Cytotoxic Precautions (inc. Epirubicin Instillation)



Canberra Hospital and Health Services

Clinical Procedure

Cytotoxic Precautions (inc. Epirubicin Instillation): Management of the Adult Patient in the Perioperative Unit

|Contents |

Contents 1

Purpose 2

Alerts 2

Personnel Monitoring 3

Patient Identification and Transfer from a Ward 3

Specimen Collection and Handling 3

Scope 3

Section 1 – Personal Protective Equipment (PPE) 4

Section 2 – Management of the Intraoperative environment 5

Section 3 – Management of the anaesthetic environment 7

Section 4 – Instillation of Epirubicin Chemotherapy 7

Subsection 1: Ordering Epirubicin 7

Subsection 2: Instillation of Epirubicin 9

Subsection 3: When Epirubicin has been instilled prior to arrival to PACU 11

Subsection 4: Drainage of Epirubicin in PACU 11

Subsection 5: Patient Transfer and Ward Handover 12

Section 5 – Waste Management 13

Section 6 – Spill management 13

Implementation 14

Related Policies, Procedures, Guidelines and Legislation 14

References 15

Definition of Terms 16

Search Terms 16

Attachments 16

Attachment 1 - Clinical Procedure – Hazardous Drug Spill Management 2015 17

|Purpose |

The purpose of this procedure is to inform staff of the appropriate management of patients on cytotoxic precautions or patients receiving chemotherapy when in the Perioperative Unit.

It ensures that the appropriate identification of the cytotoxic patient and appropriate personal protective requirements and waste management strategies associated with the handling of cytotoxic waste will be maintained.

The Canberra Hospital Health Services follows safety guidelines as recommended by eviQ, the Cancer Institute, New South Wales.

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|Scope |

|Alerts |

Hazardous drugs are primarily eliminated from the patient by renal and hepatic excretion. All body substances may be contaminated with either the unchanged drug or active drug metabolites. Exposure to hazardous substances may occur in a number of ways:-

• handling of excreta, vomit, blood, sweat and fluid drained from body cavities including intra-peritoneal, intra pleural and intra-pericardial

• handling of bedpans, urinals, emptying urinary catheter bags, colostomy/urostomy bags and vomit bowls

• handling of bed linen or clothing soiled with patient waste, or potentially contaminated with the hazardous drug

• wiping body fluids from the floor should be considered a hazardous spill (1).

It is important that a risk assessment is performed prior to commencing any surgical procedure on a patient that still requires cytotoxic precautions. This allows for suitable precautions to be put into place, to minimise the risk of exposure to all persons involved in caring for the patient.

Absorption of cytotoxic agents can occur through several mechanisms:-

• skin absorption

• inhalation of aerosols and drug particles

• hand to mouth contact

• needle stick injuries

• drug preparation and administration

• handling patient waste

• handling drug waste products

• drug and patient transport

• cleaning up spills

Personnel Monitoring

Women who are pregnant or breast feeding, or any staff planning parenthood should be aware of the reproductive risks and potential effects on foetal development when handling cytotoxics and minimise risks by following safety guidelines when disposing of human contaminated waste (1). Staff may need to liaise with the area specific Team Leader or Patient Flow Co-ordinator for appropriate allocations.

It is recommended that Perioperative nursing staff undertake either the Cytotoxic Safe Handling course through Capabiliti, or the ‘Antineoplastic Drug Administration in the Non-Cancer Setting’ modules of the Antineoplastic Administration Course, via .

Current literature recognises that different chemotherapy drugs are metabolised at different rates. Due to the variation in excretion times ACT Health has elected to standardise chemotherapy precautions on all patients for SEVEN DAYS post administration of cytotoxic drugs (2).

Patient Identification and Transfer from a Ward

It is imperative that ward staff communicate the information if a patient is receiving cytotoxic precautions in the ward setting, when that patient is called for, immediately prior to their surgery. A member of nursing staff must accompany the patient and bring a spill kit with them to Holding Bay.

The Holding Bay nurse must convey this information to the Transport Pool, when organising a wardsman to collect the patient from the ward, in addition to all members of the perioperative team, so that the appropriate precautions can be undertaken if there is a potential exposure to body fluids.

