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1 Safe Disposal Methods Management of Body Substances from Patients Undergoing and Following Cytotoxic Drug Therapy

2 Background Hospital/ Institution Home Physician Nurse Nurse Aide Personnel handling waste disposal Family/ friends Family members Home Care Nurses Other people

3 Background Hospital/ Institution Home Treatment Of Wastes CYTOTOXIC Destruction Incineration

4 Background Awareness of potential hazards must be present during each step of the process by the each of the involved personnel.

5 Background Cytotoxic drugs are primarily eliminated via kidneys -> urine, and feces Patients urine, feces and vomitus may be contaminated with either unchanged drug or metabolite Standard excretion time is 48 hours but may be prolonged 6 7 days Risk during exposure Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

6 Background 48 hour period after infusion = critical time for caution Decrease in levels of hazardous drugs excreted after 48 hours Federal Occupational Safety and Health Administration from: American J of Hosp Pharmacy 1990

7 General Precautions Precaution to prevent contamination of the exterior of container Avoid skin contact with patient s body substances Minimize generation of aerosols when handling liquid or semi liquid wastes Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

8 Equipment Thick leak proof plastic bags Use a different color Proper labeling CYTOTOXIC Container with a contaminated exterior must be placed in another container

9 Personnel Protective Equipment (PPE) PPE should be worn when handling: Bedpans, urinals, emptying urinary catheter bags, colostomy, urostomy bags and vomitus bowls Bed linen or clothing soiled by patient or potentially contaminated with unchanged drug or active metabolites Cleaning spills Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

10 Home Care Setting Patient and care giver education Increase awareness of potential contamination Supply of latex gloves for single use; dispose in garbage Flush paper and paper towels for cleaning up spills Detergent Emphasize on Good Toilet Habits

11 Home Care Setting Avoid contamination when handling wastes Wear gloves when handling bed pans Launder contaminated items separately Place disposable items in a separate bag Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

12 Contaminated Linen, Clothing, and Bedding Bed mattresses and pillows should be cleaned with detergent and water Discard as cytotoxic waste if: Heavily soiled or contaminated Mattress covering is split Surface cannot be cleaned (eg foam egg shell mattress) Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

13 Handling and Laundry Procedure Handling Place contaminated articles in heavy double plastic bag Proper labeling Laundry Procedures Put on gloves Wash at maximum running cycle capacity Discard plastic bag as cytotoxic waste Launder linen bag before reuse Guide for Handling Cytotoxic Drugs and Related Waste, New Southwales WorkCover Authority, 1997

14 Sewerage Disposal of Human Waste Products Potential public health problem No clear guidelines? Application of substances to degrade potential contaminants Federal Occupational Safety and Health Administration from: American J of Hosp Pharmacy 1990

15 Sewerage Disposal of Human Excreta Contamination of excreta For Doxorubicin: treatment with sodium hypochlorite followed by sodium thiosulfate Chemical Degradation of Wastes of Antineoplastic Agents: Idarubicin, Doxorubicin, Epirubicin, Pirarubicin, Alacurbicin and Daunorubicin: Castegnaro, M. et al, Int Arch Occup Environ Health, 1997.

16 Disposing of Human Waste Products Urine, feces, and vomitus may be disposed safely in the normal sewerage Contents of colostomy bags, etc., should be disposed in similar way Cover toilet lid when flushing potentially contaminated waste to prevent aerosol formation

17 Waste Disposal Transport to incinerator by licensed contractor Incinerate wastes, DO NOT COMPACT Incinerate at 1100 C for at least 1 sec.

18 Safety in the workplace Is a shared responsibility Thank you