Dosen Pengampu : apt. Putu Rika Veryanti, M.

Farm-Klin

Disusun oleh
Kelompok 1 kelas B :

Farmasi
Friska Raulina S. 19340274
Astri Herliansi A. K. 21340051
Diana Karina 21340052
Hermila Nopianti 21340053

Rumah Sakit
Zikra Fajri Nurta 21340054
Rizky Wulandari 21340055
Fitri Ruli Aslamah 21340056
Rendy Bagus Sulistiyono 21340057
Dwi Gita Marinka 21340058

Handling Cytotoxic
Feby Hardianti 21340059
Lusiana Berti 21340060
Hasiana Karwila 21340061
Oktavia Prajawatia Paalloan 21340062

HANDLING CYTOTOXIC
 Definisi
Senyawa sittoksik
Senyawa sittoksik adalah suatu senyawa atau zat yang dapat merusak dan sel
normal dan juga sel kanker, serta digunakan untuk menghambat pertumbuhan
Senyawa dari sel tumor maliginan.
sittoksik
Obat sitotoksik
Obat sitotoksik adalah agen yang ditujukan untuk terapi, khususnya pada
pengobatan kanker. Obat ini diketahui sangat beracun bagi sel-sel, terutama
Obat melalui tindakannya pada reproduksi sel.
sitotoksik
Handling cytotoxic drugs
Handling cytotoxic drugs adalah penanganan penggunaan obat sitostatika. Hal ini
perlu dilakukan karena obat ini dikenal sangat beracun untuk sel, terutama melalui
tindakan mereka pada reproduksi sel. Banyak yang terbukti menjadi karsinogen,
Handling mutagen atau teratogen.
cytotoxic drugs
Peran Farmasi dalam Implementasi Handling Cytotoxic

Penyiapan

Pengelolaan Limbah Sitotoksik

Pencampuran

Penanganan Kecelakaan Kerja pada

HC

Dengan prinsip 5 BENAR
(benar pasien, obat, dosis, rute
dan waktu pemberian).
Penyiapan
(nama obat, jumlah, nomer Melakukan konfirmasi ulang
batch, tannggal kadaluarsa), Untuk mendapatkan efek yang Memilih jenis pelarut yang
kepada pengguna jika ada yang
serta melengkapi form maksimal dan menghindari sesuai dangan zat aktif
tidak jelas/tidak lengkap.
permintaan over dosis

Memeriksa kelengkapan Memeriksa Melakukan Menghitung Memilih jenis pelarut

dokumen kondisi obat konfirmasi kesesuaian dosis. yang sesuai.

nama px, no, RM, ruang

Memasukkan alat kesehatan,
label, dan obat-obatan yang
akan dilakukan pencampuran
kedalam ruang steril melalui
pass box
Contoh form pencampuran
dibuku 1: Pedoman Dasar
Dispensing Sediaan Steril
Terdiri dari : nama pasien,
nomer rekam medis, ruang
perawatan, jumlah paket.
perawatan, dosis, cara
pemberian, kondisi
penyimpanan, tanggal Menghitung volume pelarut
pembuatan, dan tanggal yang digunakan sesuai dengan
kadaluarsa campuran sediaan yang diresepkan

Memasukkan alkes, Menghitung

Melengkapi dokumen Membuat label Membuat volume pelarut
label, dan obat-obatan pencampuran pengiriman label obat
PASS BOX
 Pencampuran
Melakukan dekontaminasi dan
desinfeksi BSC sesuai
Memakai APD sesuai Mencuci tangan sesuai Menghidupkan biological
PROSEDUR TETAP
PROSEDUR TETAP PROSEDUR TETAP safety cabinet (BSC) 5 menit
Protap Desinfeksi Dan
sebelum digunakan.
Dekontaminasi

1 2 3 4

Mengambil alat kesehatan dan Melakukan desinfeksi sarung Menyiapkan tempat buangan Menyiapkan meja BSC dengan
bahan obat dari passbox. tangan dengan menyemprot sampah khusus bekas sediaan memberi alas sediaan
alkohol 70%. sitostatika sitostatika