Specimen Collection and Handling

All staff involved in the collection and handling of any specimen (blood, urine, tissue) must wear the appropriate Personal Protective Equipment (PPE) during the process.

A small cytotoxic sticker must be fixed to each specimen container, in addition to one being placed on the pathology form so that all Pathology staff involved in the handling of the specimen is alerted to the hazardous manner of the contents.

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|Scope |

This procedure applies to staff in the Perioperative Unit (i.e. the Operating Rooms [OR], Post Anaesthesia Care Unit [PACU], Day Surgery Admissions and Extended Day Stay Unit [EDSU]) who undertake any care of a patient who has received chemotherapy in the last seven days; or to any staff that may handle or be exposed to any body fluids or affected waste.

This document applies to the following Canberra Hospital Health Services (CHHS) staff working within their scope of practice:

• Medical Officers

• Registered Nurses and Midwives

• Students working under supervision

• Wards person

• Hospital assistants

• staff from Pre Rinse Sterilising Unit (PRSU)

• environmental services staff

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|Section 1 – Personal Protective Equipment (PPE) |

The most effective way to prevent exposure occurring is to wear personal protective equipment (PPE). PPE must be worn during any activity which has the potential to cause exposure to hazardous drugs and related waste products (2).

Equipment

Gloves

When scrubbing for the patient who requires cytotoxic precautions Ansell Gammex gloves are to be worn. Ansell Mircothin gloves are not suitable for use with chemotherapy. Two pairs of these gloves should be worn with the top gloves being changed immediately when punctured or torn. All other staff must use purple Nitrile gloves. Gloves must be long enough to cover the cuff or wrist edge when the arms are bent or stretched. Nitrile gloves can be used for up to 240 mins before they require changing, if not breached (1,3).

Gowns

Sterile surgical gowns and disposable gowns must be made of an impermeable material. They must have a closed front, long sleeves and elasticised wrists or cuffs. Tyvek gowns are currently supplied for use (PICS code 33409).

Any staff present in the theatre should wear a gown if there is the potential for contamination through exposure to large amounts of body fluids.

Protective Eye Wear

Protective eye wear is to be worn to protect against liquid splashes to the mucous membranes of the eye. Prescription glasses are not considered PPE. Eye protection can be provided by wearing:

• Goggles

• Protective eye wear with side shields

• A transparent full faced chemical splash shield

• Full face respiratory protective equipment

All staff are required to wear protective eye wear during anaesthetic interventions and surgical procedures

All non-disposable eye wear must be cleaned with neutral solution and allowed to air dry at the end of the case or when contaminated.

Respiratory Protective Equipment

Respiratory protective equipment with a P2 (N95) particulate filter is to be used by all staff when handling chemotherapy agents or body substances contaminated with chemotherapy agents. Surgical masks do not provide sufficient protection from aerosols fumes that are generated during surgical procedures (1).

Removing PPE

PPE must be removed in the following order and disposed of in the cytotoxic waste to minimise exposure of any potential contaminants on the exposed PPE (1).

|Wearing one pair of Gloves |Wearing two pairs of gloves |

|Remove gloves |Remove outer glove |

|Perform hand hygiene with soap and water |Remove protective eyewear or face shield |

|Remove protective eyewear or face shield |Remove gown & over shoes if worn |

|Remove gown & over shoes if worn |Remove Respiratory protective equipment |

|Remove Respiratory protective equipment |Remove inner gloves |

|Perform hand hygiene with soap and water |Perform hand hygiene with soap and water |

Diathermy Plume

It is acknowledged that the plume released when diathermy is applied to tissue contains many combustion by-products that are considered to be both a chemical and biological hazard (5). During all procedures on patients requiring cytotoxic precautions, a smoke evacuator must be used to minimise the potential risk of inhaling dangerous aerosols that are produced when cauterising tissue (5).

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|Section 2 – Management of the Intraoperative environment |

Equipment Required:

• Chemotherapy precautions trolley for purple waste bin liners, safety signs, gowns, gloves, eyewear and P95 masks (located in alcove between OR1 and 2)

• Cytotoxic spill kit (located in alcove between OR1 and 2)

• Cytotoxic bin (120L) from PACU

Procedure

• Remove all non-chemotherapy safe gloves from the OR.

