CYTOTOXIC SPILL AND WASTE MANAGEMENT BY FATEH

CYTOTOXIC SPILL AMD WASTE MANAGEMENT IN HEALTHCARE SETUP WHERE CHEMOTHERAPY DRUGS WERE USED. IT WILL GUIDE THE HEALTHCARE WORKERS HOW TO HANDLE CYTOTOXIC DRUGS, HOW TO DISPOSE SAFELY AND PROTECT OURSELF & ENVIRONMENT.
EXPLAIN HOW TO DO CYTOTOXIC SPILL MANAGEMENT.

1. CYTOTOXIC SPILL AND WASTE MANAGEMENT FATEH CHAND M.Sc. NURSING [CRITICAL CARE, RAKCON] NURSING OFFICER NATIONAL CANCER INSTITUTE AIIMS JHAJJAR {HR.}

2. What is cytotoxic spill? A cytotoxic spill refers to both a liquid or powder spill of a cytotoxic drugs and or the bodily fluids of the patients within seven days of administration of a cytotoxic drugs .

3. Background: The handling of cytotoxic chemotherapy drugs is potentially hazardous to health care professionals. Chemotherapy drugs may also cause serious adverse effects to patients, if used inappropriately. The policy provides guideline for safe and appropriate management of cytotoxic substance spillage, which minimize risks to both patients and healthcare providers. Exposure can result from ingestion, inhalation and absorption through the skin or direct splashing. All personnel must be aware of the policies that are in place (in their area) for dealing with spillages and the decontamination of surfaces and individuals.

4. Potential adverse health effects: Alterations to normal blood cell count Foetal loss and possible malformation in offspring Fertility changes Abdominal pain, hair loss, nasal sores and vomiting Liver damage Contact dermatitis or allergic reaction.

5. Responsible staff Doctors Nurses Pharmacists Housekeeping staffs

6. policy?

7. General instructions All wards or clinic area were cytotoxic chemotherapy is administered should have: A copy of this policy available for all staff to read. Cytotoxic spillage kit at a prominent location near the administration area, with the clearly displayed label. Pregnant staff should not be involved in cleaning up a spillage. All non essential staff, patients, relatives and visitors must be asked to leave the affected area whilst the spillage is dealt with. All incidents involving a cytotoxic spillage must be documented.

8. Cont.. The following details must be included on the form: Nature and location of spillage. Staff involved in the spillage and mopping up procedure. Drug involved and extent of contamination. Actions taken Any direct skin or eye contact.

9. Spill kit Instructions on how to use it. Warning sign boards. PPE Head cap, Googles/ eye shield, Face mask (preferably N95), Overshoes (preferable non permeable), Gown (Non permeable and full sleeve one), Glove (2 pairs) Disposable bags (2 no’s) Scoop/ Forceps Absorbent pads/ Towels Disposable dust pan Disinfectant agent (preferably alkaline detergent) Eye wash (NS soluion-0.9%)

10. Type of spill Major spill or large volume spill ( more than 5gm or 5 ml) Minor spill or small volume spill (less than 5gm or 5 ml) Liquid spill Powder spill Carpet spill

11. Steps for spill management Isolate the area Protect yourself Confine the spill Clean up the spill Clean the area Dispose of waste Documentation of spill Replace the kit

12. 1. Isolate the area Alert staff in the immediate area that a spillage has occurred. Do not leave the spillage unattended. Evacuate the area of all non-essential personnel. Turn off fans, close windows and doors in the spillage area. Collect cytotoxic spillage kit (CSK) Inform HAZMAT Team/housekeeping department. Identify 2 trained housekeeping staff members to clean up spillage, designating one as the primary cleaner and second as a helper.

13. 2. protect

14. Put “DANGER- CYTOTOXIC SPILLAGE’’ Sign at entrance areas and alert everyone not to enter the clinic area

15. 3. Confine area Liquid spill Ensure the spill is covered with an impermeable packed pad (Thick absorbent pads, Paper towels or paper mats) Powder spill Cover with a wet paper towels/pads Cover gently to avoid spread of powder Carpet spill As above and contact cleaning supervisor for steam cleaning

16. 4. Clean up spill Take out plastic waste bags from the spill kit and roll down the edges. Gather up contaminated material enclosed in the paper towels and place in the first bag. Pour water over spill, dry with paper towel/ pads and dispose in first bag. Repeat the above step 2 more times.

17. 5. Disposal of spill If any broken glass involved, use plastic scoop or forceps available in kit to pick up the glass. Dispose the broken glass and scoop in a puncture poof sharps container and then in yellow bag with cytotoxic label. Remove PPE in following order Outer gloves Googles Mask Oversleeves and gown Head cap Overshoes

18. cont.. Apart from the goggles, all items are placed in the first bag. The goggles must be washed by wearing gloves in warm soapy water. Dry with paper towels/ pads. Discard pads to plastic bags. Place goggles back in to the spill kit. Unroll the edges of first bag and seal the bag. Place the first bag into second bag. Unroll the second bag, remove the second gloves and place into second bag and seal the bag. Remove bag to waste removal area and handover to BMW management team as soon as possible. Wash hand with soap and water.

19. 6.Clean the area Pour sodium hypochlorite 1% solution. (10ml in 990 ml of water) and wait for 30 minutes. A specific mop with nonporous disposable mop the floor with Akrosept (2 tablet in 500ml of water). Discard the contaminated solution into toilet. Rinse bucket thoroughly Double bag the mop and hand over too BMW management team.

20. Contamination of the eyes Immediately irrigate both eyes with 0.9% sodium chloride to prevent corneal damage, for approximately 10-15 minutes or Eye bath with tap water Seek medical advice immediately Report the incident to the senior nursing officer on duty.

21. Contamination of the skin Immediately wash the contaminated skin with soap and running cold water for at least 10 minutes to prevent drug absorption. Avoid the use of creams and lotions for 24 hours. Report the incident to SNO on duty.

22. Needle stick injury involving a needle contaminated with cytotoxic drugs All such incidents should be treated as any other needle stick injury. Immediately encourage bleeding. Wash with soap and cold water. Report the incident to SNO/ in charge on duty

23. documentation Document the incident in the incidence report book after completing the spill management. Replace spill kit with new one for next use.

24. Cytotoxic waste management

25. Biomedical waste management BMW means any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining there to or in the production or testing of biological or in the health camps. According to WHO, nearly 85% of all the waste generated by hospital is general waste. About 10% is biomedical waste And only 5% is the other waste such as radioactive and chemical wastes.

26. PLASTIC WASTE CATHETERS TUBINGS SYRINGS URINE BAGS IV SETS GLOVES

27. Cytotoxic waste

28. Puncture proof container

29. Cytotoxic waste

30. references Brown KA, Esper P, Kelleher LO, O’Neill B, Polovich M, White JM. (2001) Chemotherapy and biotherapy guidelines and recommendations for practice. Oncology Nursing Society. Fuchs J, Hengstler JG, Jung D, Hilti G, Konietzko J, Oesch F. DNA damage in nurses handling antineoplastic agents. Mutation Research. 342(1-2):17 – 23, 1995 Mar. Gullo , SM. (1995). Safe handling of cytotoxic agents. Oncology Nursing Forum, 22 (3), 523. Grummt T, Grummt HJ, Schott G. Chromosomal aberrations in peripheral lymphocytes of nurses and physicians handling antineoplastic drugs. Mutation Research. 302(1):19-24, 1993 May. Mayer DK. Hazards of chemotherapy. Implementing safe handling practices. Cancer. 70(4 Suppl ):988- 992, 1992 Aug 15