Chemotherapy and Other Hazardous Drugs

Safe Use and Handling

Drugs are classified as hazardous if they may cause cancer, developmental or reproductive toxicity, or harm to organs at low doses. They include drugs used for cancer chemotherapy (also called antineoplastics), antiviral drugs, hormones, some bioengineered drugs and other various drugs. To determine if a drug is classified as hazardous check the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings (2014).

Follow safety precautions when working with hazardous drugs. These include use of exhausted enclosures, procedures to avoid personal exposure and contaminating surfaces, personal protective equipment (PPE), and training of personnel in hazard awareness and safe work practices.

Federal and state regulations and guidelines exist for the use, handling, storage, treatment, and disposal of hazardous drugs in clinical and research settings. EH&S has developed guidance that includes procedures for safety, compliance, and best practices. For research involving hazardous drugs at UW, follow these guidelines:

For veterinary clinical care, use the Veterinary Hazardous Drug Program Guide from Washington State Labor & Industries.


Waste

Manage chemotherapy (chemo) and hazardous drug waste separately from other waste streams such as biohazardous waste. Chemo/hazardous drug waste should not be autoclaved. Collect chemo/hazardous drug waste as either trace or non-trace waste as defined below.


Trace Chemo/Hazardous Drug Waste

"Trace" refers to empty containers or containers that have less than 3% of the original quantity of drug remaining, such as sharps, empty syringes, and vials. An "empty" container is one in which all contents have been removed by normal means such as aspiration, pouring, or flushing.

Trace Chemo/Hazardous Drug Waste Collection

Trace chemo sharps

Collect in yellow sharps waste container:

  • sharps with trace chemo/hazardous drugs
  • sharps with trace chemo/hazardous drugs and biohazards
  • empty chemo/hazardous drug vials and containers (<3% of original quantity)

Label as "trace chemo waste" with PI name and room number (label template available). Containers are available for purchase from Biochemistry stores or from lab/medical supply vendors. See Sharps and Laboratory Glass for sharps definitions.

Trace Chemo/Hazardous Drug Waste Disposal

All trace chemo and hazardous drug waste generated at the University of Washington is collected and shipped off site for disposal by incineration at a regulated facility. Before preparing waste for shipment, the person preparing the waste must complete the EH&S Shipping Regulated Medical Waste class. Waste generators can set up an account for shipping trace chemo waste at Biohazardous/Regulated Medical Waste Vendor Collection Set Up.


Non-Trace Chemo/Hazardous Drug and EPA P-Listed Waste

Non-trace chemo/hazardous drug waste refers to unused or expired drugs, containers with more than trace amounts of chemo/hazardous drug, contaminated PPE, and contaminated items from preparation, use, and clean-up. Dispose of non-contaminated PPE and other items in the trash.

Environmental Protection Agency (EPA) P-listed drugs are acutely hazardous drugs regulated by federal law. Handle all P-listed drug waste (including empty containers and trace amounts) as non-trace chemo/hazardous drug waste. P-listed chemo/hazardous drugs include:

Waste Code Constituent of Concern Product Name Examples
P001 Warfarin and salts (>0.3%) Coumadin, Warfarin
P012 Arsenic trioxide Trisenox
P042 Epinephrine Adrenaline, EpiPen, Eppy/N, Epifrin, Epinal, Anaphylaxis kit, Epinephrine, Racepinephrine, Racord, Primatene inhaler
P046 Phentermine Phentermine (CIV)
P075 Nicotine and salts Nicotine patches, Habitrol, Nicoderm, Nicorette, Nicotrol, Tetrahydronicotyrine
P188 Physostigmine salicylate Eserine salicylate
P204 Physostigmine Eserine

Source: WA State Dept. of Ecology RCRA list

Non-Trace and P-Listed Waste Collection

Collect for pickup by EH&S:

  • unused or expired chemo/hazardous drugs
  • containers with more than trace amounts of chemo/hazardous drugs
  • P-listed drugs and empty containers
  • sharps with P-listed drugs
  • visibly contaminated items from preparation, use, and clean-up (PPE, pads, etc.)

Non-Trace and P-Listed Waste Disposal

All non-trace chemo/hazardous drug and P-listed drug waste generated at the University of Washington is collected by EH&S Environmental Programs and shipped off site for disposal by incineration at a regulated RCRA facility. To request a collection of non-trace waste, visit the EH&S Hazardous Chemical Waste website.


Sharps Waste Poster

The "Sharps Waste Poster" poster is available for download! Print in color and display for guidance on sharps waste disposal. Download and print from Adobe Acrobat for best results.


Regulations and Resources


Questions?

For questions regarding chemo/hazardous drug waste collection and disposal, contact an EH&S occupational health and safety specialist at uwcho@uw.edu or 206.543.7388. To request pickup of non-trace waste, visit the EH&S Hazardous Chemical Waste website.