• Place signs on all doors identifying that cytotoxic precautions are required.

• Ensure that a spill kit is in the OR.

• Ensure all bin liners are replaced with purple waste liners.

• Bring the 120L cytotoxic bin from PACU to the theatre (make certain that the bin is doubled bagged prior to use)

• Disposable drapes and gowns should be used.

• Remove all sharps bins from anaesthetic areas and replace with cytotoxic sharps containers.

• Remove any unnecessary equipment from the theatre and anaesthetic bay.

• Prepare the surgical table and other equipment such as an arm table with a sheet and disposable absorbable pads

The Instrument and Circulating RNs will attend to the cleaning of cytotoxic chemical spills or contaminated waste that occurs as part of the surgical procedure.

During surgical procedures spot cleaning should occur where appropriate (5). Areas that are contaminated with cytotoxic waste should be cleaned using a neutral solution and disposable paper wipes in a manner that reduces the risk of creating aerosols. Material from the spill kit may be required. Cleaning equipment is then disposed of in the cytotoxic waste bin (7).

Contaminated Linen

Any linen that has been contaminated with hazardous waste and/or body fluids must be double bagged and discarded into the cytotoxic waste linen skip.

Diathermy Plume

During all surgical procedures on cytotoxic patients, smoke evacuators must be used to minimise the potential risk of inhaling dangerous aerosols produced by cauterising tissue (5).

Surgical instruments – cleaning and transporting

The instrument and/or circulating RN must notify staff in PRSU that there is a procedure taking place on a patient requiring chemotherapy precautions. This prepares them to receive the cytotoxic contaminated equipment post procedure. All trolleys are to be labelled using cytotoxic labels prior to leaving the theatre. The Instrument and Circulating nurses are responsible for transporting all trolleys to the PRSU to minimise the handling of cytotoxic waste by other staff. Trolleys identified with a cytotoxic label must be pushed into PRSU (dirty side) and handed over to staff there.

At the end of the case when any cytotoxic spills have been thoroughly cleaned by clinical staff, the theatre can be cleaned by environmental cleaning staff.

Waste management in the OR

• All items that have come into contact with any body fluids from the patient must be disposed of in the appropriate cytotoxic waste bin (1).

• There should be no ordinary contaminated or clear plastic waste bins available for use in the theatre.

• All purple waste bags must be double bagged with the inner bag sealed first.

• Waste bags are then placed into the cytotoxic waste bin.

• Full cytotoxic waste containers will be removed from the Perioperative Unit at the end of the patient’s journey by environmental cleaning staff.

• Sharps used during the procedure, from either the anaesthetic or surgical team, must be discarded in the appropriate sized purple, cytotoxic sharps container, located in the alcove between OR1-OR2. (1.5L S-2 CYTO or, D-22CY, larger container suitable for needle board and disposable laparoscopic instruments).

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|Section 3 – Management of the anaesthetic environment |

Equipment

• Cytotoxic sharps containers

• Chemotherapy precautions trolley

• PPE as described, Section 1

Procedure

• PPE is worn by members of the anaesthetic team when performing procedures or interventions to minimise their exposure to body fluids.

• Ensure a disposable sheet is placed under all points of entry to contain spills.

• All sharps are to be disposed of in cytotoxic sharp containers.

• Any body fluids are cleaned from the patient’s skin thoroughly with soapy water to minimise the risk of chemical burns.

• Cross check position of filters on anaesthetic machine.

• The anaesthetic machine is stripped at the end of the case.

The anaesthetist or anaesthetic nurse are responsible for the cleaning of cytotoxic spills or contaminated waste which may be produced due to anaesthetic interventions.

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|Section 4 – Instillation of Epirubicin Chemotherapy |

Subsection 1: Ordering Epirubicin

i) From a Request For Admission Form

1. All relevant urology Request for Admission (RFA) forms are sent to the Perioperative Resource Officer as per standard practice.

2. In addition, a copy of any RFAs requiring Epirubicin as part of the surgical procedure will be placed in a designated area (yellow Epirubicin folder) at the Resource Officer’s desk, by Surgical Bookings staff.

