Protocol for Cytotoxic Spills and Waste Management

Transcription

1 Occupational Health and Safety (OHS) Policy Document Number # QH-PTL :2012 Protocol for Cytotoxic Spills and Waste Management Custodian/Review O fficer: Graham Easterby, a/director, Safety and Wellbeing. Version no: Purpose This Protocol describes the mandatory steps for safe management of cytotoxic spills and waste in Queensland Health. Applicable To: All Queensland Health staff. Approval Date: 01 July 2012 Effective Date: 01 July 2012 Next Review Date: 01 December 2014 Authority: Lyn Rowland, Chief Human Resources Officer, System Support Services Division Approving Officer Lyn Rowland, Chief Human Resources Officer, System Support Services Division Supersedes: 2-9#38 Managing Cytotoxic Spills and Body Waste Key Words: Cytotoxic waste and spills Waste management requirements for cytotoxic materials Working safety with cytotxic waste Accreditation References: EQuIP and other criteria and standards 2. Scope This Protocol applies to all Queensland Health employees (permanent, temporary and casual) and all organisations and individuals acting as its agents (including Visiting Medical Officers and other partners, contractors, consultants and volunteers). This Protocol does not describe the treatment of risks associated with the preparation administration or storage of cytotoxic medications. 3. Supporting documents Authorising Policy and Standard/s: Occupational Health and Safety (OHS) Policy Implementation Standard for Hazardous Chemicals Safety Management Procedures, Guidelines, Protocols Hazardous Chemicals Waste Management Protocol Storage and Handling of Hazardous Chemicals Protocol Conducting a Hazardous Chemical Task Risk Assessment Protocol Chemical Spills Preparedness and Response Guideline Ordering of Hazardous Chemicals Guideline Version No: Effective From: 01 July 2012 Page 1 of 6

2 Compiling a Hazardous Chemical Register Guideline Disposal and Management of Hazardous Materials Guideline Using ChemAlert Guideline Guideline for Using ChemAlert Forms and templates Hazardous Chemicals Stocktake Form Chemical Task Risk Assessment Worksheet Storage and Handling Risk Assessment Low Risk Spills Response Checklist 4. Related documents Work Health and Safety Act and Regulation 2011 Environmental Protection (Waste Management) Regulation 2011 Work Health and Safety Queensland (2005) Guide for Handling Cytotoxic Drugs and Related Waste. Queensland Government Queensland Health Environmental Health Procedure Waste Segregation 5. Process for Cytotoxic Spills and Waste Management 5.1 Cy totoxic Medications Cytotoxic medications have carcinogenic, mutagenic and teratogenic properties. Therefore they are considered to be hazardous substances as per the approved criteria for classifying hazardous substances (NOHSC:1008 (2004) 3rd Edition) Waste from cytotoxic medications may be in solid or liquid form Exposure to cytotoxic medications may result via: direct exposure to the medication (e.g. during preparation or administration) indirect exposure through waste products such as o the body fluids, (primarily urine, faeces, vomit and fluid drained from body cavities), of patients who are, or have undertaken cytotoxic treatment o materials (e.g. bedding, instruments) that are contaminated with cytotoxic medications or body fluids o waste from spills of cytotoxic medications Routes of entry may include: inhalation ingestion dermal absorption Version No: Effective From: 01 July 2012 Page 2 of 6

3 mucosal absorption percutaneous injury Cytotoxic medications and their metabolites are primarily excreted from the patient via urine or faeces. Excretion rates vary therefore these substances shall also be regarded as cytotoxic It is recommended that safety precautions with respect to body fluids be adopted for at least seven days after the administration of the final treatment Cytotoxic medications may also be excreted in sweat and saliva however this applies only to a small number of medications. Further advice should be sought from a suitably qualified professional. 5.2 Management of Cytotoxic Spills and Waste Spills or leaks of cytotoxic medications and waste products may occur in all areas where cytotoxic medications are administered or handled, or bathroom areas where patients receiving chemotherapy vomit or use the toilet facilities Equipment used during surgical procedures on patients who have received cytotoxic medications in the last seven days may also become contaminated. (This is dependent upon the type of surgery and if equipment was contaminated with urine, faeces, vomit or other substances such as bile) Where practicable, the Queensland Government document Guide for Handling Cytotoxic Drugs and Related Waste should be referred to, to inform clinical, pharmacy and related practice. 5.3 Spills and Leaks Containment The Health Service Chief Executive shall ensure spill kits are available in all areas where cytotoxic medications are prepared, used and stored, or where a spill is likely to occur (e.g. warehouse) The spill kit shall contain, at a minimum: instructions for clean-up and reporting of a cytotoxic spill signs to identify the spill and restrict access personal protective equipment (PPE) adequate quantities of appropriate absorbent materials (e.g. swabs, absorbent towels or a spill pillow, chemical absorbent pads, protective mats such as a bluey or chemo mat ) Version No: Effective From: 01 July 2012 Page 3 of 6

