Spillage Waste Management Patient Information
Introduction This leaflet contains the answers to some questions patients and carers may have about the disposal of chemotherapy waste and the management of a chemotherapy spillage in the home. It is not meant to replace the discussion between you and the team looking after you, but helps you to understand more about what is discussed. If you are in any doubt after reading this leaflet, please contact the clinical area where you are receiving treatment. 24 hour contact number: General information: Keep all chemotherapy medication in a safe place according to the storage instructions on the product label (for example in the refrigerator or at room temperature). Ensure that all medicines, administration equipment and sharps bins are out of the reach of children or pets. If you are a carer and are pregnant, think you may be pregnant or are breast feeding, you should not handle chemotherapy drugs, or waste. Always wash your hands thoroughly after handling chemotherapy drugs or waste. 1. Disposal of chemotherapy waste How should I dispose of empty medicine containers/bottles? Empty chemotherapy medicine bottles, cartons, tubes or plastic ointment jars can be thrown in household waste or returned to the hospital pharmacy. Put lids/caps on the containers before discarding or returning them. Use a designated spoon, syringe or cup for the administration of oral chemotherapy. Medicine spoons, syringes and cups used to give oral chemotherapy should be washed after each use in warm soapy water, left to dry and stored separately from other household crockery or cutlery. On completion of treatment medicine spoons, syringes and cups used to give oral chemotherapy should be washed, dried and discarded in household waste. 1
How should I dispose of intravenous infusion devices/bags and syringes? Empty infusion devices, bags or syringes that were used for the administration of chemotherapy drugs should be disposed of in a sharps bin. These bins are available from the hospital. Once the sharps bin is three-quarters full, it should be sealed and returned to the hospital ward/clinic on your next visit. What should I do with unused chemotherapy medicines? All unused chemotherapy medication (tablets, capsules, oral liquids, ointments, infusors, and syringes for intravenous administration) MUST be returned to the hospital pharmacy, department or ward/clinic. They should NEVER be flushed down the toilet or thrown away in house hold waste. Inform your treating hospital/ward/clinic if you have unused medication it is important for them to record why you have medication left over. How should body fluids be disposed of? Urine, stools and vomit can contain chemotherapy drugs, or their breakdown products for as long as seven days after a patient has received treatment. Therefore, it is important that you wear gloves when handling urine, stools, vomit, contaminated bed linen or incontinence pads for seven days following treatment. You should either use the gloves provided by the hospital or a pair of rubber household gloves kept especially for this purpose. Gloves should be changed immediately if torn or soiled. The contents of vomit bowls/bedpan/urinals should be flushed down the toilet. Any disposable containers should then be washed thoroughly in warm soapy water and disposed of in the household waste. Non disposable containers should be washed thoroughly in warm soapy water and left to dry. Incontinence pads and gloves should be placed in a bag prior to disposal in the household waste. Contaminated bed linen and clothes should be washed separately to other items, on the hottest temperature guidance for the item. Dry cleaning garments should not be sent for dry cleaning without prior discussion with the cleaning company. 2
2. Management of liquid chemotherapy spillages General information: Any liquid spillages of chemotherapy drugs onto the floor or on your clothes or skin should be dealt with immediately to minimise potential harm to yourself or other people. You must wear gloves when dealing with a chemotherapy spillage. You should either use the gloves provided by the hospital, or a pair of rubber household gloves kept especially for this purpose. Make sure that they are not damaged, torn or split. If you have been provided with a spillage kit, use the contents of the kit for a large spillage greater than 10 ml (two teaspoons full). Remember to inform a health care professional as soon as possible that you have had a spillage so that replacement medication or equipment can be arranged if necessary. What should I do if there is a chemotherapy spillage on work surfaces, furniture or floors? When liquid is spilled onto a hard surface its splash can travel some distance from the original spillage area. So check to see if the chemotherapy has landed on other pieces of furniture close by. Cover the spillage using absorbent paper towels e.g. kitchen roll and ensure that all the liquid has been mopped up. The work surface, furniture or floor should then be wiped clean using warm soapy water (i.e. washing up detergent) as soon as possible. This should be repeated three times. All used absorbent towels should be disposed of as clinical waste. This means it cannot be put in normal household waste please put all used waste in the yellow bag or sharps bin provided by the hospital secure the lid or tie the bag and store somewhere safe away from children and pets inform the hospital/clinic as soon as possible. If you have been provided with a home spillage kit, follow the instructions given with this. How should I deal with a chemotherapy spillage onto the skin? Wash the area with plenty of tap water for at least 10 minutes. This should then be repeated three times using warm soapy water and the area gently dried. 3
