etting up a drug administration area 437.3 C ytotoxic drug administration 447.3.1Equipment 447.3.2Parenteral administration 447.3.3Topical agents 447.3.4Oral administration 457.4Summary of control measures 8. Managing cytotoxic contaminated body wastes 45468.1 Key risk control measures 468.2 Assessment of body waste contamination 46

8.3Procedures 468.3.1The patient care area 8.3.246Patient care equipment 478.3.3 S tandard operating procedures 478.3.447 Personal protective equipment 8.4Transporting patients 8.4.1Within an establishment 8.4.2By ambulance 8.54747Laundering 488.5.1 Personal protective equipment 8.5.248Linen 488.6Summary of control measures 9. Spill management 9.147Sources of spills 9.2 S pill management strategy 495050509.3Training 509.4Spill kit contents 509.5Spill containment 519.5.1In health care settings 519.5.2In community care settings 519.5.3On carpets 519.5.4 Within a cytotoxic drug safety cabinet or cleanroom 9.651Contamination 529.6.1 Clothing and personal protective equipment 529.6.2 P enetrating injuries, skin and other body contact 529.6.3Mucosal exposure 52Reporting procedures 529.79.7.19.8Notification of incidents Summary of control measures 10. Waste management 52535410.1 W hat is cytotoxic waste? 5410.2Risk management 55Control measures 5510.2.110.310.3.1 Identification, containment and segregation Labelling requirements 555610.3.2Containment 5610.3.3Segregation 5710.4 Licences for the generation and storage of cytotoxic waste 5710.558 Requirements for handling or storage of cytotoxic waste 10.6 I nternal movement of cytotoxic waste 5810.7Waste storage 5810.8Off-site transport 59

10.8.1Licences to transport 5910.8.2Vehicle signage 5910.8.3 Other requirements for cytotoxic waste transportation 6010.9 W aste disposal and treatment 6010.9.160Thermal destruction 10.9.2Stockpiling cytotoxic waste 6010.9.3 Record-keeping requirements 6010.10Summary of control measures 6111. Caring patients in community settings 11.1 Doctor’s surgery and ambulatory care facilities 11.1.1Managing risks 11.1.2Personnel management 6262626211.1.3 I nformation, instruction and training 6211.1.4 P reparing and dispensing cytotoxic drugs 6211.1.563 Administering cytotoxic drugs 11.1.6 M anaging cytotoxic contaminated body waste 6311.1.763Spill management 11.2 C aring for patients at home 6311.2.163Role of the treating facility 11.2.2Setting up a patient care area 6311.2.3Drug transport 6311.2.4Maintaining controls 6411.2.5Equipment 6411.2.6 Administering cytotoxic drug 6411.2.7 Managing cytotoxic contaminated body waste 6411.2.8Waste management 6411.2.9Home laundering 6511.2.10 S tandard operating procedures 6511.3 Emergency procedures 6511.4Summary of control measures 6612. Cytotoxic drugs in veterinary practices 6712.1 I nformation, instruction and training 6712.2Personnel management 6712.3Managing risk 6812.3.1Good practice controls 12.4 D etermine what is needed for a drug treatment facility 12.4.112.4.2 Information for veterinary staff Emergency procedures 6868696912.5 P reparing and dispensing cytotoxic drugs 6912.5.16912.5.2 Labelling and packaging of cytotoxic drugs Drug storage 7012.6Drug administration 7012.7 Cytotoxic drug excretion and managing animal waste 70

12.8Spill management 12.9Animal care 12.9.1 S etting-up an animal care area 70717112.9.2Equipment 7112.9.3 Standard operating procedures 7112.9.4 Personal protective equipment 7112.10 C ontamination of workers 7212.10.1 C ontamination of clothing and personal protective equipment 7212.10.2 D irect exposure of workers – penetrating injuries, skin and other body contact 7212.10.37212.11 Mucosal exposure of workers – eyes Reporting procedures 12.11.1Notification of incidents involving cytotoxic drugs to SafeWork NSW 727212.11.2 A uthorisation of cyclophosphamide use from SafeWork NSW 7212.12 M anaging cytotoxic contaminated waste 7212.12.17312.13 Waste identification – labelling requirements Animal care at home 7312.13.1Role of treating facility 7412.13.2Information for carers 7412.13.3 Equipment used in animal care 7412.13.4Written procedures 7412.13.5 Spills 7412.13.612.14Laundering 75Summary of control measures 75Appendix 1 – Glossary 76Appendix 2 – Information sources 82Appendix 3 – Commonly used cytotoxic drugs 85Appendix 4 – Safety data sheet (SDS) 88Appendix 4A – SDS requirements under GHS (minimum information required on an SDS) 92Appendix 5 – Hazardous chemicals (cytotoxic drugs) register 95Appendix 6 – Risk assessment template for cytotoxic drugs 96Appendix 7 – Cytotoxic drug health monitoring guidelines for medical practitioners 97Appendix 8 – Record keeping 100Appendix 9 – Personal protective equipment 101Appendix 10 – Safe handling of cytotoxic contaminated body chemicals 105Appendix 11 – Cytotoxic drug precautions alert proforma 108Appendix 12 – Cytotoxic drug home spills proforma 109Further information 110

1. INTRODUCTION1.1 PURPOSEThis guide provides practical advice to PCBUsand workers on how to prevent or minimisethe risks to health associated with handlingcytotoxic drugs and related waste within healthcare establishments, community settingsand veterinary practices. It will assist in thedevelopment and implementation of safe systemswork of that are consistent with the requirementsof NSW work, health and safety laws.The use of cytotoxic drugs includes theirpreparation, administration, handling, storage,movement, disposal, and spills management.1.2SCOPEThis guide applies primarily to the clinical handlingof cytotoxic drugs and related waste in healthcare settings, including: hospital settings pharmacies – hospital and community analytical pathology and research laboratories doctors’ surgeries and medical practice rooms domiciliary ambulatory clinics patients’ homes nursing homes, hostels and other residentialcare settings1.3 W HAT ARE CYTOTOXICDRUGS?Cytotoxic drugs work by causing the deathof certain type of cells and are used to treatconditions such as cancer, rheumatoid arthritis,multiple sclerosis, some ophthalmic conditions.Not all drugs prescribed for cancer are cytotoxic.Cytotoxic drugs are known to be highly toxicto non-target cells, mainly through their actionon cell reproduction. Some have been shown tocause second cancers in cancer patients. Somehave also been shown to be mutagenic (causingchanges to DNA) or teratogenic (causing birthdefects) in various experimental systems.Cytotoxic drugs are increasingly being usedin a variety of health care and communitysettings, laboratories and veterinary practicesfor the treatment of cancer and other medicalconditions, such as rheumatoid arthritis, multiplesclerosis and autoimmune disorders e.g. psoriasisand systemic lupus erythromatosis.Generally, cytotoxic materials are identifiedby a purple symbol that depicts a cell in latetelophase.Cytotoxic drug veterinary clinics ambulance vehicles pharmacy and pathology courier services waste collection and disposal facilities laundry facilities and Non-Emergency PatientTransport (NEPT) funeral homes mortuaries.CYTOTOXIC DRUGS AND RELATED WASTE – RISK MANAGEMENT9

With the implementation of Globally HarmonisedSystem of Classification and Labelling (GHS),under WHS Regulation, a new GHS hazardpictogram was introduced to communicate healthhazards of workplace chemicals. The pictogrambelow should appear on labels of cytotoxic drugssupplied to workplaces from 1 January 2017.1.4 P OTENTIAL ADVERSEHEALTH EFFECTSWhere control measures are inadequate, adversehealth effects may result from workplace exposure.Health effects that have been attributed tothose who prepare and administer cytotoxicdrugs include: alterations to normal blood cell count foetal loss and possible malformationsin offspring fertility changes abdominal pain, hair loss, nasal sores andvomitingWorkplace exposure to cytotoxic drugs andrelated waste may occur where control measuresfail or are not in place. Exposure may occurthrough skin contact, skin absorption, inhalationof aerosols and drug particles, ingestion andsharps injuries. Exposure may occur when: preparing drugs administering drugs transporting drugs handling patient waste transporting and disposing of waste cleaning spills contact with equipment/surfaces in areaswhere cytotoxic drugs may be used oradministered contact with cytotoxic contaminated linen.Those most likely to be involved in theseactivities include: nurses and medical officers pharmacists laboratory staff cleaning, maintenance and wastedisposal staff laundry workers carers veterinary staff ambulance officers and drivers.10SAFEWORK NSW liver damage contact dermatitis, a local toxic reaction or anallergic reaction that may result from directcontact with the skin or mucous membranes.These effects have not been reported where ahigh standard of risk control is in place.Current statistics indicate that one-in-twoAustralian men and one-in-three Australianwomen have a life-long risk of developingcancer. However, there is little scientific evidenceto suggest that working with cytotoxic drugsactually increases the risk of developing cancer.In the absence of such data, a strategy ofprudent avoidance is recommended.Little is known about the long term effectsfrom workplace exposure to cytotoxic drugs.There are no workplace exposure limits set forcytotoxic drugs. Medical opinion suggests thateven low-level exposure to cytotoxic drugsshould be avoided. Research shows that theimplementation of suitable safety precautionsand risk control measures minimises theincidence of adverse health effects.Application of the procedures outlined in thisguide should give pregnant women and thosethat are planning parenthood substantialconfidence that risks have been minimised.If involved in the preparation or administrationof cytotoxic drugs, those who are pregnant,breast-feeding or planning parenthood shouldbe informed of the reproductive risks and thepossible effects on foetal development.

