Dr. Yukiko Kikuchi,
Assistant Professor of Public Health and Basic Nursing Studies,
Akita University Graduate School of Medicine and Faculty of Medicine
(1) Exposure countermeasures when processing excrement and vomit
Anticancer drugs taken into the body are eliminated from the body by means of metabolism and excretion. Excretion of anticancer drugs mainly follows two paths, namely excretion in the urine from the kidneys and in bile (in the feces) from the liver. The major anticancer drugs are excreted in the urine and feces within 48 hours. Therefore, when handling the excrement of patients being treated with anticancer drugs, up to 48 hours after the end of treatment is the “time period in which exposure prevention measures should be executed,” and protective equipment (such as gloves, gowns, masks, and face shields) must be worn 1) 2) 3)
. However, depending on the type of anticancer drug, the time until it is excreted may be longer than 48 hours 2)
. For more information, see pages 15 to 16 in the “The Handling-Manual of Antineoplastic Drugs for Nurses 4)
.” Moreover, excretion may also be delayed due to renal dysfunction, pleural effusion, and ascites accumulation of the patient.
If excreted into a toilet
Contamination of the surrounding area by splattering of urine on the toilet may cause exposure. As a result, have male patients also sit rather than stand when urinating, and have them flush after closing the lid of the toilet (after covering the toilet with an absorbent sheet, etc. if there is no lid). The contamination due to splattering of urine must be minimized. Moreover, have the patient flush twice to ensure that anticancer drugs do not remain in the toilet. Furthermore, use disposable cups for measuring the volume of urine and containers to collect urine. If possible, it is preferable to establish a dedicated toilet for patients taking anticancer drugs.
Use 2% sodium hypochlorite (bleach) to clean the toilets. Always put on protective equipment even when cleaning. An explanation of specific cleaning methods and their necessity must be provided to prevent exposure to anticancer drugs of employees responsible for cleaning.
When using in-bed excretion and portable toilets
Take care that excrement does not splatter onto the surrounding area. When using high polymer absorbent, insertion-type toilet covers and portable toilet covers (Fig. 1), splattering onto the surrounding area can be kept to a minimum because the urine can be processed after it hardens.
When excreting into a diaper
There is a risk of injury to the patient’s skin from anticancer drugs contained in the urine and feces. Use disposable diapers, and wash the patient’s genitals and buttocks with soap after urination and defecation every time.
When a urinary catheter has been inserted
It is preferable that the urine remains in urine collection bag when it is disposed of to avoid splattering of urine. If it is necessary to transfer the urine inside of the urine collection bag to a container, use a disposable container, and then dispose of it.
Handling a stoma pouch
To minimize contact with the excrement, use a disposable stoma pouch. Using a closable, one-piece stoma pouch is recommended.
Handling bodily fluids
Use a sealable drainage bag when draining bodily fluids, such as ascites and pleural effusion. Dispose of bodily fluids while they remain in the drainage bag.
Use something that is water-proof for the bag containing vomit. After the patient vomits into the bag, immediately seal and dispose of it. If a bag for vomiting that contains a coagulant or has functionality to prevent back-flow is used, rebounding of vomit and back-flow can be prevented when the patient is vomiting.
(2) Exposure countermeasures when processing soiled linens
For handling of linens soiled with the patient’s bodily fluids (such as excrement, vomit, and sweat), the 48 hours after the end of treatment is also the “time period in which exposure prevention measures should be executed.”
When replacing linens soiled with the bodily fluids of the patient
Always put on protective equipment before replacing the linens. Place in a water-soluble, impermeable laundry bag affixed with a dedicated label so that it is clear that it contains linens with anticancer drugs deposited on them, and wash twice in a washing machine. Moreover, use bleach with sodium hypochlorite added to the detergent. If there is an employee who is responsible for laundry, an adequate explanation of specific methods of preventing exposure must be made to this employee as well. It is preferable that disposable linens are used for patients who are incontinent or vomiting.
For in-home patients
Place laundry soiled by the patient’s bodily fluids directly into the washing machine and wash twice using normal washing detergent. It is preferable that it is separated from the laundry of the family and that bleach containing sodium hypochlorite is used.
(3) Exposure countermeasures when disposing of contaminants
When disposing of items soiled with the patient’s excrement and vomit (such as diapers, urinary catheters, stoma pouches, linens, and protective equipment) within 48 hours of the end of treatment, place in a sealable plastic bag, and dispose of in a waste container dedicated to harmful waste. If processing in-home, place in two layers of plastic bag, seal and dispose of it. The patient and the family must also be adequately instructed regarding the methods of handling excrement, processing waste, and methods of separation.
- American Society of Hospital Pharmacists: ASHP Technical assistance bulletin on handling cytotoxic and hazardous drugs, Am J Hosp Pharm, 47: 1033-1049, 1990.
- Yodaiken RE: OSHA work practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs, Am J Hosp Pharm, 43: 1193-1203, 1986.
- Eileen M, Glynn-Tucker: Safe handling of hazardous drugs. Pittsburgh, Oncology Nursing Society, 1-56, 2003.
- Noriko Ishii, Ed.: The Handling-Manual of Antineoplastic Drugs for Nurses - Basic Skills to Prevent from Occupational Exposure, 2nd Edition, Yuushobou, pp. 15-16, p. 70, 2013.