3. The Surgical Bookings staff will write the patient details in the Urology book for confirmation of delivery, as per current practice.

4. The Level 2 Registered Nurse (RN) Urology will take the copy of the RFA, with a Medical Oncology Chemotherapy Sheet (F00101(0802) 51214), located in Prep Room 1-2, for either an accredited Urology Registrar or the patient’s VMO to complete.

5. This must include:

• Minimum of 3 patient identifiers i.e., patient’s name, date of birth and UR number

• The date of prescribing Epirubicin

• The main diagnosis

• The name of the referring doctor

• Any relevant clinical notes. These can include any differences in the standard concentration (80mg/50 mL’s) and the length of time the solution is to be instilled

• The date required, i.e. day of surgery

• The signature of the prescribing doctor

6. The RN or the prescribing medical officer faxes this form to Oncology Pharmacy (Fax No: 62443516) for dispensing. The fax cover sheet must include the date and time the Epirubicin is required for, and the OR contact person, ie the Patient Flow Co-ordinator(PFC)/ Team Leader (TL).

7. The form can be sent several days prior to the required date for timely dispensing and transporting to the Perioperative Unit.

ii) Ordering Epirubicin Intraoperatively

If it is decided that Epirubicin is required for treatment once the patient’s procedure has commenced, then:

1. The RN in the OR or an accredited Urology Register or the patient’s VMO obtains a Medical Oncology Chemotherapy Sheet (F00101 (0802) 51214) from Prep Room 1-2.

2. An accredited Urology Registrar or the patient’s VMO completes the form with the required details as above.

3. The RN or the medical officer faxes the form the Oncology Pharmacy (Fax No: 62443516) for dispensing.

4. The patient is transferred to PACU at completion of the surgery.

5. The patient has the Epirubicin instilled in PACU as per Subsection 2.

Transportation of Cytotoxics from Pharmacy

Cytotoxics are transported from the Oncology Pharmacy in a sealed, leak proof container with an outer bag heat sealed where possible, ensuring that the container is protected from light, breakage and tampering. It is also labelled with a cytotoxic label (1).

Oncology Pharmacy will have the Epirubicin transported to the required OR in a protective esky packed in ice. A pharmacy trained courier from the central courier service will deliver the esky to the designated contact person.

If the Epirubicin is not to be used immediately upon arrival to the OR, the esky is to be placed in the anaesthetic fridge (Middle Room) until required. The lid must be removed. A cytotoxic spill kit must be available on transfer.

The Epirubicin can be stored in the refrigerator for a period of 28 days.

If the Epirubicin is not used

If the patient’s surgery is not performed, the Epirubicin must be returned to the Oncology Pharmacy for disposal. This can be done by the L2 RN Urology, the TL in the urology OR or the PFC.

A pharmacy trained courier can transport the drug in the sealed esky, ie the lid has been securely placed back on.

When arranging the transport, the sender must inform the courier service that the item contains cytotoxics and an appropriate courier will then be assigned to perform the transport.

Subsection 2: Instillation of Epirubicin

i) Intraoperatively

Equipment Required:

• Chemo therapy precautions trolley for purple waste bin liners, safety signs, gowns, gloves, eyewear and P95 masks (located in alcove between OR1 and 2)

• Cytotoxic spill kit (located in alcove between OR1 and 2)

• Closed circuit drainage bag (Middle Room T:5:G)

• ‘G’ plastic clamps x 2 (Urology Trolley, PICS 18307)

• Cytotoxic bin (120L) from PACU

• Epirubicin

Procedure

1. Cytotoxic purple waste bins, a chemotherapy spill kit and appropriate PPE are to be present in the OR prior to the administration of Epirubicin.

2. The trolley or bed for all patients having instillation of Epirubicin will have 2-3 disposable sheets placed on them, prior to transferring the patient from the OR table to the trolley or bed.

3. Full PPE is to be worn by the Instrument RN, the circulating RN and the operating surgeon (6). All staff in the OR are required to wear P95 masks and eye protection, for protection against aerosol dispersion of the chemotherapy agent.