Next
slide
8 7 6 5
 Pencampuran…
Meletakkan alat kesehatan dan Melakukan pencampuran
bahan obat yang akan sediaan sitostatika secara
dilarutkan di atas meja BSC. aseptis.
9 10
Menanggalkan APD sesuai Mengeluarkan wadah untuk
prosedur tetap pengiriman yang telah berisi
sediaan jadi melalui pass box.
16 15
Membungkus dengan kantong
hitam atau aluminium foil
Memberi label yang sesuai
untuk obat-obat yang harus
pada setiap infus dan spuit
terlindung cahaya.
yang sudah berisi sediaan
sitostatika
11 12
Memasukan infus untuk spuit Membuang semua bekas
yang telah berisi sediaan pencampuran obat kedalam
sitostatika ke dalam wadah wadah pembuangan khusus.
untuk pengiriman.
14 13
PEMBUANGAN SITOSTATIK
Prosedur
Gunakan Alat pelindung Diri
Penanganan
Limbah
Tempatkan limbah pada kontainer buangan tertutup. Untuk
Sitotoksik benda-benda tajam seperti syringe, vial, ampul, tempatkan di
dalam kontainer yang tidak tembus benda tajam, untuk limbah
lain tempatkan dalam kantong berwarna dan berlogo cytotoxic.

Beri Label Peringatan pada bagian luar Kantong

Bawa Limbah ke tempat Pembuangan menggunakan Troli

Tetutup

Musnahkan limbah dengan incinerator 1000oC

 Your Picture Here
Pengelolaan Limbah
Sitotoksik
Saat ini upaya pengolahan limbah
sitotoksik yang dilakukan adalah
dengan menggunakan alat berupa
incinerator, di mana limbah padat
yang terkontaminasi dengan bahan
sitotoksik akan dibakar dengan suhu
600-10000C.
Alat ini dapat memusnahkan banyak materi,
khususnya yang mengandung karbon dan
bakteri patogen, dapat mereduksi volume
limbah sekitar 80-90%, panas yang dihasilkan
juga dapat dimanfaatkan kembali untuk
menghasilkan uap Akan tetapi, alat ini dapat
menghasilkan emisi gas yang mencemari udara,
terutama digoksin dan fluran yang oleh WHO
dinyatakan karsinogenik. Hal tersebut berarti
bahwa belum ditemukannya solusi terbaik untuk
penangan limbah, khususnya pada limbah
sitotoksik yang sangat jelas dapat mencemari
lingkungan dan membahayakan kehidupan
mahkluk hidup lain.
Langkah Pemusnahan
Limbah
Pengelolaan limbah dari sisa buangan
pencampuran sediaan sitoatatika (seperti: bekas
ampul,vial, spuit, needle,dll) harus dilakukan
sedemikian rupa hingga tidak menimbulkan
bahaya pencemaran terhadap lingkungan
Bahan / benda tajam yang terkontaminasi
dibuang diberi label sitotoksik, wadah anti bocor.
Lalu langkah – langkah yang perlu dilakukan .
adalah sebagai berikut:
1.Gunakan Alat Pelindung Diri (APD).
2.Tempatkan limbah pada wadah buangan
tertutup. Untuk bendabenda tajam seperti spuit,
vial, ampul, tempatkan di dalam wadah yang
tidak tembus benda tajam, untuk limbah lain
tempatkan dalam kantong berwarna (standar
internasional warna ungu) dan berlogo sitostatika
3.Beri label peringatan pada bagian luar wadah.
4.Bawa limbah ke tempat pembuangan
menggunakan troli tertutup.
5. Musnahkan limbah dengan incenerator
1000ºC.
6. Cuci tangan.
 Penanganan Kecelakaan Kerja pada HC
1. Membersihkan tumpahan di luar BSC dalam 2. Membersihkan tumpahan di dalam
ruang steril BSC

