By JIM MULLOWNEY
In its second edition of “Safe Management of Wastes from Health-Care Activities,” released in August, the World Health Organization (WHO) singled out contact with residual amounts of chemotherapy drugs as a significant risk requiring collection, containment and proper disposal in order to avoid exposure "through contact with body fluids and secretions [urine, feces and vomit] of patients undergoing chemotherapy.”
Genotoxic/cytotoxic compounds, most commonly found in chemotherapy drugs, work by either mutating or killing cells. Unlike poisons, which can be safe when exposure is limited to tiny amounts, genotoxins/cytotoxins act more like "chemical germs," where even minimal exposure can cause a devastating chain reaction. The risk from contact to an otherwise healthy person is especially heightened when there is a significant amount of cell development happening — for example, among children and women of childbearing age.
According to the WHO report, any wastes produced by these patients within 48 hours of drug administration, and in some cases for up to a week, should be considered genotoxic.
Despite the otherwise well-regulated and well-managed handling of dangerous medical waste, chemotherapy patients treated with any of more than two dozen different chemotherapy drugs who return home after outpatient treatment can inadvertently but easily expose others to genotoxic contamination through seemingly benign occurrences such as urine splashed on a bathroom floor, clean up after an episode of vomiting, or the handling of bed sheets or a bedpan for a patient unable to use a bathroom.
The WHO report address what many in the field of chemotherapy-based treatment have long acknowledged as a dangerous "blind spot.” The human body can only destroy a portion of these genotoxic drugs. The rest passes out of the patient in urine, feces, vomit, or even sweat. The waste will still have enough dangerous drug to kill developing cells and/or cause mutations in vulnerable members of our population, especially fetuses and babies.
The WHO has done a great public service by stepping up and publicly declaring what many of us in the field have long known — this is a serious risk.
WHO core principles "require that everyone associated with financing and supporting health-care activities should provide for the costs of managing health-care waste. This is the duty of care. Manufactures also share a responsibility to take waste management into account in the development and sale of their products and services."
The WHO goes on to identify those who have a special responsibility to ensure safe collection, containment and disposal of these wastes, placing much of that responsibility with the chief pharmacist. "The chief pharmacist also has the special responsibility of ensuring that genotoxic products are used safely, and that genotoxic waste is managed safely," according to the WHO.
Jim Mullowney is the founder and CEO of Newport-based Pharma-Cycle Inc.