Cytotoxic Agents Safe Management For Nursing Students. Pat Stalker Clinical Educator, LRCP Feb 2015

Size: px

Start display at page:

Download "Cytotoxic Agents Safe Management For Nursing Students. Pat Stalker Clinical Educator, LRCP Feb 2015"

Drusilla Mitchell
8 years ago
Views:

1 Cytotoxic Agents Safe Management For Nursing Students Pat Stalker Clinical Educator, LRCP Feb 2015

2 Overview and Objectives Review key content of the nursing procedure Differentiate between Hazardous drugs and Cytotoxic Drugs Increase awareness of health risks related to working with hazardous drugs and how to protect self Gain an understanding of PPE and safe handling required when administering cytotoxic agents Knowledgeable of waste handling including spill management 1 1

3 Hazardous Drugs vs Cytotoxic Drugs Hazardous drug capable of producing at least one of the following effects: Carcinogenic, teratogenic, reproductive toxicity, organ toxicity, Genotoxicity or mimics an existing hazardous drug Includes chemo, antivirals, hormones and other drugs Cytotoxic drugs are designed to harm or destroy cells within the body Classified as hazardous drugs For patients benefits outweigh risks Staff just risks, no benefits Non-cytotoxic Hazardous drugs less toxic (NIOSH) 2 2

4 What is the risk for staff? Health effects from exposure may include skin rashes, adverse reproductive outcomes, breathing difficulties and development of leukemia or other cancers Risk is based on the extent and potency of exposure Exposure can be in the air, on work surfaces, clothing, cytotoxic waste (blood and body fluids, PPE, needles and syringes) Routes of exposure are inhalation, skin contact,/absorption, ingestion and injection 3 3

5 Cytotoxic Agents Safe Management Procedure Preparation of Patient and Family Education about drugs and precautions Resources to take home Preparation/Transport Always prepared by pharmacy no crushing or splitting tablets, no mixing of parenteral drugs Stored in plastic bags or containers with cytotoxic label, until used Shipping/receiving and portering trained in safe handling - Contamination pathway Transporting patient with cytotoxic medication infusing requires competent RN to accompany assess need to transport 4 4

6 Procedure continued Setting up in patient care areas Dedicated area Protect surfaces with blue pad No food or beverages Eyewash station available Signage for patient room 5 5

7 Personnel Administering Personnel Administering Require education on safe administration and handling including spill management. Additional education (competency/certification) is required for cytotoxic administration for oncology purposes Cytotoxic and non cytotoxic hazardous medications (for non oncology purposes) can be given by student nurses under the direction of their preceptor or instructor (who has ensured they are aware of safe management guidelines) Nursing students cannot administer cytotoxic medications for oncology purposes 6 6

8 NON ONCOLOGY PURPOSES Many drugs that are cytotoxic are given for nononcology purposes Safe handling, precautions and PPE must still be used for these patients Students may administer these drugs under the supervision/guidance of their preceptor or instructor Examples: Intravenous ganciclovir antiviral agent Cyclophosphamide IV or tablets given for various conditions such as kidney disease Methotrexate IM for Rheumatoid Arthritis 7 7

9 Pregnancy and cytotoxic medications Cytotoxic and non-cytotoxic hazardous drugs can have harmful effects to the reproductive system and fetus if handled in an unsafe manner. Effects vary with each drug. Pregnant, anticipating pregnancy or breast feeding is it safe to care for patients who have received cytotoxic medications? If you wear PPE when handling blood and body fluids or administering drugs it is safe nurses or student nurses who have concerns should talk to their leader, instructor and/or occupational health and safety 8 8

10 Cytotoxic Management PPE Double Nitrile gloves powderless, AST approved Disposable polyethylene coated, long sleeve, back closure, with knit cuffs Single patient use for your shift if not contaminated Exception is chemo suite and OR/IR surgical gown Mask for high risk situations and n95 mask for spills Eye protection for high risk Risk assessment is required to determine what PPE is required 9 9

11 Parenteral Drugs (non-oncology purposes) PPE (minimum double nitrile gloves and chemo gown) Plastic backed blue pad for work area, gauze Needleless, Leur-lok tubing and syringes Dedicated IV set-up Pharmacy prepares and primes lines Red cytotoxic disposal unit point of care, or seal in red cytotoxic plastic bag Eye wash station and shower available Universal Spill kit (and N95 respirator) continued 10 10

