Spill Control of Hazardous Drugs

Implementation Date: 11/2021

Date of Last Revision: 6/24/2023

Next Review Due: 6/23/2026

 

Reviewed by VTH Administrative Team: 11/2021

Reviewed by VTH Board: N/A

 

Reviewed & Approved by Hospital Director: 11/2021

Reviewed by Biosecurity Subcommittee: N/A

Subject to modification by the VTH Director without approval.

Policy

The intent of this policy is to define appropriate processes for containing and cleaning spills of hazardous drugs and for the disposal of any spill materials. This is applicable to all personnel who may be required to contain or clean up a spill of hazardous drugs.

Personnel who may be required to clean up spills of hazardous drugs must have received proper training and must don appropriate PPE to contain and clean spills immediately. Spill kits must be readily available in all areas where HDs are routinely handled. Spill materials must be disposed of as hazardous waste.

Guidelines

1. Personnel who may be required to clean up a spill of HDs must receive proper training in spill management and the use of PPE and NIOSH-certified respirators. Only qualified personnel with appropriate PPE can contain and clean spills.
   
   
2. Spill kits that contain all of the materials needed to clean HD spills must be readily available in all areas where HDs are routinely handled. If HDs are being prepared or administered in a non-routine healthcare area, a spill kit and respirator must be available.
   
   
3. Management and circumstances of spills must be documented. Personnel who are potentially exposed during the spill, spill cleanup, or who have direct skin or eye contact with HDs require immediate evaluation. Non-employees exposed to an HD spill should follow entity policy, which may include reporting to designated emergency service for initial evaluation and completion of exposure or incident form.
   
   
4. Spill kits will be placed in areas where HDs are received, stored, and administered.
   1. The Dispensary will stock a Chemotherapy Drug Spill Kit which includes the following:
      1. #2 Pairs of ChemoPlus gloves
      2. #1 ChemoPlus Gown
      3. #1 Pair of safety glasses
      4. #1 Respirator mask
      5. #3 Spill towels
      6. #2 Chemotherapy waste bags
      7. #1 Pair of shoe coverings
      8. #1 Sign to denote an HD spill (Caution: Spill)
      9. #2 ChemoSorb pads
      10. #1 Scoop with detachable scraper
      11. #2 Tie wraps
   2. Supplies should be sufficient to absorb a spill of about 1,000ml
   3. All spill materials must be disposed of as hazardous waste.

Procedure (if applicable)

Spills less than 5 mL / 5 gm

1. Alert others about the spill and place visible signs (Caution: Spill) to restrict access to the area. Do not leave the spill unattended. Remove any contaminated clothing and wash any affected skin with soap and water. Prior to cleaning the spill, appropriate PPE should be donned.
   
   
2. Liquids should be wiped up with an absorbent gauze pad with an impermeable backing. Solids should be wiped with wet absorbent gauze with an impermeable backing. The spill area(s) must be cleaned using a detergent solution, followed by clean water. Repeat this cleaning step 2+ times.
   
   
3. Any broken glass fragments shall be picked up using a small scoop (never with the hands) and placed in a hazardous drug sharps container.
   
   
4. Contaminated reusable items, such as glassware and scoops, shall be washed twice with detergent by a trained employee wearing double gloves and a disposable gown. This PPE shall be disposed of as trace hazardous drug waste.
   
   
5. Place all contaminated absorbent pads and other materials in a bulk HD waste container.
   
   
6. After removing PPE, wash hands, arms and face.
   
   
7. Reusable protective goggles should be cleaned with mild detergent and water after each use.

 

Spills more than 5 mL / 5 gm

1. Alert others of the spill and place visible signs (Caution: Spill) to restrict access to the area. Do not leave spill unattended. Remove any contaminated clothing and wash any affected skin with soap and water. Obtain the nearest spill control kit.
   
   
2. Contain the spill. Refer to the procedure form in the kit, if applicable. Stop the spread of the spill by placing wipes around the perimeter. For liquid or powder spills, gently lay the ChemoSorb Pad over the spill. Do not press it onto the spill and do not touch any of spill material.
   
   
3. Once the spill has been contained with ChemoSorb pads/wipes, don PPE in the following order:
   1. Respirator mask --> Safety glasses --> Hairnet --> First pair of gloves --> Chemo gown --> Shoe covers --> Second pair of gloves. 
      
      
4. Open waste bag and fold it down so it is possible to place items in the bag without touching the outside of bag. Do the same with cytotoxic waste bag. Make sure all other necessary items needed to clean the spill are within reach.
   
   
5. If spill is in powder form, it will be necessary to add water to the powder prior to continuing the cleaning process. Gently pour enough water on the ChemoSorb pad that is covering the spill to saturate the area. Do not pour water directly onto the powder. Allow the water to soak through the pad into the powder then use the plastic scoop and plastic scraper. Carefully scoop up any broken glass / powder slurry by folding the edges of the ChemoSorb pad into itself. Minimize using your hands directly to avoid contaminating your gloves, yourself, and other surfaces. Dispose of ChemoSorb pad in waste bag.
   
   
6. Using towelettes moistened with water, slowly wipe in towards the spill by starting from the outside edge of the spill. Use a fresh wipe each time you move to the outside area of the spill. Use any remaining towelettes to dry the area and dispose of in the waste bag.
   Remove ONLY THE FOLLOWING PPE in the following sequence and then dispose of in the waste bag: Overshoes --> Outer pair of gloves --> Chemo gown --> Safety glasses.
   
   
7. Touching only the outside of the waste bag, carefully close the bag and tie it at the top using one of the tie wraps. Do not press down on the bag as this may disperse hazardous particles in the air. Place the white bag inside the cytotoxic waste bag without touching the outside of the cytotoxic bag. Place any caution signs inside the bag. Remove the inner pair of gloves and mask and place inside bag. Touching only the outside of the cytotoxic bag, close the bag using the other tie wrap. Place the sealed cytotoxic waste bag into a solid waste container.
   
   
8. After disposing of all waste, thoroughly wash your hands with soap and water. Report the incident to your supervisor and fill out the Spill Documentation Form. Ensure that a replacement spill kit is available or arrange to have another kit ordered.
   
   
9. Submit the Spill Documentation Form to Dispensary to review and maintain in their records. The Dispensary will keep a scanned document on file and provide a copy to Biosecurity & Safety.

Definitions (if applicable)

HD : Hazardous Drug

PPE : Personal Protective Equipment

Veterinary Teaching Hospital (VTH): The collective clinical services of the Large Animal Clinic, Midwest Equine, the Small Animal Clinic, and the Veterinary Medicine South Clinic.