Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

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12. MANAGEMENT OF WASTE, ACCIDENTAL EXPOSURE, SPILLS AND RETURNS 12.3.2 Antineoplastic Type Hazardous Drug Waste in the Home RATING: ++ Establish policies and procedures regarding the management of cytotoxic waste in the home. RECOMMENDATIONS 12.3.2.1 Caregiving staff must provide the patients / caregivers involved in administering antineoplastic type hazardous drugs in the home with cytotoxic waste management receptacles. 12.3.2.2 The home care workers (or the patients / caregivers, as applicable) must return the cytotoxic waste receptacles to the institution for final disposal. There are two methods of doing so to avoid contaminating the worker’s personal vehicle: ‣ a) soft items may be placed in a heavy-duty, leakproof, double plastic bag identified with the “Cytotoxic” hazard symbol. Sharps must be placed in a perforationresistant, rigid container identified with the “Cytotoxic” hazard symbol. Any excess fluid (e.g. remaining drugs, etc.) must be placed in a sealed container (e.g. jar with lid) and placed in a rigid container, the bottom of which is to be covered with an absorbent pad. For transport by car, a double bag identified with the “Cytotoxic” hazard symbol should be placed in a reusable, rigid container (e.g. cooler). This container must be leakproof, rigid, washable with detergent and water and properly identified with the “Cytotoxic” hazard symbol; OR ‣ b) in accordance with the Regulation respecting Biomedical Waste (Art. 22), sharps must be placed in a rigid, sealed, leakproof, perforation-resistant container. A fairly large, rigid, non-reusable container (e.g. 8 to 10 litres) may be used to dispose of all contaminated items (needles, tubing, gowns, gloves, etc.). This container must be sturdy and leakproof. It must never be filled more than three-quarters full. The contents should not be touched with bare hands, nor should they be pushed down to compact the waste. The container must be sealable for transport and identified with the “Cytotoxic” hazard symbol; ‣ the cytotoxic waste container (scenario a or b) should be placed in the trunk of the car and secured to prevent it from tipping over while the vehicle is moving. Pursuant to the Code of Ethics of Pharmacists, the pharmacist must, when someone makes a reasonable request of him, “participate in the safe collection of expired or unused medicines” as part of the administration of drugs. This provision applies in particular to hazardous drugs, regardless of whether or not they are antineoplastic. CSHP, Sections 5.2, 7.2 ♦ R.Q. c. P-10, r.5, Art. 3.01.07 12.3.3 Accidental Exposure RATING: +++ Establish policies and procedures regarding accidental worker exposure. RECOMMENDATIONS 12.3.3.1 If a hazardous drug (including a vesicant agent) accidentally comes into contact with a worker’s skin or clothing, the worker must immediately remove the contaminated clothing and thoroughly wash the affected area with soap and water. If necessary, the contaminated worker should take a full shower. A full shower can be made available in the vicinity (e.g. in the oncology clinics/units). 12.3.3.2 If a hazardous drug comes into contact with a worker’s eyes, the worker should wash his eyes, preferably with an appropriate device installed on an easily accessible faucet / sink. Alternatively, a portable eye rinse system may be used. The worker must immediately rinse his eyes with water or an isotonic fluid (e.g. sterile NaCl 0.9%) for at 12-4 ASSTSAS PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS
12. MANAGEMENT OF WASTE, ACCIDENTAL EXPOSURE, SPILLS AND RETURNS least 15 minutes. Drug projections can be harmful to contact lens wearers, who must remove their lenses immediately in the event of accidental exposure. Contrary to popular belief, contact lenses do not provide protection. 12.3.3.3 In the event of a needlestick with a needle that has been in contact with a hazardous drug, massage in the direction of the wound to make it bleed and to limit absorption of the drug (avoid pinching, which causes suction and restricts the flow of blood). Next, thoroughly wash the affected area with water and contact the Occupational Health and Safety (OHS) Department. In the event of a needlestick with a needle that has been in contact with a hazardous drug AND a patient, apply the follow-up protocol for postaccidental exposure to blood and biological fluids within two hours or according to the policy of the institution. 12.3.3.4 Any accidental exposure to a hazardous drug through the skin or eyes or through blood or biological fluids must be declared on the accident or incident report form in use at the institution. This report must be filed with the Occupational Health and Safety (OHS) Department, which will provide medical follow-up when required and analyze the event. This report is to be kept in the employee’s file and/or in a record, in accordance with Article 280 of the Act respecting Occupational Health and Safety. In addition, according to the Recueil de règles de conservation des documents des établissements de santé et de services sociaux du Québec (Quebec Code regarding Document Retention in Health and Social Service Institutions), the reports must be kept for at least 20 years following the end of the worker’s employment or for 40 years following the start of employment, whichever is longer. These records may not be destroyed. It is advisable to carry out a global analysis of these accidents for prevention purposes. It should thus be possible to trace these reports back for a given period. APES, p. 5-42 ♦ ASHP, p. 1184 ♦ CSHP, Sections 8.3.3, 8.14 ♦ ONS, p. 33-35 12.3.4 Spill RATING: +++ Establish policies and procedures regarding the management of a spill. RECOMMENDATIONS 12.3.4.1 The institution should develop policies and procedures which take into account the various types of spills (i.e., limited amount vs substantial amount, location, etc.) and the workers who must be called upon (e.g. pharmacy workers, care unit/clinic workers, hygiene and sanitation workers). These policies and procedures should be incorporated into the institution’s emergency measures planning process, the procedure for which is described in the Manuel de planification des mesures d’urgence (Emergency Preparedness Manual published by the MSSS (available, in French only, in the Publications section of the MSSS Web site). 12.3.4.2 A spill management team may be trained, if it is deemed necessary. Call criteria should be set for this team (e.g. spill of more than 1 litre, more than 1 spill kit required to manage the spill). A procedure is suggested in Appendix 4. A call code may be established for this team as suggested in the manual mentioned above. Code “brown” is often used in institutions for chemical spills. 12.3.4.3 A spill management kit must be available in the Pharmacy Department and near the care units/clinics where hazardous drugs are administered, as well as in the cytotoxic waste transport cart. In addition, nurses who administer hazardous drugs in the home must carry a spill kit. PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 12-5
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This guide has been developed by th
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Table of Contents PREAMBLE ........
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List of Tables Table 1 Medication C
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PREAMBLE In September 2004, the Uni
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1. INTRODUCTION 1.1.1 Survey Regard
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1. INTRODUCTION 1.3 Guide Structure
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2. RISKS RELATED TO THE USE OF HAZA
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Pharmacy Care Wastes Support Receiv
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3. PREVENTION OBJECTIVES AND ACTION
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4. GENERAL PREVENTIVE MEASURES 4 GE
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4. GENERAL PREVENTIVE MEASURES 4.1.
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4. GENERAL PREVENTIVE MEASURES 4.1.
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4. GENERAL PREVENTIVE MEASURES clea
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4. GENERAL PREVENTIVE MEASURES Tabl
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4. GENERAL PREVENTIVE MEASURES Gras
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5. RECEIVING AND TRANSPORT 5.3.2 De
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6. UNPACKING AND STORAGE 6 UNPACKIN
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6. UNPACKING AND STORAGE 6.3.3 Unpa
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Page 118 and 119: 15. MEDICAL, BIOLOGICAL AND ENVIRON
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Page 123 and 124: 16. REFERENCES 16 REFERENCES AHQ [1
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