Those who normally prepare or administercytotoxic drugs may elect not to do so and, insuch cases, appropriate and suitable alternativeduties must be provided.1.5RISK CONTROLDue to the concentrations and quantities used,the most significant risk of workplace exposure tocytotoxic drugs is during their manufacture andpreparation. A significant risk also occurs whenhandling cytotoxic drugs and related wastes.To protect the health of workers, the first priorityis to eliminate or minimise the risks to health.Risk control may be implemented by: planning and designing of workplace set-up tominimise exposure to cytotoxic drugs using control measures and specialisedequipment, such as cytotoxic drug safetycabinets establishing written policies and protocols toensure the safe handling of cytotoxic drugs implementing stringent handling proceduresfor both drugs and waste materials training and educating workers wearing personal protective equipment integrating a health monitoring program that:–– includes the assessment and counsellingof prospective workers before theycommence any work involving cytotoxicdrugs and related waste–– ensures worker confidentialityIt is paramount that patients and carers areappropriately educated before treatment so thatthey understand and appreciate the health andsafety requirements for themselves and others.CYTOTOXIC DRUGS AND RELATED WASTE – RISK MANAGEMENT11

2. LEGISLATIVE REQUIREMENTSThere are a number of work health and safetyrequirements that are relevant when using andhandling cytotoxic drugs and related waste.See Appendix 2.2.1 W ORK HEALTH ANDSAFETY ACT 2011In NSW, there is a legal obligation to providea healthy and safe workplace. Under the WorkHealth and Safety Act 2011 (WHS Act), a PersonConducting a Business or Undertaking (PCBU)must ensure, so far as is reasonably practicable,the health and safety of workers and provide andmaintain a work environment without the risks totheir health and safety. Self-employed persons,workers, and manufacturers, importers andsuppliers of plant, equipment and chemicals alsohave obligations for workplace health and safetyunder WHS Act.A person who designs, manufactures or suppliesany plant or chemicals for use by people at workmust provide, so far as is reasonably practicable,adequate information about the plant orchemicals to the persons to whom it is suppliedto ensure its safe use.The Work Health and Safety Regulation 2011(WHS Regulation) makes specific provisionsfor hazardous chemicals including dangerousgoods. So far as is reasonably practicableinformation must be provided to ensure it issafe and without risks to health when properlyused, even when a chemical is not classified asa hazardous chemical or dangerous goods (seebelow). Product information, including adverseeffects, is often provided with packaged drugsand provides an additional source of informationabout their risks and safe use.12SAFEWORK NSW2.2 W ORK HEALTH ANDSAFETY REGULATION 2011Work involving the handling and transport ofcytotoxic drugs falls within the scope of theWHS Regulation, specifically Chapter 3, GeneralRisk and Workplace Management and Chapter 7Hazardous Chemicals.A limited number of chemicals are exempt fromthe WHS Regulation, including therapeutic goodsthat are brought into the workplace for personaluse. However, exemption does not apply when thechemicals are used for a work-related activity.2.2.1Managing risksEven when a chemical including a cytotoxic drug,is not classified as a hazardous chemical by themanufacturer or importer, the PCBU must stillcomply with Chapter 3 of the WHS Regulationwith respect to that chemical and the PCBU mustensure that each chemical does not pose a healthor safety risk to those at work.In other words: any hazards associated with the cytotoxicdrug must be identified any risks must be assessed in consultationwith workers risks must be eliminated or controlled inconsultation with workers training must be provided information and supervision must be provided first-aid and emergency procedures must bedeveloped.Key safe use information is provided on labels,and more detailed workplace, health and safetyinformation is provided in safety data sheets.The safety data sheet and the label are themain information sources for most workplacerisk assessments. Other sources of informationinclude, product information sheets, researchpapers, Medical Information Management System(MIMS) and technical reports.

2.2.2Hazardous chemicalsChapter 7 of the WHS Regulation aims to protectpeople against risks to their health and safetywhen hazardous chemicals are used at work.For a chemical used at a workplace to beclassified as a hazardous chemical, it must: meet the criteria set out in the Safe WorkAustralia publication, Classification ofhazardous chemicals under the WHSRegulations; or be listed in the Hazardous ChemicalsInformation System of Safe Work AustraliaMost cytotoxic drugs will be classifiable ashazardous chemicals in accordance with theClassification of hazardous chemicals under theWHS Regulations hazardous chemicals. The SafeWork Australia Code of Practice for Managingthe risks of hazardous chemicals in the workplaceprovides practical guidance on complying withthe WHS Regulation.Cyclophosphamide is a carcinogenic chemicalrequiring authorisation under Clause 384 of theWHS Regulation and its use must be authorisedby SafeWork NSW in accordance with Clause383 and authorisation must be obtained to use,handle or store. Schedule 10 of WHS Regulationcontains a list of prohibited carcinogens (Table10.1) and a list of restricted carcinogens (Table10.2). For information on authorisation see Guidefor applicants for authorisation to use, handle orstore prohibited or restricted carcinogens and theapplication form Application for the authorisationto use, handle or store prohibited and restrictedcarcinogens.Where/when cytotoxic drugs are classified ashazardous chemicals, any waste they generateis also likely to be classified as a hazardouschemical and the WHS Regulation applies.The NSW Environment Protection Authority(NSW EPA) regulates the transport of cytotoxicwaste, particularly bulk transports. See Chapter10 on waste management for further information.2.2.3 uties of manufacturers,Dimporters and suppliers ofhazardous chemicalsIn addition to the general duties of the WHS Act,the WHS Regulation requires manufacturers andimporters who supply hazardous chemicals toworkplaces to provide certain information abouttheir product.They are required to: determine whether a chemical is a hazardouschemical prepare and provide specific information inthe form of safety data sheets and labels toPCBUs who use their chemicals.Suppliers (excluding retailers) are required to: provide PCBUs with a copy of themanufacturer’s or importer’s safety datasheets ensure that containers of hazardous chemicalsare correctly labelled with safety information.When hospital departments supply cytotoxicdrugs to other hospitals, or to other facilities orservices, they are considered to be suppliers.2.2.4LabellingIn a workplace, how a cytotoxic drug is to beused, determines the appropriate label that isrequired. The NSW Poisons and TherapeuticGoods Regulation 2008 requires a supplier toensure that the packaging and labelling of aScheduled medicine or poison complies withthe Commonwealth Standard for the UniformScheduling of Medicines and Poisons (SUSMP).However, the labelling requirements of thisstandard do not apply to a poison that is: packed and sold solely for dispensary,health care facility/services, laboratory ormanufacturing purposes labelled in accordance with the Safe WorkAustralia Code of Practice for the Labelling ofworkplace hazardous chemicals 2015.Cytotoxic drugs that are packed and sold solelyfor workplace uses such as dispensary, industrial,laboratory or manufacturing purposes must belabelled in accordance with the requirements ofthe WHS Regulation.CYTOTOXIC DRUGS AND RELATED WASTE – RISK MANAGEMENT13

Under the WHS Regulation, suppliers and PCBUshave specific responsibilities for labelling cytotoxicdrugs that are hazardous chemicals. In NSW, thesupplier must ensure hazardous chemicals areappropriately labelled (see Clause 338).A PCBU must ensure that a container that holdsa hazardous chemical used at work, includingone supplied to or manufactured within thePCBU’s workplace or transferred or decantedfrom its original container at the workplace, isappropriately labelled (see clauses 335 and 342).The label must: clearly identify the hazardous chemical provide basic health and safety informationabout the chemical, including any relevanthazard and precautionary statements.For specific practical guidance and advice onlabelling requirements, refer to the: Code of practice for labelling of workplacehazardous chemicals 2015, Safe Work Australia Code of practice for managing the risks ofhazardous chemicals in the workplace 2012,Safe Work Australia Factsheet for understanding safety datasheets for hazardous chemicals, Safe WorkAustralia Factsheet for understanding hazardouschemical labels, Safe Work Australia Standard for the uniform scheduling ofmedicines and poisons (SUSMP) 2011.14SAFEWORK NSW

