Needles should not be disconnected from syringes nor re-sheathed nor should bags be disconnected from IV tubing before disposal. Any remaining non sharp waste that has or may have been contaminated with cytotoxics including wipes, wound dressings, aprons and gloves are disposed of in the yellow with purple stripe clinical waste bags.
Specific cytotoxic waste stream storage carts and collection should be used. Spillages of vomit, urine or faeces on the floor within the drug specific timeframe from administration for having active metabolites present up to 7 days should be treated as a cytotoxic spill and cleaned accordingly.
Contaminated products must not be transported long distances before being disposed of into a cytotoxic waste bin. The cytotoxic waste bin should be taken to the area of clinical activity.
All waste generated within LTHT must be double bagged and tied using the swan neck method with the appropriate coded tie securely fastened before placing for collection. Ties are provided by Facilities staff. These ties enable the producer of the waste to be traced should the need arise, and help to prevent the waste leaking from the bag.
Facilities staff will not remove waste that has not been appropriately and securely fastened. Cytotoxic waste within LTHT should be stored at the designated collection points ready for incineration. All cytotoxic waste both colours of disposal bins and yellow with purple stripe bags must be placed into large wheelie bins that have had a purple tag attached.
These are also identified by posters above the bins. All cytotoxic waste is incinerated at C. Staff should make themselves aware of these places. Cytotoxic waste should not be allowed to accumulate. Areas that have access to cytotoxic bins should dispose of unused cytotoxic medicines in the clinical area.
Non-disposable equipment may become contaminated. Therefore clinical areas should have ensured that items such as trolleys and trays are cleaned in between each patient as per LTHT infection control policy.
Management of Cytotoxic Spillage All staff involved in the preparation, handling, storage, transportation and administration of cytotoxic medicines should be familiar with the procedures to be followed in the event of spillage, including the requirement to wear appropriate PPE. Only staff that have undergone training in these areas are to be involved in the management of a cytotoxic spill.
All staff who are pregnant or breast feeding should NOT be involved in managing spillages of cytotoxics. Wherever cytotoxic medicines are prepared or administered, the following must be readily available;. Groups of staff that may have intermittent contact with cytotoxic medicines e. In the event of a spill or suspected contamination staff must act immediately The area must be isolated to prevent further spread All spillages and contaminations must be reported through Datix.
Complete a Datix. If a spillage occurs onto soft furnishings, as much spillage as possible should be absorbed using the procedure detailed above. The soft furnishings should be quarantined away from patient areas until a risk assessment has been performed. The size and nature of the spillage must be ascertained. Where spillage occurs onto bed mattresses and pillows, these should be cleaned with detergent and hot water but should be discarded as cytotoxic waste if:.
The Environmental Manager on extension should be contacted for large items that cannot be disposed of using existing means. However, if the spillage is large, then consideration should be given to disposal of the item into a yellow with purple stripe bag.
Spillage during Transport within LTHT If a cytotoxic medicine is damaged and leaks during transportation, it should be disposed of immediately into a blue with purple lid bin.
The bin should be packed with absorbent cloths before it is sealed, to ensure that the chance of spillage is minimised. If it is thought likely that leakage could occur then place the bin in a yellow with purple stripe waste bag and secure. Any spillage that has resulted in a leak to the surrounding environment should be handled as described previously. Contamination of a person must be dealt with promptly as a priority over any other All contamination of staff must be reported immediately to the senior nurse on duty.
Accidental Contact of Cytotoxic with Eyes An eye irrigation kit and access to a mains water supply must be available where cytotoxic medicines are administered to be used in the event of eye contamination. It is the responsibility of the individual practitioner to ensure that this facility is available at all times in community settings. Eye wash kits should contain sodium chloride 0. If eyes come into contact with oxaliplatin, sterile water should be used and areas should make sure bottles of this are available to use for this purpose.
If there is any suspicion that there has been exposure of the eye to cytotoxic medicines, then the individual concerned must:. Once this has been performed, the individual concerned must attend the accident and emergency department to obtain medical attention. It is important that the individual can communicate the name of medicine to which the eye has been exposed to the medical staff performing the examination.
Accidental Contact of Cytotoxic with Skin Any areas of skin that come into contact with cytotoxic medicines must be rinsed immediately with copious quantities of cold water. This is to minimise absorption through the skin. Accidental Inoculation of Cytotoxic Medicines The following immediate first aid measures should be taken following accidental percutaneous inoculation of a cytotoxic medicine:.
However, all small spillages must be reported on the documentation associated with local reporting procedures Datix. Eating and drinking are prohibited in areas where cytotoxics are prepared or administered.