4. A disposable cystoscopy drape should be used for the procedure to allow for easy disposal into a cytotoxic waste container.

5. After the urological procedure is completed and the bladder is emptied, an Indwelling Catheter (IDC) is inserted and the balloon inflated.

6. The instrument RN must prepare for the instillation of Epirubicin away from the reusable instrumentation to avoid contamination.

7. Care must be taken to prevent leaks and sprays from a loose connection or from excessive pressure during drug delivery. Place an absorbent pad under the catheter and closed circuit drainage bag system.

8. The patient’s exposed skin must be covered as much as is practical with the disposable cystoscopy drape. If any spillage occurs onto patient’s skin, the skin must be washed immediately with soapy water to minimise skin contamination.

9. Epirubicin is administered by the surgeon intravesically through the IDC into the bladder. The syringe is then immediately disposed of into the purple cytotoxic waste bin and the catheter is double clamped with 2 ‘G’ clamps and connected to a closed circuit drainage bag by the operating surgeon or instrument RN.

10. Clear post operative instructions are to be written by the operating surgeon regarding the duration of clamping. In addition, clear positioning orders are to be written on the sheet.

11. The drainage bag must be labelled with a purple chemotherapy label.

12. The time of installation of the drug must be recorded on the Registered Nurses Theatre Report.

13. The medication is recorded as given on the Medical Oncology Chemotherapy Sheet by the doctor.

14. All non-permeable gowns, purple gloves, masks and contaminated drapes etc are to be disposed of into the purple bin. Once Epirubicin has been instilled, any linen contaminated must be placed in the purple cytotoxic waste bin for disposal.

15. The patient must be transferred to PACU free from contaminants, ie. on a clean, dry bed in a dry gown, with 2-3 disposable sheets placed underneath the patient.

16. A spill kit must now accompany the patient at all times.

17. The instrument RN must take a spill kit to PACU, and inform the receiving PACU nurse of the time when the Epirubicin was instilled as part of the nursing handover.

18. The 120L cytotoxic waste bin is also taken to PACU.

ii) In PACU

Equipment Required:

• Bladder Trolley

• Spill kit (Located in storage area, PACU)

• ‘G’ plastic clamps x 2 (Urology trolley, PICS 18307)

• Epirubicin

• Disposable sheets

Procedure

1. When the PACU nurse is satisfied with the patients’ airway and haemodynamic parameters, the Urology team can commence the administration of the Epirubicin.

2. This procedure must only be performed and documented by the Urology Registrar or Consultant.

3. The patient’s identity and prescription are verified.

4. The area is prepared so that the Epirubicin can be instilled, i.e. the bladder trolley is covered with disposable sheets. The Epirubicin, in the protective esky, and a spill kit is brought to the bedside.

5. The doctor and the RN both complete hand hygiene and don the required PPE.

6. The patient is covered with disposable sheets so that skin contamination is minimised.

7. The catheter is disconnected from the drainage bag with the tip kept sterile.

8. Attach the syringe containing the Epirubicin to the catheter and instil the medication slowly. Do not use force. Instillation is to stop if the patient complains of pain.

9. The indwelling catheter (IDC) is then double clamped using the 2 ‘G’ clamps. A closed circuit drainage bag should be attached.

10. A purple chemotherapy label is placed on the bag.

11. The PACU RN is to document the time the Epirubicin was instilled in the patient’s notes, [ACT Health Progress Notes - 40260 (0114)].

12. The medication is recorded as given on the Medical Oncology Chemotherapy Sheet by the doctor. In addition, clear positioning orders are to be written on the sheet.

Subsection 3: When Epirubicin has been instilled prior to arrival to PACU

1. The IDC is double clamped with 2 ‘G’ clamps and has a closed circuit drainage bag with a purple chemotherapy label attached.

2. The Instrument RN informs the PACU RN time of instillation of Epirubicin to allow for calculation of IDC drainage.

3. The Epirubicin is left insitu for the medically specified time period.

When the patient is haemodynamically stable and can maintain their airway:

4. The patient is rolled clockwise at fifteen minute intervals in order to allow full coverage of the bladder to the chemotherapy treatment.