• Meminta pertolongan, jangan tinggalkan area sebelum diizinkan. • Serap tumpahan dengan kassa untuk tumpahan cair atau
• Beri tanda peringatan di sekitar area.
handuk basah untuk tumpahan serbuk.
• Petugas penolong menggunakan Alat Pelindung Diri (APD) • Tanggalkan sarung tangan dan buang, lalu pakai 2 pasang
• Angkat partikel kaca dan pecahan-pecahan dengan
sarung tangan baru.
menggunakan alat seperti sendok dan tempatkan dalam kantong
• Angkat hati-hati pecahan tajam dan serpihan kaca sekaligus
buangan. dengan alas kerja/ meja/ penyerap dan tempatkan dalam
• Serap tumpahan cair dengan kassa penyerap dan buang dalam
wadah buangan.
kantong tersebut. • Cuci permukaan, dinding bagian dalam BSC dengan
• Serap tumpahan serbuk dengan handuk basah dan buang dalam
detergent, bilas dengan aquadestilata menggunakan kassa.
kantong tersebut. Buang kassa dalam wadah pada buangan.
• Cuci seluruh area dengan larutan detergent.
• Ulangi pencucian 3 x.
• Bilas dengan aquadest. • Keringkan dengan kassa baru, buang dalam wadah
• Ulangi pencucian dan pembilasan sampai seluruh obat terangkat.
buangan.
• Tanggalkan glove luar dan tutup kaki, tempatkan dalam kantong • Tutup wadah dan buang dalam wadah buangan akhir.
pertama.
• Tanggalkan APD dan buang sarung tangan, masker, dalam
• Tutup kantong dan tempatkan pada kantong kedua.
wadah buangan akhir untuk dimusnahkan dengan
• Tanggalkan pakaian pelindung lainnya dan sarung tangan dalam, inscenerator.
tempatkan dalam kantong kedua.
• Cuci tangan.
• Ikat kantong secara aman dan masukan dalam tempat
penampung khusus untuk dimusnahkan dengan incenerator.
• Cuci tangan.
 Your Picture Here

Fasilitas Handling
Cytotoxic

LAFC Vertikal / BSC kelas II

LAFC dengan aliran udara vertikal (aliran udara menuju ke bawah)

sehingga memberikan lingkungan kerja yang lebih aman bagi
petugas. LAFC vertikal disebut juga dengan Biological Safety
Cabinet (BSC). BSC juga memiliki banyak tipe dan yang
digunakan untuk pencampuran sitostatika adalah BSC kelas II yang
dirancang untuk memberikan perlindungan terhadap petugas,
produk, dan lingkungan. Pada tipe ini terjadi resirkulasi udara di
mana hanya 30% udara yang dikeluarkan dan 70% udara
dimasukkan kembali ke area kerja.
Insert Your Image

Fasilitas Handling Cytotoxic

Alat Pelindung Diri (APD) yang digunakan dalam pencampuran sediaan steril
meliputi :
 Baju Pelindung
 Pakaian terdiri dari pakaian dalam dan pakaian luar
 Pakaian Pelindung (pakaian luar) harus terbuat dari material yang tidak melepaskan debu
dan serat.
 Bahan yang digunakan tidak tembus oleh cairan
 Pakaian pelindung dibuat lengan panjang dengan manset elastik pada tangan dan kaki.
 Sarung tangan
Sarung tangan yang dipilih harus memiliki permeabilitas yang minimal sehingga dapat
memaksimalkan perlindungan bagi petugas dan cukup panjang untuk menutup pergelangan
tangan. Sarung tangan terbuat dari latex dan tidak berbedak (powder free). Khusus untuk
penanganan sediaan sitostatika harus menggunakan dua lapis.
 Tutup Kepala
Tutup kepala harus dapat menutupi rambut sekeliling agar tidak ada partikel kotoran yang
dapat mengkontaminasi sediaan.
 Masker & Kaca mata
• Untuk melindungi mata dan mengurangi inhalasi digunakan kaca mata dan masker.
• Disamping untuk melindungi petugas penggunaan masker juga untuk mengurangi
kontaminan.
• Kaca mata yang digunakan harus dapat melindungi mata dari kemungkinan adanya
percikan obat kanker.
 Sepatu
• Terbuat dari bahan yang tidak tembus benda tajam
• Tutup kaki digunakan sampai menutup manset baju dalam
 Persyaratan dalam Handling Cytotoxic
Persyaratan ruang aseptik

