SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE HANDLING LIQUID CHEMOTHERAPY SPILLS DATE: REVIEWED: PAGES: 03/86 11/17 1 of 6 PS1094 ISSUED FOR: Nursing RESPONSIBILITY: RN PURPOSE: OBJECTIVE: KNOWLEDGE BASE: INDICATIONS: The purpose of this procedure is to provide safety guidelines in case of an accidental spill of a bag or other large liquid amount (more than a few drops) of chemotherapeutic agents outside of a biologic safety cabinet. Personnel who have received proper training in skill management and the use of PPE and NIOSH-certified respirators will clean accidental liquid spill(s) of chemotherapy without contaminating themselves or others. The RN cleaning an accidental chemotherapy spill should be aware that chemotherapy contamination may produce adverse reactions in the contaminated personnel. Any time liquid chemotherapy is spilled or leaked from its prepared container from Pharmacy if the spill can be contained by one spill kit and there is no known or suspected exposure to airborne powders or vapors. NOTE: If spill cannot be contained by one spill kit or if there are known or suspected exposure to airborne powders or vapors, follow procedure as outlined in SMHCS Corporate Policy # 00.SAF.31, Code Orange-Incidental Internal Chemical/Hazardous Material Spill. A full-face chemical cartridge respirator or powered air-purifying respirator (PARP) is required for these occurrences. If eye and face protection is required, PARP should be used with goggles.
TITLE: HANDLING LIQUID CHEMOTHERAPY SPILLS PAGE: 2 of 6 EQUIPMENT: Utilize the chemo spill kit ( found in the clean utility closet on 8WT, in the Chemo Cabinet in SMI, on the Chemo Caddy, or from Central Supply, which contains the following: 1. Chemo-approved (ASTM tested) gloves (2 pairs) 2. Non-permeable disposable gown made with a laminate material and with a long sleeves, elastic or knit cuffs, back closure, and no seams or closures that could allow HD exposure 3. Mask Fit tested N-95 or N-100 particle mask 4. Disposable bags/tie wraps 5. Shoe covers 6. Disposable dustpan and scrapper/scoop 7. Puncture proof container 8. Absorbent toweling 9. Goggles (if eye protection only is needed) 10. Face shields (if full eye and face protection is needed) 11. Chemo sorb pads spill-proof 12. Spill warning sign In addition, obtain from supply room: 13. Wash basins (2) Fill one basin with a detergent solution obtained from housekeeping and the other with water. NOTE: Double gloving is required for all hazardous drug handling activities, not just preparation and administration. PROCEDURE: 1. Post the spill sign to warn others about the presence of a hazardous spill. If spill is out of control, call other staff members for help restricting access to spill area. 2. Immediately after a spill, check for personal contamination with the chemotherapeutic agent. If this occurs, do the following: a. Eye Contact: Flood the affected eye with copious amounts of water for at least 15 minutes. Saline eyewash may be used if available. Report to Employee Health Services or to the Emergency Care Center for evaluation. b. Skin Contact: Wash the skin thoroughly with soap and water. Report to Employee Health Services or to the Emergency Care Center for evaluation. c. If apparel becomes contaminated, it will be removed in a manner that prevents exposure to the contaminated materials. Non-disposable clothing contaminated with HDs should be placed in a yellow impervious bag and labeled with the name, department, and extension number of the owner and hand-carried by the owner to the Linen Room of SMH (3WT) for proper washing
TITLE: HANDLING LIQUID CHEMOTHERAPY SPILLS PAGE: 3 of 6 according to the organization s policy. Potentially contaminated clothing may not be taken out of the hospital until laundered. 3. If no personal contamination occurred, don gown, gloves, goggles/eye shield, respirator mask, and shoe covers. Double glove with large gloves first. Make sure second pair of gloves fit over the cuffs of the gown. Change gloves every 30 min or when torn, punctured, or contaminated. Gowns are changed according to manufacturer recommendations based on permeation information. If no information exists, change gowns every 2-3 hours or immediately after a spill or splash. 4. Lay chemosorb pads over the spill. The pads will absorb the liquid and transform it into a gel to assist in disposal. Caution: Chemosorb gel is extremely slippery when wet. Avoid skin and eye contact. 5. Detach scoop from scraper and use both to pick up the chemosorb gel. Place contaminated gel into a waste bag. If there is any broken glass, use scoop to place it in a puncture proof yellow chemotherapy sharps container. 