Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

11. PATIENT CARE
11.3 Preventive Measures
11.3.1 Personal Protective Equipment RATING: +++
Wear personal protective equipment when handling bedding or handling/cleaning up
excreta or vomitus.
RECOMMENDATIONS
11.3.1.1 Workers who handle the biological fluids, excreta, bedding and soiled equipment (e.g.
bedpans) of patients who have received antineoplastic type hazardous drugs must wear
one (1) pair of gloves (see 4.1.7.7) and a protective gown (see 4.1.7.8). These
precautions should be taken for a minimum of 48 hours following the administration of
the last dose of the drugs, with the exception of certain drugs with a half-life greater
than 48 hours (Table 8 contains a representative list of the elimination time for certain
drugs). In these cases, the period during which PPE must be worn must be increased
accordingly. One pair of gloves must be worn when providing personal care to the
patient and when changing the patient’s clothes or sheets. A gown may be necessary if
providing personal care to the patient involves a significant risk of splashing.
Caregiving staff who are not providing direct patient care (e.g. physician, pharmacist
talking with the patient) are not required to wear PPE.
11.3.1.2 Face protection (see 4.1.7.10) must be worn when there is a risk of splashing (e.g. when
emptying and cleaning the bedpans of patients receiving antineoplastic type hazardous
drugs).
APES, p. 5-28 ♦ ASHP, p. 1188 ♦ CSHP, Section 8.13 ♦ NIOSH, p. 17 ♦ ONS, p. 27 ♦ OSHA, Section Vc3
11.3.2 Organization of Work RATING: ++
Use work methods that minimize exposure to hazardous products in the excreta.
RECOMMENDATIONS
11.3.2.1 The caregiving staff should use techniques for handling biological fluids and excreta
that minimize exposure risks:
‣ limit, as much as possible, the measuring of biological fluids (i.e., excreta), in view
of the risk of splashing when pouring. In some cases, weighing the patient may be
used to assess the ingesta-excreta balance, rather than measuring the volume of
fluids ingested and eliminated;
‣ encourage the patient to use the toilet, rather than a bedpan or urinal;
‣ encourage men to urinate while sitting, to reduce the risk of aerosol creation and
droplet contamination;
‣ use disposable diapers. If they are soiled by a patient who has received
chemotherapy treatment during the previous 48 hours or more (see 11.3.1.1), discard
them in a cytotoxic waste receptacle;
‣ collect fluid from pleural drainage or ascites in a disposable, closed system and
discard in a cytotoxic waste receptacle;
‣ rinse bedpans after every use and wash them with detergent and water once a day;
store them such that they will not be used by another patient. Clean the storage areas
regularly. When available, disposable bedpans or the use of closed-circuit bedpan
washing machines may be considered. However, contamination must be minimized
when transporting the bedpans from the patient’s room to the bedpan washing
machine on the care unit.
‣ use absorbent pads to cover the excreta of patients who have received antineoplastic
type hazardous drugs during the previous 48 hours or more (see 11.3.1.1), e.g.
vomitus, stools or urine, while waiting for the hygiene and sanitation workers to
11-2 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS