Safe Handling of Hazardous Drugs

Question 1

What are the three most common routes of exposure to hazardous drugs in the clinical area?

Answer 1

1) Ingestion
2) Inhalation
3) Absorption

Question 2

What is the difference between an un-contained spill and a contained spill?

Answer 2

• Uncontained = spill of a drug of body waste receiving hazardous drugs
• Contained = drug solution or body waste spill absorbed into something else, like a bed linene

Question 3

What are the PPE components of a spill kit?

Answer 3

• N95 Respirators (keep up to date with fit tests)
• Disposable gown impermeable to hazardous drugs with long cuffed sleeves and closes in the back
• Two pairs chemo gloves
• Disposable goggles or face shields
• Shoe covers
• Hair bonnet

Question 4

What supplies are in a spill kit?

Answer 4

• Disposable scoop and scraper
• Absorbent material (eg. spill towels, gauze pads)
• Two large plastic hazardous waste disposal bags
• Decontaminating agent
• Warning sign and plastic tape to quarantine area
• Puncture and leak resistant drug waste container
• Documents with the BCCA spill policy document and site directives

Question 5

What should you do immediately if you are exposed to a hazardous drug or it’s waste?

Answer 5

In the event that there is, or potentially is, personal contamination, either from spilling of clean-up of spill, do the following immediately:

1) Remove PPE and discard according to site instructions
2) Immediately cleanse affected skin with soap and water, shower PRN
3) If eye exposure, flush at eyewash station for 15 minutes
4) Obtain medical attention - ER
5) Contact workplace health call center
6) Employer will document exposure in employee exposure record, and employee will notify their MD

Question 6

Describe the steps for cleaning a spill that is reasonably contained (eg. it is not a devastating, large spill that would require a Code Brown hazmat team)

Answer 6

1) Isolate area and alert everyone to prevent spread; never work alone, but reasonably restrict the number of helpers
2) Inform supervisor
3) If contamination has occurred, follow the personnel contamination procedure (this is more important than the clean up itself!)
4) Obtain spill kit
5) Don PPE
6) Limit spill through absorbent sheets or spill control pads (if powder substance use damp cloths to prevent aerosol generation)
7) Use contents of spill kit to clean the spill; any broken glass to be picked up with scoop into sharps, never by hand
8) Place sharps container into hazardous drug disposal bag along with other waste
9) If its a biohazardous drug, specific disinfecting agents specific to that agent must be applied first
10) Decontaminate area by cleaning three times using a basic detergent solution followed by water
11) All material to be placed in sealed containers and labelled as hazardous waste, including PPE when complete
12) Linen should be disposed of normally, and any soiled patient clothing should be placed in a plastic bag to be taken home to be laundered by the patient (separate from other clothing and washed twice)
13) Wash hands with soap and water
14) Contact workplace health call center
15) Document incident in exposure records of employees involved in a spill/cleanup
16) Replace items in spill kit station

Question 7

How are PPE’s to be used?

Answer 7

• PPE’s to be worn whenever hazardous drugs are handled and must be available in all areas the drugs are handled
• Must be worn when disconnecting and disposing of equipment used in administration
• Change gloves q30 minutes or immediately if contaminated, torn or punctured
• Change gowns daily or immediately if contaminated/after spill clean up
• Don’t wear PPE’s outside hazardous drug area
• Used disposable PPE’s must be discarded as hazardous waste
• Wash with soap and water immediately after removal of gloves

Question 8

How do we teach safety in the home for patients and families receiving hazardous drug waste?

Answer 8

• Wear gloves for handling any drug spills or body secretions
• When finished with gloves put in a plastic bag and discard
• Have designated plastic bowl/bucket for any emesis
• If any spills, soak and clean with disposable cloths, soapy water and rinse with water > put everything into plastic bag before tossing into separate bin
• Hand hygiene
• Wash clothing/linens that are soiled separately, using longest cycle (hot or cold) and air dry
• Timeline - 48 hours post chemo is when precautions to be taken
• Safe handling of oral drugs - do not crush or split, talk with MRP/pharmacist if instructions say to do so

Question 9

How can we prevent exposure to ingestion, inhalation and absorption of drugs?

Answer 9

• Don’t store food in same area as chemo, and don’t eat/drink
• Wash hands before eating
• Don’t apply cosmetics in chemo area
• Wash hands after removing gloves
• Wear 2 pair gloves and gown during admin and disposable of drugs
• Change gloves q30 min and when contaminated
• Use needless system and great caution
• Know spill policies and policy for contamination (workplace health claim)
• Ensure coworkers know who received hazardous drugs within last 48 hours
• Use correct disposable systems
• All drugs should be prepped by pharmacy in a flow hood - send back drugs if it needs to be put into another format (eg. we shouldn’t be injecting drugs under pressure from a syringe into bags, that should be pharmacy)