Important Steps

Key Points

1.

Initiate first aid and decontamination as described below for the specific contact type.

Specific procedures are found in sections below.

2.

Report incident to immediate supervisor.

3.

Report to the Occupational Health Department to be assessed by an Occupational Health Specialist.

4.

After hours, report to the hospital’s Emergency Department.

5.

Document appropriately.

Important Steps

Key Points

1.

Initiate an investigation to determine the cause of the incident and what corrective action can be taken to minimize the possibility of recurrence.

2.

Document appropriately.

Important Steps

Key Points

1.

Remove contaminated clothing as soon as possible.

By removing contaminated clothing you reduce skin contact time and thus reduce skin absorption.

2.

Place disposable protective clothing into the appropriate cytotoxic waste container.

3.

Place contaminated hospital clothing into the designated dirty linen hamper.
Tie the bag off to contain and prevent the spread of aerosols or particulates.

All linen is handled the same way by the laundering company- however it is important to tie off the bags to prevent spread of contamination from the bag.

Personal clothing should be placed into a doubled plastic laundry bag and tied off.  The staff member will take it home to wash separate from other laundry.

If personal clothing is saturated, disposal is recommended.

4.

Wash affected body area with copious amounts of clean water followed by soap and water.

Wash hands for 10 minutes. Do not scrub.

Use a gentle stream of water to prevent splashing and potential aerosolization of contaminants.

A minimum of 10 minutes is required to ensure removal of the contaminant.

Scrubbing may cause skin breakdown and create a route of entry into the body.

5.

Follow procedure described above in ‘All Accidental Contacts, Everyone’.

Important Steps

Key Points

1.

Wash the puncture site thoroughly with soap and running water.

2.

Allow wound to bleed freely.

Bleeding will flush contaminants from the body to some degree.

For deep puncture with a vesicant drug, additional follow-up by a physician may be required through the Occupational Health Unit.

3.

Follow procedure described above in ‘All Accidental Contacts, Everyone’.

Important Steps

Key Points

1.

Flush affected eyes with copious amounts of water or normal saline for a minimum of 15 minutes.

Take immediate action when there is eye contact with hazardous drugs.  These are readily absorbed through the eye.

2.

If contact lenses are present remove carefully and discard in cytotoxic waste.

If contact lenses are adhered to the eye do not attempt to remove.  You may damage the cornea.

Contact lenses are very absorbent.  It is not certain that they can be thoroughly cleaned therefore they should be discarded.

3.

Follow procedure described above in ‘All Accidental Contacts, Everyone’.

Important Steps

Key Points

1.

Do not swallow.

2.

Flush mouth with copious amounts of water.

When flushing avoid excessive spitting in order to minimize aerosol generation and therefore spread of contamination.

3.

Follow procedure described above in ‘All Accidental Contacts, Everyone’.

Important Steps

Key Points

1.

Initiate treatment for all individuals exposed to the hazardous drugs.

Follow the guidelines given for accidental contact (see section ‘All Accidental Contacts’ above).

See section ‘All Accidental Contacts’ above.

2.

Isolate the spill area and restrict access through the area.

3.

Get the spill kit and other required material.

4.

Don the following Personal Protective Equipment (PPE):

• Gown
• 2 pairs of gloves – ensure the second pair of gloves overlaps the cuff of the gown
• N95 mask for which you have passed a fit test
• Goggles or face shield
• Shoe covers

Double gloving is recommended during the clean-up of liquid spills.

5.

Collect any broken glass carefully using the scoop and brush provided in the spill kit.  Place the glass into a puncture resistant cytotoxic waste sharps container.

Do not pick up broken glass or sharps by hand.

6.

Liquid spills:

• Work from the outside of the spill inwards.
• Gently place absorbent pillows or towels over the spill.
• Allow time to absorb.
• Wipe up.

Place pillows or towels in the small disposable bag provided in the kit.