Table 1: Workplace labelling for hazardous chemicalsLabel itemsAll containersContainers toosmall to attachfull labelContainershaving chemicalsdecanted ortransferredContainersholdinghazardous wastechemicalsProduct Identifier:IUPAC name or CASname or technical nameYesYesYesYes (specify thenature of thewaste as closelyas possible)United Nations number,class and subsidiary risk(where required by ADGCode and NSW EPA)NoNoNoYes (whererequired by ADGCode and NSWEPA)Ingredients andformulationYesNoNoNoIdentity and proportionof each chemicalingredientYesNoNoNoYesName and Australianaddress and businesstelephone number of themanufacturer or importerYesNoYesHazard pictogram(s)YesYes or hazardstatementYes or hazardstatementYesHazard statement(s)YesYes or hazardpictogramYes or hazardpictogramYesSignal st aid and emergencyprocedure detailsYes when notincluded inthe hazardstatement orprecautionarystatementNoNoNoAny other informationthat is reasonablypracticable to includeYesYesNoNoExpiry date (if applicable) YesNoNoNoCYTOTOXIC DRUGS AND RELATED WASTE – RISK MANAGEMENT15

2.2.5Safety Data SheetsThe Safety Data Sheet (SDS) is a document thatdescribes the chemical and physical propertiesof the hazardous chemicals and provides adviceon the safe handling and use of the hazardouschemicals. The safety data sheet is a recognisedsource of information in the workplace andunderpins the overall risk managementprogram to control exposure to hazardous anddangerous chemicals.Legal obligations in relation to safety datasheets are specified in the WHS Regulation.Manufacturers are required to classify chemicalsand prepare safety data sheets. Importers mustensure that the manufacturer’s responsibilitiesare met.Suppliers are required to provide safetydata sheets for those chemicals classifiedas hazardous chemicals if they supply toworkplaces. If a supplier fails to provide anadequate safety data sheet, other sources ofinformation should be used to obtain informationand to assist in the risk management process.PCBUs must ensure that safety data sheets andother sources of information are accessible toworkers who may be exposed to the chemicals.For more specific guidance and advice on safetydata sheets, refer to the: Code of practice for the preparation of safetydata sheets for hazardous chemicals 2011,Safe Work Australia. Code of practice for managing the risks ofhazardous chemicals in the workplace 2012,Safe Work Australia.2.2.6 uty of supplier supplyingDcarcinogenic chemicalsA person who supplies a restricted carcinogenicchemical (Cyclophosphamide) for use at workmust keep a record containing: the name of the person to whom thecarcinogenic chemical has been supplied the name and quantity of the carcinogenicchemical supplied.The record must be retained for at least five years.16SAFEWORK NSW2.2.7 S ummary of duties of PCBUswho use hazardous chemicalsPCBUs must use information provided bymanufacturers, importers or suppliers to identifythe hazardous chemicals used in the workplace,assess the risk to health, and control any risk tohealth associated with their use, in consultationwith workers.In summary, the WHS Regulation requiresPCBUs to: obtain a copy of the manufacturer’s orimporter’s safety data sheet and ensure that itis accessible to workers ensure all containers of hazardous chemicalsare labelled according to legislation set-up a hazardous chemical register (seeAppendix 5) assess workers’ risk to health from exposure tohazardous chemicals eliminate or control the risk associated withthe use of hazardous chemicals provide workers with information, instructionand training consult with workers on the above.SafeWork NSW is the competent authorityon dangerous goods in NSW. However, theNSW Environment Protection Authority (EPA)is responsible for regulating the transport ofdangerous goods in NSW.Cytotoxic drugs that are classified as dangerousgoods and are being transported must complywith the Australian Code for the Transport ofDangerous Goods by Road and Rail (the ADGCode) and NSW EPA’s requirements.

2.2.8Plant and equipmentChapter 5 Plant and structures of the WHSRegulation outlines specific obligations withrespect to plant, as well as the general obligationto ensure workplace health and safety. Plantincludes any machinery, equipment or appliance.With respect to cytotoxic drugs and relatedwaste, plant may include cytotoxic drug safetycabinets, trolleys for carrying cytotoxic drugsadministration equipment, drug delivery se

3.1 dentify hazards of cytotoxic drugs used and stored at the workplaceI 21 3.2 Assess the risks 22 3.3 Record, review and revise the risk assessment 25 3.4 Control the risk 25 3.5 Hierarchy of control 25 3.5.1 Eliminate the risk 26 3.5.2 rsonal protective equipmentPe 27 3.6 ake the workplace saferM 27