Cytotoxic Spill Management

Introduction

Spills may occur whenever cytotoxic drugs and waste are handled (store, during transportation, preparation, administration or disposal). Once a hazardous drug spill occurs, it must be cleaned up immediately.

Hence,

• Cytotoxic spill kits should be readily available in all areas where hazardous drugs are routinely handled.
• All personnel who may be involved in handling cytotoxic drugs must be given appropriate training in the management of cytotoxic spills.

Clean-Up Procedure

In the event of a cytotoxic spill in any area,

1. Assess
   Assess the size and scope of the spill. Call for trained help, if necessary.
2. Signage
   Alert other staff in the area to the potential hazard and limit access by placing the warning sign in a prominent position.
3. Staff protection
   Remove the contents of the spill kit and don appropriate PPE in this order: booties, mask, gown, head cover, goggles and gloves.
4. Cleaning procedure
   When cleaning a cytotoxic spill, it should begin from the outside of the spill area and gradually work towards the centre.
• For a liquid spill, carefully place a sufficient quantity of absorbent pad over the spilled liquid.
• If the spill involves a powder, carefully place sufficient absorbent pad over the powder and then carefully wet the mat with water so that the powder dissolves and is absorbed by the pad.
• Gather up the contaminated absorbent pad and carefully clean up any broken glass with the brush and small dustpan. Discard all of this waste into the sharps container.
5. Completing procedure
• Wash the area of the spill thoroughly using strong alkaline cleaning agent or deactivation agent and rewipe with water (3 times). Swab with alcohol 70% (only in clean and cytotoxic drug safety cabinet).
• Dry the area completely to prevent accidental slippage on wet floor.
• Discard all contaminated items (e.g. gauze, first layer of glove) into the cytotoxic waste bag and tie it.
6. Discard
• Discard the previously tied cytotoxic bag and all used items (e.g. respirator, gown, shoe cover and second layer of glove) into a second cytotoxic waste bag.
• Label the cytotoxic waste bag with "Cytotoxic Waste - Handle with Care" label (if needed).
7. Wash hands thoroughly with soap and water.
8. Arrange for
• Collection of waste according to institution policy.
• Hospital cleaning staff to re-clean the area.
9. Incident reporting
   Complete the cytotoxic drug spill incident report form and forward to pharmacy department. Obtain a replacement of the spill kit.

Decontamination

Decontamination occurs by inactivating, neutralizing, or physically removing HD residue from non-disposable surfaces (e.g., stainless steel C-PECs) and transferring it to absorbent, disposable materials (e.g., wipes, pads, towels) appropriate to the area being cleaned.

The decontaminating, deactivating, cleaning, and disinfecting agents selected must be appropriate for the type of HD contaminants, location, and surfaces to be cleaned.

• The SDSs for many HDs recommend sodium hypochlorite solution as an appropriate deactivating agent. However, it damaged stainless steel.
• The observed effect with detergent cleaning was pH dependent.
  

External Links

• ISOPP Standards of Practice Safe Handling of Cytotoxics, 2007
  
• ISOPP Standards for the Safe Handling of Cytotoxics, 2022
  
• Ministry of Health Systemic Therapy Protocol, 2016
• ASHP Guidelines on Handling Hazardous Drugs, 2018
• Manual for Sterile Preparations, 2021
  
• Manufacturers' recommendations for handling spilled antineoplastic agents, 1989
  
• Chemical degradation of wastes of antineoplastic agents: cyclophosphamide, ifosfamide and melphalan, 1997
  
• Chemical degradation of wastes of antineoplastic agents. 2: Six anthracyclines: idarubicin, doxorubicin, epirubicin, pirarubicin, aclarubicin, and daunorubicin, 1997
  
• Studies on the decontamination of surfaces exposed to cytotoxic drugs in chemotherapy workstations, 2006
  
• Comparison of Decontamination Efficacy of Cleaning Solutions on a Biological Safety Cabinet Workbench Contaminated by Cyclophosphamide, 2017