4 a small scoop to collect any glass fragments bottles of water for rinsing and for dampening pads over a powder spill alginate bag and a labelled or purple cloth laundry bag for contaminated linen alkaline detergent two plastic cytotoxic waste bags Spill kit contents shall be checked by the work area manager at least annually and used materials replaced immediately. 5.4 Contaminated Laundry and Bedding Contaminated linen shall be segregated at the point of generation (e.g. the ward or unit) Cytotoxic contaminated laundry shall be segregated by using: alginate bags cytotoxic labelled or purple cloth laundry bags appropriately signed and secure storage areas Cytotoxic contaminated laundry shall not be bagged in general or clinical linen bags or waste bags Contaminated bed mattresses and pillows shall be cleaned according to the local cytotoxic spill instructions Mattresses and pillows shall be discarded as cytotoxic waste if: they are heavily soiled or contaminated the mattress or pillow covering is split the surface cannot be cleaned (e.g. foam egg-shell mattress). 5.5 Cytotoxic Waste Cytotoxic waste containers and bags shall be marked with the international Late in Telophase symbol printed in white (Attachment A Figure 1) and the words Cytotoxic Waste (Attachment A Figure 2) Receptacles for the disposal of cytotoxic waste are rigid (e.g. sharps containers) and non-rigid (e.g. bin liners) All cytotoxic waste must be disposed of in a dedicated cytotoxic waste receptacle Body waste such as urine, faeces and vomitus can be disposed of safely in the sewerage system Generation of aerosols or particulate matter when handling urine, vomit, faeces or fluid from body cavities shall be avoided When using toilet amenities, patients shall be reminded to close the toilet lid prior to flushing to contain any aerosols that may result. Version No: Effective From: 01 July 2012 Page 4 of 6

5 5.5.7 Re-usable equipment, i.e. bedpans and surgical instruments, shall be cleaned then sterilised in accordance with local clinical instructions It is recommended that a local procedure for advising sterilising departments of possible cytotoxic contamination be developed to ensure appropriate workers are not inadvertently exposed Disposable equipment and receptacles shall be disposed of as cytotoxic waste All non-rigid waste receptacles must be placed inside rigid cytotoxic waste receptacles (Attachment A Figure 3) Care must be taken not to overfill waste receptacles Cytotoxic collection bins must be located as close as practicable to the site of generation and to transport corridors Movement of cytotoxic waster through public areas or general staff thoroughfares should be avoided All cytotoxic contaminated sharps shall be placed into rigid-walled, punctureresistant containers that meet AS4031 Non-reusable containers for the collection of sharp medical items used in healthcare areas Sharps containers shall be labelled CYTOTOXIC SHARPS - INCINERATE AT 1100 C. Once the sharps container has been sealed and secured, it can be placed directly into a secondary container for internal movement or transportation. 6. Definition of Terms Term Definition / Explanation / Details Source Carcinogenic The ability or tendency to produce cancer. Medline Plus Medical Dictionary Clinical Waste Cytotoxic Waste Waste that has the potential to cause disease, including, for example: the following: (a) animal waste (b) discarded sharps (c) human tissue waste (d) laboratory waste Material that is, or may be contaminated by a cytotoxic medication. Waste Reductions and Recycling Regulation 2011 Environmental Protection (Waste Management) Regulation 2000 Mutagenic Inducing, or capable of inducing genetic mutation. Medline Plus Medical Dictionary Related waste Sharps Waste that constitutes, or is contaminated with, chemicals, cytotoxic drugs, human body parts, pharmaceutical products or radioactive substances. Objects or devices having sharp points or protuberances or cutting edges, capable of cutting or piercing the skin. Waste Reductions and Recycling Regulation 2011 AS4031:1992 Nonreusable container Version No: Effective From: 01 July 2012 Page 5 of 6

6 Includes hypodermic, intravenous or other medical needles, pasteur pipettes, scalpel blades, lancets, scissors, glass slides, broken glass such as vials, bottles and laboratory glass. for the collection of sharp medical items used in health care areas Teratogenic Of, relating to, or causing developmental malformations. Medline Plus Medical Dictionary 7. Approval and Implementation Policy Custodian Graham Easterby, a/director, Safety and Wellbeing Responsible Executive Team Member: Lyn Rowland, Chief Human Resources Officer, System Support Services Division Approving Officer: Lyn Rowland, Chief Human Resources Officer, System Support Services Division Approval date: 01 July 2012 Effective from: 01 July 2012 Version No: Effective From: 01 July 2012 Page 6 of 6

7 Attachment A Cytotoxic Symbols Figure 1 Cytotoxic Symbol Figure 2: Cytotoxic waste label Figure 3 - Cytotoxic pedal bin and purple bin liner