5. The PACU Nurse is to document the interval turns and times in the ACT Health Progress Notes, e.g.

Supine @ 1400hrs

Right Lateral @ 1415hrs

Prone @ 1430hrs

Left Lateral @ 1445hrs

The PACU RN must check for leakage around the catheter or evidence of incontinence, and take precautions as necessary.

1. The RN must document how the procedure was tolerated by the patient in the ACT Health Progress Notes.

2. The patient is to remain in PACU for the duration of the Epirubicin administration, instillation and rotation phases.

Subsection 4: Drainage of Epirubicin in PACU

At completion of the designated time:

The IDC can either be removed, remain insitu on free drainage, or continuous bladder irrigation may commence. The action required must be documented on the ACT Health Operation Record [45320(0615)].

The bag must be clearly labelled with a purple chemotherapy label if it is to be left insitu.

The PACU RN must be aware of the post operative orders for catheter management before the draining occurs as different equipment is required.

Equipment Required:

• Chemotherapy spill kit

• Bladder trolley

• Cytotoxic waste bin

• Disposable sheets

• Syringe

Procedure

1. The PACU RN dons full chemotherapy PPE before commencing drainage.

2. Disposable sheets are placed underneath and around the patient’s perineal area to prevent skin contamination and to contain spills.

3. The IDC is unclamped and fluid is allowed to drain from the bladder into the closed circuit drainage bag

4. If the IDC is to be removed once the drainage has slowed or ceased the IDC balloon can be deflated and the IDC and drainage bag are removed and discarded into the purple cytotoxic waste bin. The amount in the drainage bag is recorded on the Fluid Balance Chart.

5. If the IDC is to remain insitu once the bladder has been drained, another closed circuit drainage bag is connected to the IDC, or continuous bladder irrigation is commenced.

6. Any fluid coming out of the bladder from continuous irrigation should be handled using cytotoxic waste precautions.

7. Volume may be ascertained by weighing a closed urine bag.

8. The PACU RN records the volume, colour and presence of clots in the ACT Health Progress Notes.

Subsection 5: Patient Transfer and Ward Handover

All staff involved in the transfer of the patient must be informed of the patient’s chemotherapy status.

1. The patient must not be transferred while Epirubicin remains instilled.

2. The RN must assess the risk of being exposed to body fluids, and wear PPE appropriate to this assessment. In all instances, a spill kit is required during transfer to ward or medical imaging department.

3. The ward RN is to be informed of the chemotherapy agent, the duration and administration process that occurred while in the perioperative environment during the clinical handover of the patient on the receiving surgical ward.

4. Chemotherapy precautions will subsequently be required for seven days post administration plus ongoing patient education regarding such precautions will need to be implemented. (1)

If the patient is transferred to Extended Day Surgery Unit (EDSU), then staff must follow

Canberra Hospital and Health Services, Clinical Procedure, Chemotherapy: Care of the Adult Patient (eviQ), CHHS15/056

and Plans Register/Chemotherapy Care of the Adult Patient eviQ.docx

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|Section 5 – Waste Management |

Cytotoxic waste is waste contaminated with cytotoxic drug(s) or metabolites, including contaminated body waste (6). All cytotoxic waste must be double-bagged as this reduces the risk of environmental contamination from aerosols and vaporisation (1).

A 120L cytotoxic waste bin is kept in PACU. When performing surgery on a cytotoxic patient this bin is to be collected from PACU and relocated to the appropriate theatre:

• Ensure that the bin is wiped over to remove any contaminates.

• All contaminated waste from the cytotoxic patient is to be placed in this bin.

• When the case is completed and all contaminated waste is removed from the theatre, the bin follows the patient back to PACU.

• If a waste bin is not in PACU, please ask environmental cleaning staff to get one from the dock. This bin must be wiped down by environmental cleaning staff before it enters the theatre complex.

• If waste bins are not available then cytotoxic buckets can be used.

When the patient has been transferred to the ward and the bin is no longer required, PACU staff contact environmental cleaning staff to dispose of the contaminated one and replace it with a clean one.

Small amounts of fluids post surgical procedure should be disposed of in the waste bin. Larger amounts should be sucked up and contained in suction canisters, or sucked up and contained in a Neptune device.

