title: Safe handling of cytotoxics: guideline recommendations.
abstract: BACKGROUND
  This evidence-based practice guideline was developed to update and address new issues in the handling of cytotoxics, including the use of oral cytotoxics; the selection and use of personal protective equipment; and treatment in diverse settings, including the home setting.
  
  
  METHODS
  The guideline was developed primarily from an adaptation and endorsement of an existing guideline and from three systematic reviews. Before publication, the guideline underwent a series of peer and external reviews to gather feedback. All comments were addressed, and the guideline was amended when required. The guideline applies to health care workers who could come into contact with cytotoxic drugs at any point in the medication circuit. The intended users are hospital administrators, educators, and managers; occupational health and safety services; and pharmacy and health care workers.
  
  
  RESULTS
  The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize opportunities for accidental exposure. They are not limited to just the point of care; they cover the entire chain of cytotoxics handling from the time such agents enter the institution until they leave in the patient or as waste.
  
  
  CONCLUSIONS
  Reducing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from earlier guidelines because of the availability of new evidence.
authors: Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON. ; Centre for Global eHealth Innovation, University Health Network and University of Toronto, Toronto, ON.
authors: A C
authors: AC
authors: Easty
authors: Cancer Care Ontario, Program in Evidence-Based Care, Hamilton, ON. ; Department of Oncology, McMaster University, Hamilton, ON.
authors: N
authors: N
authors: Coakley
authors: Institute for Safe Medication Practices Canada (ISMP Canada), Toronto, ON.
authors: R
authors: R
authors: Cheng
authors: Public Health Ontario, Hamilton ON. ; St. Joseph's Healthcare, Hamilton, ON.
authors: M
authors: M
authors: Cividino
authors: Princess Margaret Cancer Centre, Toronto, ON.
authors: P
authors: P
authors: Savage
authors: Juravinski Hospital, Hamilton, ON. ; Department of Oncology, McMaster University, Hamilton, ON.
authors: R
authors: R
authors: Tozer
authors: Centre for Global eHealth Innovation, University Health Network and University of Toronto, Toronto, ON.
authors: R E
authors: RE
authors: White
keywords: Cytotoxic drugs; cytotoxic drug administration; cytotoxic drug preparation; guidelines; hazardous waste; personal protective equipment