Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

11. PATIENT CARE
11 PATIENT CARE
11.1 Issues and Risks
The biological fluids of patients who have received chemotherapy contain drug residues. Contact with patient
excreta, bedpans, sheets or wash water may be a source of contamination (see Table 7). Tasks such as emptying
bedpans, washing patients, changing sheets and cleaning toilets have been shown to cause contamination of the
caregiver’s gloves and hands and occasionally, of the caregiver’s forehead and forearms. Wearing gloves reduces
hand contamination by 4 when washing patients and by 1.6 when changing sheets (Fransman, 2005).
Table 7. Contamination of Objects in Contact with a Patient who has
Received Cyclophosphamide (CP)
Parameter
Average Amounts
Measured*
% of Samples
Contaminated
Outside of the bedpan 0.28 ng/cm 2 100%
Cloth used to wash the patient 10 ng/cm 2 100%
Towel used to dry the patient 13 ng/cm 2 89%
Patient’s pillow 2.6 ng/cm 2 71%
Sheet (abdomen) 1.8 ng/cm 2 79%
* Measurements taken the day after the administration of CP. The maximum value proposed in the USA is 1 ng/cm 2 .
Source: Fransman, 2005
The scientific literature reports that the bathrooms (floors, toilet bowls) and the environment (bedding, bedpans)
of patients who have received antineoplastic drugs may be contaminated with traces of hazardous drugs
(Fransman, 2005). It would be logical to think that this type of patient should be placed in a private room, to
prevent the contamination of other patients in the room. Moreover, this would facilitate the implementation of
adapted hygiene and sanitation measures (dedicated, disposable equipment, etc.). However, to date, no studies
have been done that would support a recommendation in this regard.
Similarly, in view of the contamination of the bedding, sharing a bed with someone who has received
antineoplastic type hazardous drugs during the previous 48 hours (or more, depending on the drug; see Table 8)
may constitute an exposure risk. It should be remembered that the exposure varies with the frequency and duration
of exposure and the amount of drug to which one is exposed (see 2.3.3). However, there are no studies evaluating
the exposure of those sharing a bed with a patient who has received treatment with hazardous drugs. The
Committee is thus unable to make a recommendation in this regard.
11.2 Exposed Workers
‣ Care unit / outpatient clinic / home care workers (e.g. nurses, physicians, inhalation therapists, patient service
associates)
‣ Other patients, families of patients
‣ Hygiene and Sanitation Department workers
‣ Biomedical engineering workers
PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 11-1