Divisions
Instructions for Cleaning Spills of Liquid Hazardous Drugs
  • For information about the hazards of the spilled drug, contact the area pharmacy or use the Pharmacy-sponsored Micromedex web page (micromedex.mc.duke.edu).
  • Whenever possible, spills of LIQUID hazardous drugs will be handled by employees in the area of the spill.
  • Employees may call 911 to contact OESO for telephone advice or assistance cleaning up the spill. OESO will respond to large spills that are beyond the capacity of employees in the vicinity of the spill.

Equipment Needed: 
Chemotherapy/hazardous drug spill kit (available from Pharmacy Store Room at 919-681-5364), including:

  • Tyvek gown or coveralls
  • Shoe covers
  • Splash goggles
  • Two pairs chemotherapy tested disposable gloves
  • Absorbent Pads
  • Scoop with detachable scraper for collecting glass fragments
  • Two 5 gallon plastic waste disposal bags
  • One Ziploc bag for returning contaminated splash goggles to Pharmacy
  • Hazardous Drug Waste labels
  1. Alert nearby persons about the spill. Pregnant employees shall leave the area during clean up.
  2. If the spilled drug got on anyone's skin, eyes, or clothing, see supplemental info below (*).
  3. Prevent risk of additional skin contact with the spilled drug.
  4. Obtain chemotherapy/hazardous drugs spill kit.
  5. Put on safety goggles and double gloves from kit. If spill involves more than 5 mL or covers more than one square foot (or, for smaller spills, at the discretion of the person cleaning the spill), put on Tyvek gown and shoe covers (or coveralls) from kit. Tuck sleeves into the outer gloves.
  6. If there are broken glass fragments, use the detachable scraper to carefully "sweep" them or other sharps into the scoop. Place these sharps in a needle box.
  7. Use the absorbent pads to gently cover and wipe up the spilled material. If additional absorbent material is needed, use plastic lined blue pads (chux) or other available materials. Place used absorbent in one of the clear 5-gallon bags from the spill kit.
  8. Clean the area thoroughly with water. Disposable materials used in this step should go into the open bag from the spill kit.
  9. Clean the area three times using a detergent solution, then rinse. (Housekeeping can be called in for this step ONLY.)
  10. Place any contaminated hospital linens in a hospital laundry bag.
  11. Place other (personal) contaminated clothing in a sealed plastic bag. If it will be laundered, double bag for transport, then wash twice before combining with other laundry. If it will be discarded, place it in the open bag from the spill kit.
  12. Remove the shoe covers (if used) and outer pair of gloves. Place these into the open bag from the spill kit.
  13. Remove the goggles and place them into the open bag from the spill kit. (Alternately, goggles may be washed and reused.)
  14. Close the open waste bag (by knotting or using twist tie or tape), then place it into the second clear 5-gallon bag from the spill kit.
  15. Remove the Tyvek gown (or coveralls) and inner gloves. Place these into the second bag from the spill kit. Close the outer bag.
  16. Wash hands thoroughly.
  17. Read carefully for proper disposal Instructions for spills of chemotherapeutic or regulated hazardous drugs:

    If the spill involved a chemotherapy drug OR contains a constituent from the list below, the material must be disposed through the Occupational and Environmental Safety Office (OESO) and the following procedure should be followed:

    1. Determine a location where the bag can be left for a few days without being moved or thrown in the trash. Contact OESO at 919-684-2794 to arrange for waste pick-up.
    2. Be prepared to give the name of the drug, location of the waste bag, and the name and telephone number for a responsible person who will be available during business hours.
    3. Fill in the blanks on the “Hazardous Drug Waste” labels and put them on the bag, then put bag in location described to OESO.

    Drugs subject to EPA hazardous waste management requirements if discarded or unused:

    Acetone
    Choral Hydrate
    Chloroform
    Dichlorodifluoromethane
    Epinephrine (Adrenaline)
    Formaldehyde
    Hexachlorophene
    Lindane
    Mercury
    Nicotine
    Nitroglycerine
    Paraldehyde
    Phenacetin
    Phentermine (CIV)
    Physostigmine
    Physotigmine Salicylate
    Reserpine 
    Resorcinol 
    Selenium Sulfide
    Sodium Azide 
    Streptozoticin (Streptozotocin) 
    Strychnine
    Warfarin (Coumadin) 

    If the drug is not a chemotherapy drug OR on the above list, put the knotted bag of spill waste directly into a biohazard container (WITHOUT labels).

  18. Call the Pharmacy Store Room at 919-681-5364 to obtain a replacement chemotherapy/ hazardous drug spill kit.
  19. Nursing staff should bag and label any contaminated pumps and send to Pharmacy.
  20. Follow reporting procedures in the supplemental info below(**).

Supplemental Information

*Obvious contamination of gloves, clothing, skin or eyes will be treated as follows:

Remove contaminated gloves or clothing (if applicable).

  1. Wash the affected skin area with soap (not germicidal cleaner) and lukewarm water. For eye exposure, immediately flush the affected eye with water or isotonic eyewash (or normal saline) for at least 15 minutes.
  2. For direct skin or eye contact,
    1. Obtain medical attention as soon as possible. Employees should go to Employee Occupational Health and Wellness or the Emergency Dept.
    2. Fill out the appropriate incident report form and submit as follows:
      • Employees who are exposed must fill out a Report of Work-Related Injury/Illness and send to Employee Health.
      • If patient injury occurs, notify Pharmacy Quality Improvement ( pager 919-970-2494 ) and Risk Management ( pager 919-970-2404 ) immediately.
      • If a visitor is exposed, notify Risk Management.
    3. Inform the appropriate area manager.

**Reporting Requirements for ALL Incidents During Patient Treatment:

Any drug spill during patient treatment should be documented in the Safety Reporting System.

About these instructions and when they should be used:

These instructions are provided with hazardous drugs spill kits so that, whenever possible, spills of LIQUID hazardous drugs can be handled by employees in the area of the spill. Hazardous drugs are those marked "Chemotherapy" or "Hazardous drug" by the pharmacy.

Additional Information:

For information about the hazards of the spilled drug, contact the area pharmacy or use the Pharmacy-sponsored Micromedex web page. Ask for or look for a Material Safety Data Sheet (MSDS) on the drug.
It is not necessary to report hazardous drug spills to the Occupational and Environmental Safety Office (OESO) unless hazardous waste pickup is required. However, employees may call 911 to contact OESO for telephone advice or assistance cleaning up the spill. OESO will respond to large spills that are beyond the capacity of employees in the vicinity of the spill.  If you call 911, tell the dispatcher there is a hazardous drug spill and give a number where you or someone else in your work area can be reached.  Please make sure someone is available to answer the telephone and talk with the Spill Responder from OESO.

Hazardous Drug Spill Training is Available through OESO's Training Website

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