Hazardous Precautions. Prepared By: Hazardous Precautions Working Group Updated: March 2014

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1 Hazardous Precautions Prepared By: Hazardous Precautions Working Group Updated: March

2 What are Hazardous Medications? They are therapeutic agents that are often used in the treatment of: cancer, anti-rejection post solid organ transplant, arthritis, etc. They are highly toxic to cells They are primarily excreted by the kidneys and the liver Depending on the medication, body fluids might be contaminated with the medication or its metabolites Policy: ADM-HS-34 Hazardous Medications Workplace Safety Management 2

3 There are two (2) categories of Hazardous medications Category 1 and 2 Medications Hazard is with handling, mixing, administering medications Category 1 Medications Hazard also is where there is a risk of handling body fluids 3

4 Exposure through handling of: Category 1 Hazardous Category 1 & 2 Medication plus: Medications Body Fluids & equipment that contacts body fluids: Waste disposal Linen soiled with fluids Sweat Saliva Vomit & emesis basins Blood Feces and Bed pans, Hygie bags, Colostomy / urostomy bags Urine from urinals / catheters / catheter bags Spills Handling, dispensing, mixing & administering hazardous medications: Special signage on medications packages Yellow Stickers Pink Stickers Green Stickers Meds in paper bags or in zip lock bags Dispose of med cups, syringes, nitrile gloves & other PPE in special red waste containers 4

5 Safe Handling Precautions should be maintained 7 days after completion of treatment for Hazardous Medications Category 1 only Women who are pregnant, breastfeeding, or people who are planning to become pregnant should not: handle Category 1 & 2 hazardous medications or provide care to clients on Category 1 meds. 5

6 New Identification Procedure Hazardous Drug - Category 1 Hazardous Precautions sign will be posted outside the room of client PPE includes: Double nitrile gloves for dispensing meds and personal care, Fluid resistant gown for personal care, Mask with visor dependent on splash risk N-95 respirator and goggles if risk of aerosolization 6

7 New Identification Procedure Hazardous Drug Category 2 The medication itself poses the risk No significant risk with managing body fluids No signage required PPE includes: Single nitrile gloves when administering and dispensing meds 7

8 How are clients on Category 1 or 2 medications identified? Caution The Caution triangle in Quadramed will be identified and completed in the epr at the following times: Prior to admission by: personnel involved in admission process At Admission and During stay when hazardous medications are ordered / discontinued by: Pharmacy &/or Nursing Removal of Caution flag when medication is discontinued: After seven (7) days for category 1 by Pharmacy / Nursing Immediately for category 2 by Pharmacy 8

9 How is the client on Category 1 Hazardous Medications identified? Signage was previously called Cytotoxic Precautions and has been changed to this more comprehensive term 9

10 What safeguards are in place for clients on Category 1 or 2 medications? Program Manager / Delegate will ensure that all supplies are available for the client room prior to the client being admitted to the unit, including: Personal protective equipment (PPE) Notifying housekeeping of requirement for Hazardous Waste container, (with red biomedical bags) Hazardous Spill kit is in Clean Utility Room As well as for clients on Category 1 Medications Signage requirements Hazardous Precautions Yellow Linen containers by housekeeping 10

11 Wearing Personal Protective Equipment Category 1 PPE for hazardous precautions is not the same as PPE for clients in infection control isolation e.g. contact precautions Apply PPE if staff are: giving / handling / dispensing a medication at risk of coming into contact with a body fluid or surfaces contaminated with the medication or its metabolites Care that poses no risk (i.e. answering a call bell, delivering a meal tray) does NOT require PPE If there could be a splash of body fluids to the face, wear a mask with visor or mask with goggles (e.g. emptying urine into toilet) 11

12 Personal Protective Equipment Category 1 Wear PPE whenever you handle hazardous medications agents, or come in contact with body fluid, or risk of splash or spray Gown Must be moisture resistant e.g. microfibre yellow rewashable gown OR Disposable gowns Change immediately if contaminated / splashed / sprayed Eye / face protection Wear mask with face shield (or mask with goggles (know where eyewash facility is located for 1 st Aid) Wear N95 respirator and goggles if client has a tracheostomy, or is receiving BiPAP or CPAP, or Bag Valve Mask ventilation (e.g. CPR with Ambu bag) 12

