Spills of chemotherapy and hazardous drugs are never a good thing.  In addition to being costly to replace and time consuming to re-compound, a hazardous drugs (HDs) spill could potentially expose healthcare workers to direct contact with the drug which may have a detrimental affect to their health.  The Healthcare industry knows that chemotherapy and hazardous drugs can cause both immediate and long-term detrimental health effects.[1]  Everything from burning tissue that contacts HDs to causing a higher level of miscarriages[2], the effects of HDs on healthcare workers has been studied and documented.  That is why it is so important to protect the healthcare workers that receive, compound, transport, administer, clean-up and dispose of the hazardous drugs.

Facility procedures to limit exposure and to protect the people that may come into contact with the hazardous drugs include environmental controls such as the use of a negative pressure environment/cleanroom, procedural controls such as in receiving and transporting the HDs and personal protective equipment (PPE) such as chemotherapy/HD gowns, gloves, masks or respirators and eye protection.  Many of these procedures are done or checked daily.  When there is a spill, however, often healthcare personnel are not as familiar with the spill cleanup procedures because a spill may not happen often and/or may occur in many different places within a given facility.  In fact, with home administration of many chemotherapy drugs, even a patient’s home may become a spill location.  It is important to understand the best way to clean up and dispose of the chemotherapy or hazardous drugs in any scenario.  Below are the steps needed to properly clean up a chemotherapy and hazardous drug as detailed by the Oncology Nursing Society’s Safe Handling of Hazardous Drugs Handbook, Third Edition. [3]

1. Assess the exposure risk of people in the area. Isolate them from the spill, if possible.
   • A spill may occur anywhere the drug is. This could be in the receiving department of a hospital, an administration area where patients are receiving treatment or a home or assisted living facility.  One way to make it easier to clean up a spill is to have a spill kit ready with all the materials needed to safely clean up the spill. Many spill kits contain a sign that alerts people that there has been a spill and to stay out of the area until it is cleaned up.
2. If the HD has come into contact with an individual’s clothing, remove the clothing and wash the affected skin with soap and water.
3. Don all necessary personal protective equipment to protect yourself from the effects of the chemotherapy/HDs.
   • This includes a chemotherapy rated gown or coveralls, double chemotherapy-rated gloves, a NIOSH-approved respirator and eye or face protection. Standard surgical face masks or cloth masks are ineffective.  We also recommend wearing shoe covers so that the HD is not inadvertently carried throughout the area on the sole of a shoe.
4. Contain the spill using a plastic-backed absorbent pad.
   • It is important to wear gloves as well as use a poly or plastic-backed absorbent pad. Start at the outside of the spill and work inward. While the absorbent pad does soak up the hazardous drug liquid, it does not necessarily deactivate the HD. If you use an absorbent pad with activated carbon, or other deactivation method, it will deactivate the drug as soon as it gets absorbed into the pad itself.
5. If necessary, use as scoop and scraper to clean up glass, plastic or other debris that has come into contact with the HD.
6. Place the used absorbent pads, scoop, scraper or brush and any other debris into the waste bag.
   • The waste bag should be a chemotherapy waste-rated bag that can withstand the drug and any debris that may have been contaminated by the chemotherapy or HD. It should also be marked as a chemotherapy/HD waste bag.
   • Avoid contamination with the top and outside of the bag. If someone else is helping keep the bag open, they also have to wear the full set of PPE in step 3.
7. Check around the area of the spill for any droplets.
   • Make sure you have good lighting to look around beds, chairs or other furniture to ensure that no residual HD or debris remains.
8. Use a deactivation product to clean the area of the spill.
   • The entire area of the spill should be cleaned with a deactivation cleaner. A bleach solution or other cleaner can be used if nothing else is available.  Start from the outside and work toward the epicenter of the spill. This will prevent spreading of any residual chemotherapy or HD residue.
   • If the spill occurs on carpet, the recommendation is to remove the contaminated section of carpet and dispose of it in the hazardous waste bag or container. While this may be easily done in a hospital or other healthcare facility, it isn’t as easily done in a home. In the case of an HD spill on a carpet that cannot be removed, use an absorbent powder on the carpet and vacuum it up using a vacuum with a HEPA filter. Clean the vacuum and discard the HEPA filter afterwards. Then, clean the carpet according to institutional procedures.
9. Clean the area again with water to adequately remove residual HDs and cleaning solution.
   • While many spill kits contain both a cleaner and wipes, if something else is used, any cleaning materials must be disposed of in the chemotherapy/HD waste bag and cannot be reused.
10. Place all wipes and cleaning supplies into the chemotherapy/HD rated waste bag.
    • Be careful to not touch other surfaces as the gloves may be contaminated.
11. If you have a hazardous waste container in the area, seal or twist tie the contents of the chemotherapy/HD rated waste bag and place the contents into the HD waste container.
    • If you don’t have a container, you can use a larger, 15-gallon HD waste bag as your container and move to the next step.
12. Place all PPE used into the hazardous waste container or bag.
    • The PPE should be removed and placed into the chemotherapy/HD waste bag in the following order:
      1. Starting with the outside pair of gloves, remove only the outside pair being careful to turn them inside out as you remove them.
      2. Remove the face or eye protection next while being careful to limit touching the outside.
      3. Remove the gown being careful to turn it inside out and only touch the inside of the gown while placing it into the waste bag.
      4. Remove the shoe protection next and place them into the waste bag.
      5. Next, remove the inner gloves being careful to turn them inside out while removing them while not touching the outside of the gloves.
      6. Wash your hands with soap and water before moving to the next step.
      7. Remove the respirator or mask being careful not to touch the outside of the mask.
      8. If you are using a 15-gallon hazardous waste bag as your waste container, place all the PPE contents into the bag and close it with a twist tie.