Avoid splashing and vigorous wiping to prevent the generation of aerosols.

7.

Powder spills:

• Using water dampened disposable gauze pads, carefully cover the spilled powder.
• Collect all powder from non absorbent surfaces.
• Place the gauze pads with the powder into the small cytotoxic waste bag provided in the spill kit.
• Repeat application of dampened gauze until all visible powder is removed.

Use dampened gauze to prevent the powder from becoming airborne.

8.

Once visible spilled material is removed, call Housekeeping to wash the spill area.

Ensure that Housekeeping staff know that all hazardous material has been removed.

9.

Spills on carpeted areas or cloth covered furniture:

• Isolate any carpeted areas or furniture onto which the hazardous drug has spilled.
• Use absorbent pads, towels to remove as much of the spill as possible.
• Discard clean-up material into the small cytotoxic waste bag.

Consult an Occupational Hygienist if further decontamination instructions are required.

Hazardous drugs should never be used or stored in areas where there is carpeting or cloth-covered furniture as it is not easily decontaminated due to the absorbent nature.

10.   

Seal the small cytotoxic waste bags.  Put the sealed bag into the spill kit box and seal the box with the cytotoxic label provided.  Place the spill kit box into the large cytotoxic waste bag provided with the kit.

11.

Remove PPE:

• Remove shoe covers
• Remove outer layer of gloves and place in cytotoxic waste bag.
• Remove gown and place in red cytotoxic waste bag.
• Remove second pair of gloves and wash hands.
• Remove goggles and/or mask.
• Dispose of gloves, mask, and goggles in cytotoxic waste bag. 
• Wash hands thoroughly

12.

Place the large waste bag into a puncture proof cytotoxic waste container.  Ensure “Cytotoxic” label is affixed to the container.

13.

Document the spill according to your hospital’s reporting policy ensuring to state the following:

• The drug and approximate amount spilled
• How the spill occurred
• Spill management procedures followed
• Who was exposed to the spill

Actions taken to prevent a recurrence.

Important Steps

Key Points

1.

Gather clean up material listed in section above “Additional Required Materials for Housekeeping Staff”

2.

Don the following PPE:
Gown

• 2 pairs of gloves – ensure the second pair of gloves overlaps the cuff of the gown
• N95 mask for which you have passed a fit test
• Goggles or face shield
• Shoe covers

Double gloving is recommended during the clean-up of liquid spills.

3.

Floors
Wash:

• Wet one mop in pail with neutral cleaner and squeeze out extra fluid.
• Mop spill area.
• Rinse mop in pail with cleaner and squeeze out.
• Mop spill area again.
• Return mop to pail.

Rinse:

• Wet second mop in pail with rinse water and squeeze out.
• Rinse area that has just been cleaned.
• Return mop to pail.

4.

Surfaces:
Wash:

• Apply neutral cleaner from squeeze bottle over contaminated area.
• Wipe surface with a clean cloth.
• Discard cloth into cytotoxic waste container.
• Apply cleaner to the area again.
• Wipe with second cloth.
• Discard cloth into cytotoxic waste container.

Rinse:

• Wet a clean cloth in rinse water (nearest sink).
• Wipe spill surface area.
• Discard cloth into cytotoxic waste bin.

Repeat the above steps.

Make sure the entire spill area is cleaned.

5.

Remove gloves and discard into cytotoxic waste bin.

Gloves should be removed so contamination is not spread.

6.

Transport pails and mops to nearest janitor closet.

7.

Mop and pail clean –up:

• put on clean gloves
• squeeze mop heads
• place mop heads into double linen bag
• tie off
• empty pails carefully into the slop sink
• rinse and empty pails 2 times

Make sure all PPE is work for this process.

8.

Remove PPE as described above.

9.

Take bagged mop heads to the usual place for final cleaning.

Mops and linens are cleaned by the external laundering service.  They will take precaution to prevent staff exposure.