13 Personal Protective Equipment Category 1 & 2 ALWAYS wear PPE whenever you handle hazardous medications agents Nitrile gloves policy states: Single gloves for handling hazardous medication category 2 Double glove for meds and handling waste & body fluids for hazardous medication category 1 Change after 30 minutes of wear time Discard gloves, med cup, syringe in red Biomedical Waste bags Discard needles / sharps in red sharps containers 13

14 Disposal of Waste ADM-EM-4 Hazardous Materials Disposal Obtain hazardous waste container lined with RED Biohazard bags from housekeeping (Category 1 & 2 meds) 2 or 5 gallon container or Garbage cart with red bags Dispose of used nitrile gloves, mask, disposable fluid resistant gown, or dispose of medication cup, in the red biomedical bag Use the commode liners for disposal of urine & feces, this reduces the risk of splash Client waste such as urine, feces, vomit, and contents of colostomy and urostomy bags may be flushed in the toilet. Please double flush. (& cover toilet with towel or blue pad) Ensure surfaces are wiped / cleaned twice between patients with cavi-wipes, oxivir-tb, or use virox and paper towels. 14

15 Handling Linens Obtain linen hamper for cytotoxic contaminated linen (room with Hazardous Precautions sign for Hazardous Medications category 1 If linen has been contaminated it should go in a double bagged YELLOW linen bag and a biohazard label attached to it where it goes to Regional Laundry PURPLE Bag is used for client s personal clothing clothing is put inside the Yellow linen bag. Linen handling at Regional Laundry These Yellow bags are set aside for 7-10 days, and then are laundered. This enables metabolites to become non-hazardous. So there will be a delay in the return of client personal laundry. 15

16 Patient / Client / Family Pamphlets for Education 16

17 What to do if there is an Accidental Exposure to: Eyes Immediately flush affected eye(s) at eye wash station for at least 15 minutes, and report to Occ Health, or go to Emergency If contact lenses are present, remove and throw in biomedical waste Skin Remove contaminated clothing immediately and wash affected area first with water then with soap and water for 10 minutes (nondisposable clothing should be placed in a double laundry bag. At home, pre-wash clothing twice separately in hot water) Needle Stick Immediately wash puncture site with soap and running water for 15 minutes Squeeze puncture site to bleed freely Clean with alcohol 17

18 Accidental Exposure Inhalation Move from area of exposure and seek emergency treatment immediately Ingestion Flush mouth with copious amounts of water and seek emergency treatment In ALL case of exposure go to Occupational Health Services for follow up, and complete an incident report in SafetE-Net. If after hours and on weekends, go to emergency. For more information please refer to policy & procedure: ADM-HS-34 Hazardous Medication Workplace Safety Management ADM-EM-4 Hazardous Materials Disposal 18

19 Hazardous spill What is a spill? Examples may include: Spill of liquid medication Client sick after swallowing medication Incontinent or spill of body fluids Obtain Chemo or Cytotoxic spill kit (stored in Clean Utility Room, Housekeeping, Switchboard, Stores) Follow instructions on package. Apply PPE to keep yourself safe. After cleaning, remove PPE, and wash your hands with soap and water 19

20 Cleaning Equipment Any equipment that is removed from a client room to be repurposed Wear PPE Clean Items with Caviwipes, Virox wipes, Percept Clean item 3x with different cloth each time If reusable cloth, put in Yellow biohazard linen container. If disposable cloth, place in Red Hazardos waste container Remove PPE, and WASH HANDS (don t use alcohol) If client has a spill (urine, feces, emesis) Get a cytotoxic kit Wear PPE pick up solid matter and flush in toilet (plus 2 extra flushes) If liquid, (urine, emesis) On carpet / fabric apply granules to help absorb material On tile/vinyl/hard surface 20

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