13. Wash your hands again.
    • If you need to touch or move the 15-gallon HD waste bag, wear appropriate HD-rated gloves and wash your hands afterwards.
14. If your facility requires it, complete a spill incident report and send it to the appropriate body.
15. If applicable, vent the area to help remove any HD vaporization that may have occurred. While the ASHP nor OSHA provide procedures for ventilation after an HD spill, most cleanrooms are adequately designed to filter any HD vapors. For other settings, clean or filtered air may help with reducing any potential HD air exposure.
16. If there is a chemotherapy or hazardous drug exposure to anyone in the area, contact your doctor or health professional immediately.
    • Wash any affected skin with soap and water.
    • Rinse eyes for at least 15 minutes with water or an isotonic solution.
    • Complete an incident report per your facility requirements.

For more information on handling chemotherapy or hazardous drugs, visit the Oncology Nursing Society’s website at www.ons.org or purchase their published handbook Safe Handling of Hazardous Drugs (Third Edition) | ONS.

Acute Care Pharmaceuticals supplies USP <797> and <800> compliant personal protective equipment, cleanroom disinfectants and cleaners and chemotherapy-related supplies for hospital pharmacies, cleanrooms, compounding and administration facilities. If you are interested in our Chemotherapy /Hazardous Drug Spill Kit or any of our other products, give us a call at 888.909.7700 or visit us at www.Pharma-Choice.com.

Source: Polovich, M., Olsen, M. M. (2018) Safe Handing of Hazardous Drugs, Third Edition: Management of Spills. Pittsburgh, Pennsylvania, Oncology Nursing Society

[1] Susan Arnold & Hannah M. Kaup (2019) Assessing variability of antineoplastic drugs handling practices in clinical settings, Journal of Occupational and Environmental Hygiene, 16:12, 757-762, DOI: 10.1080/15459624.2019.1667502

[2] Chasle S, How CC. The effect of cytotoxic chemotherapy on female fertility. Eur J Oncol Nurs. 2003 Jun;7(2):91-8. doi: 10.1016/s1462-3889(02)00081-9. PMID: 12849562.

[3] Polovich, M., Olsen, M. M. (2018) Safe Handing of Hazardous Drugs, Third Edition: Management of Spills. Pittsburgh, Pennsylvania, Oncology Nursing Society