# Aseptic compounding of hazardous anticancer drugs in the pharmacy

Source: https://onco.cc/protocols/aseptic-compounding-of-hazardous-anticancer-drugs/  
OnCo record `aseptic-compounding-of-hazardous-anticancer-drugs` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer drugs given by drip or injection are usually made up in a hospital pharmacy, inside a sealed cabinet that protects both the drug from germs and the staff from the drug. Staff wear chemotherapy gloves and gowns, use sealed transfer devices, and prepare the drip lines in the cabinet so that nurses do not have to open the drug on the ward.

## Summary

Compounding hazardous drugs carries the highest exposure risk of any handling task. The NIOSH Alert (2004), endorsed by ASCO (2019) alongside USP chapter 800, OSHA and ONS, is the most detailed open standard. Drugs on the NIOSH list (2024 update) are prepared in a ventilated cabinet: where asepsis is needed, a Class II biological safety cabinet (type B2 preferred), a Class III cabinet or an aseptic containment isolator, exhausting filtered air outside where feasible. Staff wear double chemotherapy-tested gloves, changed every 30 minutes or when damaged, and a disposable, non-absorbent, closed-front gown with cuffs; the outer glove goes over the cuff. Closed-system transfer devices may reduce contamination but are not a substitute for a cabinet and are used inside one. Intravenous tubing is primed in the cabinet or in-line with drug-free fluid, never at the bedside. Work surfaces are cleaned with a deactivating agent where available and a cleaning agent before and after each activity and at the end of the shift, with protective gloves.

The evidence is weak throughout. ASCO's standards are consensus based; on external ventilation of cleanrooms it found no long-term clinical evidence and leaves it to institutions; on CSTDs it found low-quality evidence and called for a testing protocol. The Cochrane review (24 observational cluster studies, 359 hospitals, mostly PhaSeal) could draw no firm conclusions. In the UK, COSHH makes the employer responsible for assessing and controlling exposure, with monitoring where carcinogens are handled.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: chemotherapy compounding; cytotoxic reconstitution; aseptic preparation of chemotherapy; chemotherapy isolator; biological safety cabinet; USP 800 compounding; pharmacy chemotherapy preparation

## Connected records

- protocols: [Anticancer treatment prescribing and pharmacy verification before each cycle](https://onco.cc/protocols/sact-prescribing-and-pharmacy-verification/), [Safe handling of hazardous anticancer drugs where they are given: protective equipment, closed systems, spills, waste and body fluids](https://onco.cc/protocols/hazardous-drug-handling-in-clinical-areas/)
- technologies: [Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)](https://onco.cc/technologies/closed-system-transfer-devices/), [Oncology pharmacy automation and compounding robots](https://onco.cc/technologies/pharmacy-automation/)

---
JSON: https://onco.cc/api/v1/entities/aseptic-compounding-of-hazardous-anticancer-drugs.json