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|Section 6 – Spill management |

Equipment

• Spill kit

• PPE

In the event of a spill of a chemotherapy drug, cytotoxic body fluids or waste (6), all staff must:

• Alert all staff in the area that a spill has occurred.

• Don full PPE

• Use the contents of the spill kit or other equipment to clean the contaminated area/s.

• Cover the spill using available absorbent material or spill pillow to soak up any liquid.

• Discard the absorbent material into the cytotoxic bin.

• Wash all contaminated areas several times with neutral solution , working from the least contaminated areas to the greatest to avoid further spreading cytotoxic agents.

• Rinse the area thoroughly with water.

• Dry the affected areas with absorbent towels or other suitable material.

• Discard the contaminated cleaning waste into the cytotoxic bin.

• Remove PPE as described, Section 1.

• Complete incident report via RiskMan.

• Restock cytotoxic spill kits and other equipment as required

Please refer to Attachment 1- Clinical Procedure- Hazardous Drug Spill Management (eviQ).

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|Implementation |

The procedure will be implemented in all sections of the Perioperative Unit. The information will be communicated to staff by notices in the area specific communication books and references to the procedure will be made in the Orientation Manuals.

There will be in-service sessions on the instillation of Epirubicin in all areas of the Perioperative Unit.

Staff in Surgical Bookings will require education about the change in practice for the relevant RFAs.

The procedure will also be found in a laminated hard copy attached to both the Chemotherapy Precautions Trolley, and, in PACU, the Bladder Trolley.

Medical Oncology Chemotherapy Sheet (F00101 (0802)51214) need to be ordered from Stationery Supplies.

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|Related Policies, Procedures, Guidelines and Legislation |

Procedures

• Chemotherapy: Care of the Adult Patient (eviQ)

• Clinical Handover Procedure

• Decontamination Procedure: STR-GEN-PR-116.

Guidelines

• AHPRA Professional Scope of Practice

• Australia and New Zealand Urology Nurses Society. (2012) Instillation of Intravesical Solutions

• Clinical Oncology Society of Australia. Guidelines for the Safe Prescribing, Dispensing and Administration of Cancer Chemotherapy.



• Government of South Australia (2015) Cytotoxic Drugs and Related Waste. A Risk Management Guide for South Australian Health Services.



Legislation

• Work Health and Safety Act (2011)

• Dangerous Substances Act (2004)

• Medicines, Poisons and Therapeutic Goods Act (ACT) (2008)

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|References |

1. eviQ Cancer Treatments Online. Supporting Document- Safe handling and Waste Management of Hazardous Drugs 2015



2. Canberra Hospital Health Services Clinical Procedure. Chemotherapy: Care of the Adult Patient (eviQ). CHHS15/056

3.

4. Hill DS, O’Neill JK, Powell RJ, Oliver DW. Surgical smoke-A health hazard in the operating theatre: A study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. Journal of Plastic, Reconstructive & Aesthetic Surgery 2012; 65: 911-916.

5. The Australian College of Operating Room Nurses Ltd. ACORN Standards for Perioperative Nursing 2014-2015. Adelaide, South Australia.

6. MellingerE, Skinker L, Sears D, Gardner D, Shult P. Safe handling of chemotherapy in the perioperative setting. AORN Journal 2010; 91: 435-450.

7. Government of South Australia. Cytotoxic Drugs and Related Waste. A Risk Management Guide for South Australian Health Services 2015.



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|Definition of Terms |

Cytotoxic – an agent or process that is toxic to cells.

Chemotherapy – the use of any chemical agents to treat or control disease, most often used to describe treatment of malignant and other diseases with toxic agents.

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|Search Terms |

Perioperative Unit, chemotherapy, Epirubicin, Intravesical chemotherapy

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|Attachments |

Attachment 1 - eviQ Cancer Treatments Online. Clinical Procedure – Hazardous Drug Spill Management 2015

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

|Date Amended |Section Amended |Approved By |

|Eg: 17 August 2014 |Section 1 |ED/CHHSPC Chair |

| | | |

Attachment 1 - Clinical Procedure – Hazardous Drug Spill Management 2015

Accessed from eviQ Cancer Treatments Online ()

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