If you have a shower, this is preferable to washing the isolated area. Contact your hospital team and inform them this has happened and they will give you further advice. Do not apply any moisturising cream or hand cream on the affected area. Observe for signs of redness, soreness, blistering and/or irritation which may happen soon after the spillage, contact your emergency contact numbers or ward/clinic immediately if this occurs. How should I deal with a chemotherapy spillage in the eyes? Immediately flush the eyes and the surrounding areas with large volumes of cool tap water. This should be done for at least 10 minutes. Go to your nearest Casualty Department as it is important that you seek medical attention for any spillages into the eye. How should I deal with a chemotherapy spillage onto clothing/bed linen etc? If receiving chemotherapy through a pump at home, you may wish to buy a plastic mattress protector to prevent spillage of chemotherapy into the bed if an accident occurs (available from markets/bedding companies and Argos double bed protector price approx 10-15). Wearing a pair of gloves, blot dry with a paper towel and remove the contaminated clothing or bed linen immediately. The clothes/linen should be washed separately from other clothing as soon as possible on the highest temperature guidance for the item. This should be repeated three times to ensure all drugs are completely removed. If the drug has soaked through the clothes to the skin, this should be dealt with as outlined above. Mattress or plastic mattress covers should be washed three times with warm soapy water (wearing gloves) and allowed to dry. 3. For patients receiving continuous intravenous infusions at home What should I do if there is a large volume of chemotherapy spilt on work surfaces or floors? 4
You may have been provided with a chemotherapy spillage kit for use in the home in the event of a chemotherapy spillage. The kits are usually only provided if there is a risk of a large volume of chemotherapy drug being spilt. Contents of the home spillage kit: Two pairs of gloves. Plastic apron. Clinical waste bag. Bag tie. Cytotoxic label. Absorbent towel. Wipes to clean contaminated area. Sharps bin. A visimask (face mask) Plastic overshoes. Instructions for use: Any liquid spillages of chemotherapy drugs onto the floor or work surfaces should be dealt with immediately to minimise potential harm to yourself or other people. If possible, move any furniture, household gadgets or rugs at risk of being contaminated away from the spillage to prevent it becoming involved. Open the chemotherapy spillage kit and remove the contents. Put on the white plastic apron, 2 pairs of gloves, and plastic overshoes (if the spillage is on the floor) and visimask (face mask). Use the absorbent towels provided to place a ring around the spillage so that it cannot spread to a larger area. Cover the liquid with a paper towel until the fluid has been soaked up through the towel and the towel is moist i.e. when the towel is picked up the fluid will not drip out of the towel. Repeat until all the liquid has been mopped up. Pick up the moist towels and place them in the clinical waste bag. The floor or work surface should then be given a routine clean with warm soapy water (i.e. washing up liquid) as soon as possible. This should be repeated three times. Take off the outer gloves, then the visimask, then the apron, then the overshoes and lastly, the second pair of gloves and place in the clinical waste bag. 5
Seal the bag with the tie and place it into the sharps bin provided. Seal the sharps bin. Remember to inform a health care professional as soon as practical that you have had a spillage, so that replacement medication or equipment can be arranged if necessary. Return the sealed sharps bin to the hospital ward or clinic on your next visit. Local sources of further information You can visit any of the health/cancer information centres listed below: Birmingham Women's NHS Foundation Trust Health Information Centre Birmingham Women's Healthcare NHS FoundationTrust Metchley Park Road Edgbaston Birmingham B15 2TG Telephone: 0121 627 2608 Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre 6
University Hospital Birmingham NHS Foundation Trust Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 697 8417 Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: http://www.birminghamcancer.nhs.uk. This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: March 2010 Review Date: March 2013 7