Dr. Yukiko Kikuchi,
Assistant Professor of Public Health and Basic Nursing Studies,
Akita University Graduate School of Medicine and Faculty of Medicine
(1) Methods of dealing with spilled anticancer drugs
When an IV drip containing anticancer drugs is spilled, display a warning sign to avoid the spread of exposure to people in the surrounding area, put on protective equipment and immediately clean the area of the spill. The protective equipment consists of a double-layer of gloves, a gown, a mask (N95 or N99), a face shield, a hair cap, etc. Prepare a spill kit with the necessary protective equipment, and also gather together the warning sign and absorbent sheets. There are also commercially available kits. When a spill occurs, a spill kit must be installed in advance in any location where anticancer drugs are stored, prepared, and administered, and also all employees handling anticancer drugs must be made aware of the processing method and trained in advance. It is necessary that patients receiving treatment with anticancer drugs in-home also understand the processing method.
Processing for spills inside of the safety cabinet
If the amount of the spill is small, allow it to be absorbed with an absorbent sheet, and then wipe. If it is a powder or granule, allow it to be adsorbed by an absorbent sheet moistened with water, and then blot. If sharp items are mixed in due to breaking an ampule, etc., collect with a plastic scoop or similar tool, and dispose of in a puncture-resistant waste container.
If 150 mL or more of an IV drip containing anticancer drugs or 1 vial or more of drug solution is spilled, clean the inside of the hood, and then clean the entire safety cabinet because some of the drug may remain. If a HEPA filter (high efficiency particulate air filter) is contaminated, the HEPA filter must be replaced after cleaning. The use of the contaminated safety cabinet is prohibited until the replacement is complete because the HEPA filter replacement must be performed by an expert technician.
Processing for spills outside of the safety cabinet
If anticancer drugs are spilled on a work table or floor, blot the spilled drug solution with an absorbent sheet, wash this area three times with household floor cleaner, and then finally blot with an absorbent sheet or towel. For spills on carpets, sprinkle powdered carpet cleaner on the area of the spill, allow it to absorb the drug solution, and vacuum up the powder using a vacuum cleaner. Wipe the surface of the vacuum cleaner with 2% sodium hypochlorite to clean, and then store. Place the used protective equipment, the absorbent sheets, vacuum cleaner bag, etc. into a sealable plastic bag, and dispose of as harmful waste.
Medical waste with anticancer drugs deposited on it, supplies used in the processing of spills, and waste contaminated by the excrement and vomit of patients within 48 hours after ending treatment must be handled with the utmost care until its final disposal to avoid the spread of contamination to the surrounding area via these items. Store in a puncture-resistant waste container until they can be processed according to the manuals, etc. defined by the hospital. Not only medical personnel, but also employees performing cleaning work who handle medical waste and waste-disposal workers must be made aware and handle waste safely.
(2) Emergency response when exposed
If exposure to anticancer drugs occurs, it is necessary to treat it promptly and appropriately to minimize its harmful effects.
When it comes into contact with skin or eyes
Flush skin or eyes with anticancer drugs deposited on them well with water. If deposited on skin, wash using soap as well. If it gets in eyes, flush using a specialty eye cup with water pressure at a level that will not damage the eyes. If there is no eye cup, blink while applying running water from the tap in a wash basin. After washing, the patient must always be examined by a physician. It is necessary to install a washbasin and eyecups to enable rapid washing in locations where anticancer drugs are handled.
When aerosol is inhaled
When anticancer drugs are inhaled by mouth, gargle immediately with an adequate amount of water. When inhaled through the nose cavity, a nasal lavage procedure is necessary. After washing, the patient must always be examined by a physician.
Because inhalation of aerosol when mixing and preparing anticancer drugs is possible even when wearing a mask, always gargle after doing so.
When accidentally stabbed with a needle used for anticancer drug treatment
Squeeze the insertion point of the syringe needle to check whether or not it contains drug solution. Even if it does not contain drug solution, disinfect the location of needle stick. If it is possible that it contains drug solution, treatment by a physician is required. As a general method of treatment, steroids is injected into the skin and subcutaneously from the area surrounding the wound opening of the needle stick toward its center, and after the injection, a topical steroid ointment is applied, and then a cold compress filled with saline solution, etc. is applied. The warm compress with 0.1% acrinol solution (Rivanol) used in the past is not recommended because it does not have an anti-inflammatory action, and there are also hypersensitivity and adverse reactions to acrinol.
As an emergency response method when exposed to anticancer drugs, it is important that a protocol that clearly states the emergency response per contact site with anticancer drugs and route, and emergency contact information is created, which is displayed in locations where anticancer drugs are handled, and that individuals handling anticancer drugs are made sufficiently aware of it.
Moreover, create and retain an incident or variance report for later verification of each of the conditions of exposure. Maintenance of an organizational system regarding medical checkups and subsequent health care of employees who have been exposed as well as future preventive countermeasures is necessary.
- American Society of Hospital Pharmacists: ASHP Technical assistance bulletin on handling cytotoxic and hazardous drugs, Am J Hosp Pharm, 47: 1033-1049, 1990.
- Noriko Ishii, Ed.: The Handling-Manual of Antineoplastic Drugs for Nurses: Basic Skills to Prevent from Occupational Exposure, 2nd Edition, Yuushobou, 2013
- Yodaiken RE: OSHA Work practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs, Am J Hosp Pharm, 43: 1193-1203, 1986.
- Ishida Y et al.: Experimental study into the effects of applying gauze medicated with acrinol solution to skin injuries resulting from extravasation of medical drugs, Japanese Journal of Nursing Art and Science, 3 (1): 58-65, 2004.