When managing a hazardous drug spill what personal protective equipment is most appropriate?

The following clinical procedure provides information on how to manage a hazardous drug spill safely. Only healthcare professionals trained, educated and/or deemed competent as per institutional guidelines on the safe handling and waste management of hazardous drugs should perform this procedure. Staff should always adhere to local policies and procedures when managing hazardous drug spills. 

Equipment

Spill kits should be kept in areas where hazardous drugs are transported, stored, handled, prepared, administered and disposed of. They generally include some or all of the following contents: 

Spill kit:

• instruction sheet
• cytotoxic/hazardous drug spill sign(s)
• personal protective equipment (PPE):
  • single use chemoprotectant gloves x 2
  • impermeable chemotherapy gown
  • protective eyewear
  • P2 or N95 mask
  • overshoes
  • hairnet
• absorbent materials such as:
  • chemical absorbent spill pillow
  • chemical absorbent mat(s)
  • chemical absorbent granules
• a small scoop or scraper to collect any glass fragments
• detergent/cleaning solution 
• water for powder spills (to reduce dust and particulate matter)
• hazardous/cytotoxic waste bag(s).

For a BCG live vaccine spill:

• spill kit as above and
• locally approved tuberculocidal disinfectant or bleach.

Spill kits should be reviewed routinely to ensure supplies are adequate and contents have not expired or degraded over time. The contents of available spill kits may vary from those listed above and will depend on the brand of spill kit used by individual institutions. Extra items may need to be sourced in order to maintain safe practice. 

Procedure

1. Alert and call for assistance to notify people in the immediate vicinity that a hazardous spill has occurred and direct them to stay clear. Do not leave the spill, request a spill kit be brought to the area.
2. Open the spill kit. Display hazard sign(s) around perimeter of spill and call for assistance if required. 
3. Don PPE in the following order:
   1. mask (P2 or N95) - this should always be donned first due to inhalation risk associated with spills
   2. protective eyewear
   3. hairnet (if required)
   4. 1st pair of gloves
   5. impermeable gown (ensure cuff of gown is over the gloves)
   6. overshoes (if required)
   7. 2nd pair of gloves (ensure gloves are over cuff of gown).
4. Contain the spill 
   1. For a liquid spill: place absorbent cloths around the perimeter, cover spill with absorbent granules, spill pillow or mat. Take care not to generate any splashes or aerosols.
   2. For a powder spill: place an absorbent chemical mat over the powder ensuring minimal dust production. Carefully wet the mat with water (without flooding) so that the powder dissolves and is absorbed by the mat. 
5. Open two cytotoxic waste bags and place one inside the other.
6. Using the scoop and scraper, gather the absorbed material and collect any broken glass.
7. Discard collected waste into the inner waste bag or cytotoxic sharps waste container (e.g. the broken glass). 
8. Clean contaminated area several times with water and detergent, working from the outer aspect of the spill inwards. Rinse the area thoroughly with water. Continue until area is completely cleaned. 
9. Place used cloths into the inner waste bag.
10. For a BCG live vaccine spill: a second clean is required with a 10% bleach solution or locally approved tuberculocidal disinfectant to prevent transmission of BCG infection.
11. Dry the affected area with absorbent towels or other suitable materials and dispose of all items into the inner waste bag.
12. Remove outer gloves and place into the inner waste bag. Seal bag.
13. Remove additional PPE placing into the outer waste bag in the following order:
    1. overshoes
    2. gown
    3. protective eyewear
    4. hairnet
    5. mask
    6. inner gloves.

Note: perform hand hygiene between steps if hands become contaminated at any point. 

14. Seal outer waste bag and discard into appropriate waste bin.

15. Perform hand hygiene For cytotoxic spills: use soap and water only. For spills that pose a biohazard risk (e.g. live BCG vaccine): wash hands with an alcohol-based antibacterial solution.

16. Replace spill kit.

Documentation

Complete an incident report as per institutional requirements as soon as possible and include:

• full details of the incident
• immediate first aid provided, e.g. washing and removal of contaminated clothing
• details of PPE worn
• the full name of the drug involved and the individual components, including diluents
• health surveillance of workers involved in the incident.

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This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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11 Sep 2022

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