12 Parenteral drugs (non-oncology) continued IM, SQ use air sandwich technique Blood and body fluid precautions for minimum 48 hours (PPE required) Dispose of PPE and equipment in cytotoxic container Wash hands, soap and water 11 11

13 Oral drugs (non-oncology purposes) PPE (double gloves, minimum gown, mask and eye protection for high risk i.e. liquids, per tube) Do not split tablets, crush or open capsules this needs to be done in pharmacy Who opens package patient or nurse? All packaging, med cup and PPE are disposed of in cytotoxic waste Precautions (PPE) for blood and body fluids for minimum 48 hours post last dose Wash hands post removal of PPE with soap and water 12 12

14 Handling and Disposal of body fluids Blood, sweat, saliva/mucous, emesis, feces and urine for minimum 48 hours post cytotoxic agent PPE according to risk assessment Disposal in toilet, cover with plastic back pad, flush twice Patients flush twice Hygie bags or diapers disposed of in cytotoxic waste Bedpans, urinals etc. should be disposable and are placed in cytotoxic waste Patient education for precautions at home 13 13

15 Disposal of contaminated items and linen PPE (minimum double gloves and gown) Assume body fluids are on linens Unless saturated with fluids can go in regular linen, but tie linen bag shut, so no-one adds and is at risk for contamination If saturated dispose of in cytotoxic container Non-disposable items rinse thoroughly and return for processing 14 14

16 Accidental Staff exposure to cytotoxic agents Skin wash effected area x 15 mins with water, then wash with soap and water (remove contaminated clothing first) Injection express drug and fluid and wash area as above if vesicant treat as extravasation and monitor for 2-3 days for redness, swelling or pain, Eyes flush with water or saline x 15 mins Inhalation OHS or emerg AEMS and report to OHS or emerg if after hours for all exposures Inform leaders/instructors 15 15

17 What is a cytotoxic spill Blood and body fluids within 48 hours of cytotoxic drug Oral chemo especially if liquid IV or other parenteral cytotoxic medication that has leaked Risk assessment regarding amount of spill, amount of spread and knowledge to clean up Can you manage the spill? 16 16

18 Universal Spill Kit - contents PPE for two (add N95 respirator) Disposable shoe covers Nitrile gloves (inner and outer gloves) Safety Goggles Zytron Coveralls Hazwik boom x 2 Universal Plus Absorbent Pads (10) Liquid Solidifier Powder Dust pan and whisk Caution tape and duct tape Grease pencil and paint pencil Virox read to use Red Bio Hazard Bag Pail with lid and label 17 17

19 PPE TVEK Jumpsuit (yellow) Disposable shoe covers and safety glasses 18

20 PPE Continued 2 pair Nitrile Gloves Obtain and don your N95 before entering area of spill 19

21 Supplies to absorb spills Universal Pad 12 x 12 Haz-wik sock or boom Do not use on cytotoxic spills 20

22 Other supplies 21

23 Management of spills Step by step guide for Cytotoxic spill management included in spill kit 22 22

24 Management of Spills Recognize and alert others, call for assistance if needed (students will need assistance/supervision from instructor/preceptor) Don PPE including N95 Respirator Attend to staff and patient contaminated by spill first, remove others at risk of exposure Remove any contaminated clothing 23

25 Spill Management cont.. Contain and absorb spilled liquids using absorbent materials. Cleaning the spill should proceed progressively from areas of lesser to greater contamination. Wash/rinse area of cytotoxic spill with detergent/soap(virox in spill kit) and water until thoroughly cleaned. Detergent should be thoroughly rinsed and removed with water (suggested twice)

26 Management of spill cont. Remove protective clothing and dispose of in cytotoxic pail with all contaminated materials used in spill clean up. Goggles can be re-used if they are cleaned with soap and water (on their own) wearing gloves. Wash hands with soap and water when clean-up procedure is complete. Complete AEMS Notify : supervisor/leader, MD and pharmacy if replacement drug is required 25 25

27 Summary Working with hazardous drugs does not equal exposure. Improper handling or protection put all in the environment at risk (Martha Polovich, 2008) 26 26

28 Questions and Resources Nursing Manual Cytotoxic Safe Handling OHS Universal Spill Kit self directed learning Pat Stalker, Clinical Educator, LRCP 27 27

Safe Handling of Cytotoxic Materials

Safe Handling of Cytotoxic Materials Kara Henman RN, MN, CON(C) Oncology Practice Consultant Cancer Care Nova Scotia What are hazardous drugs? Chemotherapy Immunosuppressive agents Biological agents Antiviral