This is of particular relevance to staff who are trying to conceive, pregnant or are breastfeeding. However, none of the methods have been shown to produce clear evidence of benefit and produce results that are difficult to interpret. For these reasons, the routine monitoring of staff is not undertaken at LTHT. Cytotoxic medicines for parenteral use or oral liquid presentations transported to a clinical area must be packaged to ensure that there is no leak or spillage during transportation.
Packaging must be suitable for the product and sufficiently robust to withstand normal conditions of transport and handling. The plastic packaging is clearly labelled to show the nature of the contents, with an appropriate warning symbol. When batches of individual treatments are delivered to the area of use, they must be transported in a rigid container, able to withstand puncture.
Such containers should be;. Dedicated and distinct chemotherapy transport boxes are used exclusively for the transport of chemotherapy administered into the cerebrospinal fluid within LTHT. Vinca alkaloids are only transported in a designated Vinca alkaloid transport box.
This is clear box with an orange front. Medicines which are not cytotoxic should be transported in a separate container from cytotoxic medicines. Cytotoxic medicines must not be transported using the pneumatic air-tube system. They must be received at their destination by a member of staff who will be responsible for opening the container and ensuring that its contents are appropriately stored before use. Bulk Unpacking of Cytotoxic Medicines All staff involved in bulk unpacking of cytotoxic medicines must undertake formal training prior to taking part in this process.
The medicine must be received at its destination by a competent trained member of pharmacy staff who will be responsible for opening the package and ensuring that its contents are appropriately stored. The member of pharmacy staff unpacking the cytotoxic medicines must make use of appropriate PPE. Storage in Pharmacy Prior to manipulation, cytotoxic medicine that requires refrigeration must be stored either in a cold store on shelving reserved solely for that purpose and clearly labelled as such or in a refrigerator reserved solely for that purpose, and clearly labelled as such.
Prior to manipulation, cytotoxic medicine that requires storage at room temperature must be stored in a store on shelving reserved solely for that purpose and clearly labelled as such or in a cupboard reserved solely for that purpose and clearly labelled as such.
All products must be stored in alphanumeric order. In some circumstances where packaging is similar to other products, risk management may have deemed storage out of alphanumeric order.
Local guidance should be followed. Prior to release of parenteral medicines to clinical areas, cytotoxic medicines must be stored in the designated areas for refrigerated and non-refrigerated items. Spillages within Isolator Cabinets The spillage should be managed as follows. Management of Contaminated Patient Waste Products within LTHT There is evidence to suggest that contamination from the urine, faeces, sweat, saliva, semen or vomit of a patient receiving cytotoxic medicines places handlers at risk of exposure to cytotoxic medicines.
Potentially hazardous amounts of these medicines or their active metabolites have been identified in excreta. Staff handling this waste should wear appropriate PPE gloves and gown. If there is a risk of splashing a mask should also be worn. Pregnant and breastfeeding women should not participate in the management of waste from patient receiving cytotoxic medicine. As a general rule, the excreta from patients who are receiving these medicines should be assumed to be hazardous for up to 7 days after the completion of treatment.
Waste such as urine, faeces and vomit may be disposed of safely in the normal sewage system. Want to read more? Already subscribed?
Try Nursing Standard Student Alternatively, you can purchase access to this article for the next seven days. Organisational access. Read this article via your institutional log in or pair token. Contact your local law enforcement office and your pharmacist about take-back programs in your community. Throwing the medication away. If you cannot take your medication to a disposal location or flush it, you may need to put it in the trash.
Do not throw away oral chemotherapy see below. Before throwing away medication, follow these important steps:. Mix the medication with an undesirable substance such as cat litter or used coffee grounds. Do not crush pills, tablets, or capsules. Remove the label or completely cross out any personal information before throwing out or recycling an empty container.
This will help protect your identity. It is illegal for your health care team to personally accept returned opioid pain medication.
Some pharmacy chains also provide this service in their stores. Medicines returned to these locations are collected and destroyed in a safe manner. The DEA maintains a website where you can search for the nearest public disposal location. But some communities have rules and restrictions against this. You should never throw out or flush leftover chemotherapy. Normally, you will not have extra oral chemotherapy because doctors typically prescribe it in the exact dosage and amount necessary.
But if you do, return it to your doctor or nurse for disposal. If you have additional questions about disposing of unused or expired medications, ask your doctor or pharmacist how to proceed. This 1-page printable PDF gives an introduction to safety and handling of pain medications, including suggestions for storing and disposing of these medications, terms to know, and questions to ask the doctor.
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