Policy # 2.6.5
UNIVERSITY OF IOWA COMMUNITY HOMECARE
SUBJECT: Acute Chemotherapy Exposures and Spills
POLICY:
1. Any exposure to or spills of chemotherapeutic agents shall be reported to an immediate supervisor and documented on an Unusual Occurrence Report.
2. All nurses shall carry chemo spill kits in their car when they are transporting or administering chemotherapeutic agents.
3. Patients receiving continuous infusion of chemotherapeutic agents shall be instructed in the proper method for cleaning up a chemo spill and instructed to report any spills that occur in their home. Patients will be supplied with spill kits if required by state law.
NURSING PROCEDURE:
1. An Unusual Occurrence Report must be completed to document the exposure.
2. Acute Exposures:
a. Remove contaminated gloves and gowns and discard.
b. Wash the contaminated skin thoroughly with soap and water.
c. If the eye is involved, flood the eye with copious amounts of water.
d. If the skin or eye contact is significant, a medical evaluation should be obtained as soon as feasibly possible after the exposure.
3. Acute Spills:
a. Any spill shall be cleaned up immediately. Personnel shall wear chemosafety gloves, eyewear, and disposable gown with closed front, long sleeves, and elastic knit cuffs that are tucked under the gloves.
b. Use absorbent towels, one at a time, to absorb the spill.
c. As the absorbent towel becomes saturated, carefully remove it from the spill and place it into a leak-proof, puncture-proof container along with any broken glass or other disposable contaminated material.
d. When the spill is completely removed, clean the spill area thoroughly with soap and water.
e. Remove the protective gown, eyewear, and gloves and dispose of in an appropriate chemo waste container.
f. Wash hands thoroughly.
g. Return the container to the center for disposal.
h. Document description of the spill and the method used for clean up on the Unusual Occurrence Report and in the clinical progress notes.
i. If the patient is exposed, document in the clinical progress notes, what steps were taken to protect the patient.
PATIENT AND CAREGIVER EDUCATION:
POLICY:
1. Patients and caregivers shall be taught safe, proper handling and disposal of waste generated during continuous infusions of chemotherapy such as disposal of cassettes and tubings, care of contaminated linen and excretions, and chemo spill management.
2. A chemo disposal container or equivalent with distinctive chemotherapy warning labels shall be placed in the home for disposal of supplies.
PROCEDURE:
1. Give all patients/caregivers who receive chemotherapy or other cytotoxic drug(s) in the home the following instructions for cleaning up a spill and place documentation in the patient's file to confirm training:
a. Put on a pair of disposable gloves constructed out of an impervious material such as latex.
b. Remove any and all sharps, put into a sharps container.
c. Soak up the spill with an absorbent disposable material, such as paper towels.
d. Disinfect the spill area with soap and water or a household cleaner such as window cleaner, 409, alcohol, bleach or liquid carpet cleaner.
e. Put the absorbent material and the gloves into a chemotherapy waste container.
2. If a spill occurs on a patient's or caregiver's clothing or sheets, these articles should be washed separately from regular laundry in hot water.
3. If a spill occurs on unprotected furniture, the area should be scrubbed with soap and water and rinsed with clean water wearing protective chemosafety gloves.
4. Patients and caregivers should be instructed to notify the nurse when a spill occurs.
5. Patients and caregivers should be taught to use care when handling vomitus or excretions of the patient for 48 hours post treatment and to use good handwashing technique.
Written: 1/97
Reviewed: 5/01, 6/04, 3/07, 7/10, 6/12, 6/13, 9/15
Revised:
Approved By:
Acute Chemotherapy Exposure and Spills - 2