6. Use spill towels, detergent and water to pick up remaining gel. Place towels in the provided waste bag.. 7. Clean spill area (Include any reusable items and equipment) three (3) times beginning with the least contaminated area and finishing with the most contaminated area. Clean with detergent solution and rinse with water. To clean hard surfaces: wipe with absorbent pads. Notify Environmental Services to disinfect the area also. To clean carpet: notify the hospital s Operation of Plant Department at extension 1793 during business hours. After hours, or on the weekends, contact pager #1430. 8. When the area is cleaned, rinsed and dried, put all the cleaning items in a plastic bag provided in the spill kit. Place secured plastic bag in a chemotherapy waste container to be sure of proper disposal. 9. Take off outer gloves from the inside out, then gown taking care to avoid contact with the outer surface. Then remove shoe covers if used. Place used PPE in plastic bag that comes with spill kit. Then remove inner gloves from the
TITLE: HANDLING LIQUID CHEMOTHERAPY SPILLS PAGE: 4 of 6 inside out and place in bag. Last, remove eye and face protection if used. Dispose of these in the plastic bag provided and dispose of it in a chemotherapy waste container. Wash hands thoroughly with soap and water. CAUTION NOTES: 1. If sheets or other linens are accidentally contaminated, place them in a yellow impervious linen bag to assure proper handling. 2. Wear protective goggles and face shield if the situation appears dangerous to these areas. 3. Do not dispose of unused drugs or contaminated solutions in drains or toilets. Partial and unused bags of chemotherapy will be returned to the Pharmacy for disposal. DOCUMENTATION: If a spill or employee contamination should occur, complete an Occurrence Report and take the recommended actions. REFERENCE: 1. Polovich, M., Olsen, M., & LeFebvre, K. B. (2014). Chemotherapy and Biotherapy Guidelines and Recommendations for Practice (4 th ed.). Pittsburgh, PA: Oncology Nursing Society. 2. Polovich, M. (Ed). (2011).Safe Handling of Hazardous Drugs (2 nd edition). Pittsburgh, PA: Oncology Nursing Society. 3. NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings. 2004. National Institute for Occupational Safety and Health. Cincinnati: OH. Publication No. 2004-165. 4. SMHCS Policy. Code Orange Response: Chemical/Hazardous Material Spill. (00.SAF.31). SMH: Author. 5. USP.(2016). Hazardous Drugs in the Healthcare Setting. Retrieved May 26, 2016 from http://www.usp.org/sites/default/files/usp_pdf/en/m7808.pd 6. Eisenberg, Seth. (2017). Hazardous Drugs and USP 800>. CJON, 21(2), 179-187 7. Wyant, Tracy. (2017). The Importance of Respiratory Protection.for Oncology Nurses. ONS Voice., January, 2017, p.26
TITLE: HANDLING LIQUID CHEMOTHERAPY SPILLS PAGE: 5 of 6 8. USP Compounding Compendium. (2016) <800>Hazardous Drugs-Handling in the Healthcare Setting. Retrieved May 11, 2107 from https://www.usp.org/sites/default/files/usp_pdf/en/m7808.pdf REVIEWING AUTHOR (S): Deena Damsky Dell MSN,CNS, AOCN, RN-BC, LNC Barbara Poropat BSN, RN, OCN, NPD Oncology Diane Alder BSN. RN. OCN, Clinical Coordinator Rachael Pierce BSN, RN, OCN. Clinical Coordinator Tamela Fonseca BSN, CCRC, Clinical Manager Oncology Yulonda Greene MBA, BSN, RN, OCN
TITLE: HANDLING LIQUID CHEMOTHERAPY SPILLS PAGE: 6 of 6 Decision Tree Will more than 1 spill kit be required to contain spill? YES NO Is there known or suspected exposure to airborne vapors? YES NO If the answer to either question is YES, activate Hospital Code Orange Policy by calling x 7233 and reporting location, type and quantity of spill. Restrict access to area. If the answer to both of the above questions is NO, obtain a chemo spill kit. Post sign to warn others to stay away. Check for personal contamination. If no personal contamination, don PPE. Lay ChemoSorb pads over spill. Detach scoop from scraper and use both to pick up ChemoSorb gel. Place contaminated gel in waste bag. If there is broken glass, use scoop to place it in sharps container. Use spill towels, detergent and water to pick up remaining gel Clean spill area, including reusable items and equipment, with detergent solution and water 3 times beginning with least contaminated area. Notify Operation of Plant department to clean contaminated carpet. Put all cleaning items in secured plastic bag and place in chemotherapy waste container. Remove PPE. Discard in waste bag. Wash hands with soap and water Complete an occurrence report.