Ruang tidak ada sudut atau siku Aliran udara diketahui dan
terkontrol

Dinding terbuat dari epoksi Tekanan ruangan diatur

Partikel udara sangat dibatasi : kelas

Suhu dan kelembaban udara
100, 1000, 10.000 partikel/liter
terkontrol (suhu : 18-22 derajat
celcius dan kelembaban 35-50%).
 Persyaratan dalam
Handling Cytotoxic

Penanganan sitostatika memerlukan ruangan khusus dan terkontrol. Letak ruangan diusahakan tidak untuk lalu lintas orang. Ruangan ini terdiri dari:

1. Ruang persiapan
Digunakan untuk kegiatan administrasi (perhitungan dosis dan volume cairan, pembuatan etiket, pelabelan) dan penyiapan bahan obat serta
alat kesehatan yang dibutuhkan.

2. Ruang cuci tangan dan ganti

Sebelum masuk ke ruang antara, petugas harus mencuci tangan dan mengenakan APD.

3. Ruang antara
Petugas masuk ke clean room melalui ruang antara atau ruang penyangga udara. Ruangan ini diatur dengan tepat sehingga hanya satu pintu
pada satu sisi saja yang dapat dibuka pada saat yang bersamaan.

4. Ruang bersih (clean room)

LAFC harus diletakkan di sebuah clean room (ruang bersih). Clean room merupakan ruangan khusus yang dibuat dengan pengendalian
terhadap ukuran dan jumlah partikel. Ruangan ini dirancang untuk mencegah partikel masuk dan tertahan dalam ruangan, pengendalian juga
dilakukan terhadap suhu, kelembaban, dan tekanan udara.
 Persyaratan dalam
Handling Cytotoxic

Lanjutan...

5. Jumlah partikel terkontrol. Jumlah partikel berukuran 0,5 mikron tidak lebih dari 350.000 partikel per meter kubik udara, jumlah
mikroorganisme tidak lebih dari 100 per meter kubik udara.
6. Konstruksi khusus seperti dinding, langit-langit dan lantai tidak bersudut, tidak retak, dan dilapisi dengan bahan yang mudah
dibersihkan dan kedap air untuk mengurangi penyebaran atau penumpukan partikel. Sebaiknya tidak ada bagian ruangan yang
tersembunyi dan sukar dibersihkan.
7. Suhu dan kelembaban terkontrol. Suhu berkisar 18-28ºC dan kelembaban 35-50% untuk menjaga agar petugas tetap nyaman dalam
ruangan dengan pakaian kerjanya dan tidak berkeringat secara berlebihan. Di dalam ruangan tersedia termometer serta barometer untuk
mengukur suhu dan kelembaban ruangan dan dicatat setiap hari.
8. Barang dalam ruangan diusahakan seminimal mungkin dan mudah dibersihkan.
9. Dilengkapi High Efficiency Particulate Air (HEPA) filter untuk menyaring udara yang keluar dan masuk ruangan. HEPA filter
merupakan penyaring dengan efisiensi yang sangat tinggi (99,97-99,99%).
10. Tekanan udara di dalam ruangan lebih positif daripada tekanan udara di ruang sekitarnya.
11. Terdapat pass box yang menghubungkan ruang persiapan dengan clean room. Pass box merupakan tempat untuk keluar masuknya alat
dan obat dari clean room sebelum dan sesudah pencampuran. Idealnya, pass box dilengkapi dengan vakum dan lampu UV untuk
meminimalisasi kontaminasi.
12. Tersedia alat komunikasi (interkom) dan sebaiknya dirancang agar mudah dibersihkan
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Do you need
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Contents Title
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Contents Title
Get a modern PowerPoint Presentation that is beautifully designed. I
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Contents Title
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Contents A
Get a modern PowerPoint Presentation that is beautifully designed. I hope and I believe
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Contents Contents
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Your Text Your Text Your Text Your Text

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AWESOME
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VISION MISSION
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