Managing cytotoxic medicine spills

Spills

Spills of cytotoxic medicines and related waste must be dealt with immediately as they pose a health risk to those exposed. Spills may occur in all areas where cytotoxic medicines or related waste are:

• prepared
• administered
• handled
• stored
• transported
• disposed of

A risk assessment should identify all areas where there is a risk of cytotoxic spill.

Types of spills

Spills may involve:

• cytotoxic medicines in all forms:
  • liquid
  • powder
  • broken tablets/open capsules
  • creams
• packaged drugs spilling (or leaking) as they are prepared, stored or transported
• drugs spilling or leaking as they are administered
• drugs spilling while a patient is being moved
• cytotoxic-contaminated body substances
• cytotoxic-contaminated waste

Spills may lead to the contamination of:

• floors
• work surfaces
• equipment
• personal protective equipment (PPE)
• vehicles
• bedding
• clothing

Spill kits

To help manage a cytotoxic spill as soon as it happens, a spill kit with the necessary equipment should be available in all areas where a spill is likely to occur. This includes vehicles.

A risk assessment of the area will help you to work out what to put in your spill kit. Contents may include:

• Instructions for use. For example, procedures for managing a cytotoxic spill.
• Signs to identify and isolate the spill area.
• PPE for two employees, including:
  • disposable impermeable gowns, coveralls with elasticised cuffs or industrial coveralls
  • nitrile or polyvinyl chloride (PVC) industrial gloves, long enough to cover the cuffs of the gown or coverall (consider a double layer of gloves)
  • disposable impermeable overshoes
  • safety glasses or goggles
  • respiratory protective equipment (P2/N95 face-fitting respirator)
  • face shield
  • hairnet or head cover
• Adequate quantities of absorbent materials, such as:
  • swabs
  • absorbent towels
  • spill pillows
  • chemical absorbent pads
  • protective mats (bluey or 'chemo mat')
• Wash bowl and detergent (with pH>10).
• A small scoop to collect any glass fragments.
• Two purple plastic waste bags, clearly identified as cytotoxic.
• Incident report forms.

Review spill kits regularly to ensure supplies are:

• adequate
• in good condition
• in date

Single-use commercially prepared cytotoxic spill kits are also available.

How to deal with a spill

Procedures for preparing and administering cytotoxic medicines should cover how to manage spills. Employers should provide training to all employees who are likely to deal with spills. Training should cover:

• ways to prevent cytotoxic spills
• spill containment and decontamination procedures
• ways to report cytotoxic spills
• where to access spill kits
• how to replace spill kits

Where exposure occurs involving any person (employee/patient/visitor), immediately:

• remove any affected clothing
• thoroughly wash affected area under water

Seek medical advice and attention where necessary. See the Safety Data Sheet (SDS) for specific information.

When managing any spills in the workplace:

• Stay calm. Alert everyone in the immediate vicinity that a spill has occurred. Keep the area clear of people. Do not leave the cytotoxic spill unattended.
• Allocate responsibility for managing the cytotoxic spill clean-up to an employee who has:
  • not been contaminated
  • has received appropriate training
• Open cytotoxic spill kit and display signs.
• Don the respirator first, followed by other appropriate PPE. Do this at a distance from the spill to ensure the PPE does not become contaminated while donning.
• For liquid spills:
  • wait a few seconds for aerosols to settle
  • cover the spill using absorbent material from spill kit (a spill pillow may be required for a large spill)
• For powder spills:
  • carefully cover with a mat, ensuring no dust is produced
  • carefully wet the mat so the powder dissolves and is absorbed by the mat
• Gather absorbed material, including broken glass if applicable. Place in cytotoxic waste bags or cytotoxic sharps waste container.
• Clean contaminated area several times with detergent. Work from the outer aspect of the spill inwards.
• Clean the area thoroughly with water. Continue until area is completely cleaned.
• Dry the affected area with absorbent towel.
• Discard contaminated cleaning waste into a cytotoxic waste bag.
• Discard outer gloves into cytotoxic plastic waste bag. Seal this bag and place in second cytotoxic plastic waste bag.
• Discard other PPE into the outer bag.
• Place cytotoxic waste bags containing all related waste into a cytotoxic waste disposal bin.
• Wash hands with soap and water.
• Reopen the area.
• Ensure cytotoxic spill kit is replenished and maintained.
• Report incident.

See also 'Spills in home and community care settings' in Administering cytotoxic medicines and caring for patients.

Reporting procedures

Employers should have a system in place for employees to report spills internally as soon as possible. An internal report should include:

• The type of spill.
• Action taken to manage the spill and address unprotected employee exposure. For example, rapid washing of skin exposed to a cytotoxic splash without any PPE.
• The names of employees who managed the spill.
• Any employee exposure to the spill and information about control measures in place.
• Action taken to prevent future occurrences.