Spillage procedures for chemotherapy

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Objectives

Clear guidance on the management of spillages of cytotoxic chemotherapy agents. 

Scope

Children receiving chemotherapy. 

Audience

The following staff must be aware of this policy and understand its impact on delivery of SACT:

  • Medical
  • Nursing
  • Pharmacy
1. Introduction

Cytotoxic chemotherapy is potentially toxic, both to the recipient and to those who come into contact with the drug during preparation, delivery or administration.

Centralised pharmacy preparation has removed the hazards associated with preparation of chemotherapy at ward level, but not the potential for accidents associated with administration.

For example, the drug might leak from the syringe after the cap is removed, giving sets may puncture the infusion bag or the infusion bags may leak.

Any spillage may result in contamination of nursing staff, patients and carers.

3. Authorised personnel / specific staff competencies

The following staff must be aware of this policy and understand its impact on delivery of SACT:

  • Medical
  • Nursing
  • Pharmacy
4. Equipment / Materials

Contents of spillage kit:

  • 1 x Nitrile disposable gloves
  • 1 x Disposable apron
  • 1 x Face mask/ eye shield
  • 1 x Scoop and scraper
  • Absorbent granule sachets
  • Surface disinfection wipes
  • Disposal bag
  • Instructions

Some packs may also include:

  • Armlets
  • Gown
5. 1 How may hazards be minimised?
  • All staff handling chemotherapy must be aware of the nature of the preparation, its potential hazards and the remedial action to be taken if a problem arises.
  • All new staff in the clinical area must receive appropriate training both in handling chemotherapy preparations and in dealing with spills.
  • Staff should not attempt to remove air bubbles in a syringe by expelling them into the surrounding environment.
5.2 Personal contamination

Spillage onto Outer Clothing

  • If the spillage is anything other than minor, the staff member should put on a second pair of nitrile gloves.
  • The contaminated area should be blotted several times with a dry paper towel to remove as much spillage as possible, and to minimise contact of the drug with the skin.
  • Care should be taken not to excessively blot a porous area, since this may drive the spillage towards the skin.
  • In the event of major spillage onto clothing, the garments must be changed and disposed of as cytotoxic waste.
  • Gloves should be changed before starting to deal with the spillage, after hand washing.
  • A Datix form must be completed

Spillage onto Skin (without skin puncture)

  • Any contaminated clothing should be removed.
  • The affected area should be washed with copious amounts of soap and water.
  • The Nurse in Charge should be informed.
  • Advice should be sought from Pharmacy.
  • A Datix form must be completed

Needle Puncture or Contamination of Broken Skin:

  • The area around the puncture should be squeezed to encourage bleeding.
  • Any broken skin in contact with the spillage should be flushed with copious amounts of water.
  • Advice should be sought immediately from pharmacy.
  • A Datix form must be completed if the skin is punctured by a needle that has been in contact with cytotoxic drugs or if chemotherapy is in contact with broken skin.

Contamination of eyes/mucous membranes:

  • The affected area should be flushed with copious amounts of sterile sodium chloride 0.9%
  • Advice should be sought immediately from pharmacy.
  • A Datix form must be completed whenever cytotoxic drugs come into contact with the eyes or mucous membranes.
5.3 Environmental contamination

Any gloves contaminated by chemotherapy should be discarded appropriately and replaced.

A second pair of nitrile gloves should be put on when dealing with anything other than minor spillages.

5.4 Spillage in transit to ward or clinic

Spillages contained within clear plastic bag enclosing individual items or confined to the delivery tray

  • If any spillage is noted, or suspected, when cytotoxic drugs are delivered to the ward or clinic, the tray and/or packages must not be touched.
  • Pharmacy should be informed immediately.
  • A Datix form must be completed

Spillages occurring during preparation for administration, or administration

  • All patients should be kept away from the site of the spillage.
  • The number of staff in the vicinity should be minimised to avoid spreading contamination, and the area should be isolated.
  • Any contamination of the patient must be dealt with as a priority.
  • The spillage kit should be used and instructions followed.
  • All contaminated items should be removed from the vicinity and separated into items which can be disposed of, and those which cannot be.
  • Care should be taken to ensure that any other items in the vicinity cannot come into contact with the spillage.
  • Care should be taken to ensure that equipment such as drip stands, infusion pumps and bed frames are not contaminated. They should be cleaned with paper towels.
  • All contaminated equipment should be rinsed with appropriate amounts of water to remove all contamination.
  • The floors should be mopped thoroughly and dried with paper towels.
  • All contaminated material should be placed in the appropriate container for disposal (either in a cytotoxic sharps bin or a purple cytotoxic waste bag).
  • Gloves, paper towels etc. used to mop up the spillage should be considered contaminated.
  • Water in buckets used to mop floors may be disposed of in the normal way but the sluice and sinks should be thoroughly flushed thereafter with clean water.
  • Contaminated linen should be treated as ‘infected’ and sent to the laundry in a red alginate bag placed within a clear bag.
  • A Datix form must be completed

**ANY AREA RESPONSIBLE FOR PREPARATION AND ADMINISTRATION OF CYTOTOXIC MEDICATIONS SHOULD HAVE ACCESS TO SPILLAGE KIT**

Further information / exceptions

For further information please contact:

  • Ward 2A (Schiehallion) RHC Tel: 0141 4524450
  • On Call Pharmacist via switchboard
Editorial Information

Last reviewed: 01 October 2018

Next review: 31 October 2020

Author(s): G Paton

Version: 3

Approved By: Schiehallion Clinical Governance Group