Safe Handling Of Cytotoxic Drugs In Home-care: A Carer’s Guide

More and more, people are receiving cytotoxic drug treatment (oral) in the familiarity of their own homes. This change in some cancer treatments means that carers are increasingly vital in supporting patients with care at home. While this home-based care offers many benefits to the patient, it also comes with the responsibility of not only the safe use of the drugs themselves but also cleaning a possibly contaminated environment, dealing with spills and safe handling of laundry. As a carer, you play a crucial role in ensuring both the patient's safety and your well-being. This guide provides essential information and practical tips to help you navigate the safe handling of cytotoxic drugs in the home care setting.

Cytotoxic drugs are powerful medications used to destroy cancer cells. While effective in treating cancer, they can pose health risks if not handled properly. That’s why understanding potential exposure routes is crucial for carer safety.

• Skin Contact: Direct contact with cytotoxic drugs or contaminated surfaces can lead to absorption of the drug through the skin.
• Inhalation: Airborne particles from cytotoxic drugs can be inhaled during preparation and administration of the drugs themselves, or when cleaning and managing laundry in the home.
• Accidental Ingestion: While less common, accidental ingestion can occur if food or drinks are contaminated with the cytotoxic drug.
• Sharps Injuries: A patient receiving IV chemotherapy drugs is more likely to have treatment in the appropriate facility with specialised care.

The following provides clear, actionable steps for minimising risks associated with cytotoxic drug handling in the home-care setting. Remember, proactive safety measures protect both you and the person you're caring for.

PPE is non-negotiable when handling cytotoxic drugs; it's your primary barrier against potential exposure. Here’s a breakdown of essential PPE and its correct usage:

• Gloves: Use gloves specifically designed for handling cytotoxic drugs. These gloves are non-sterile with reinforced fingertips (purple), dispose of them correctly after each use.
• Gowns: Wear disposable gowns to protect your clothing and skin from accidental splashes or spills. Choose fluid-resistant gowns that cover your arms and body.
• Masks: Use surgical masks to prevent inhalation of airborne drug particles. For certain tasks like cleaning up spills, a respirator or N95 mask will offers higher protection.
• Eye Protection: Wear goggles or a face shield to protect your eyes from splashes. Appropriate PPE includes specific gloves, long sleeved gowns made from materials tested for use with chemotherapy, masks and/or respirators, and face shields or goggles.
  
  

Remember: Properly putting on (donning) and taking off (doffing) PPE is crucial. Healthcare providers can demonstrate the correct techniques and provide visual aids. Dispose of contaminated PPE in designated containers following local regulations.

Spills are high-risk situations, requiring prompt and careful action. A spill can be defined as urine, diarrhoea, vomit or blood associated with injury. Have a designated spill kit readily available and be familiar with the following steps:

• Immediate Actions: Secure the area, alerting others to stay clear. Put on appropriate PPE, including gloves, gown, mask, and eye protection.
• Containment: Use absorbent materials from the spill kit to contain the spill and prevent further spread.
• Cleanup: Carefully collect the contaminated absorbent materials and dispose of them as cytotoxic waste, double bag for extra protection.
• Decontamination: Clean the spill area with appropriate cleaning agents as per guidelines provided by healthcare professionals.
• Reporting: Report the spill to the healthcare provider and follow any necessary procedures for documentation.

Remember: Never attempt to clean a spill without proper PPE and training. Always consult the spill kit instructions and contact healthcare providers for guidance. Patients and carers should be provided with information to contact medical and nursing staff 24 hours a day. Patients receiving home-based chemotherapy should also be given a spill kit and instructions on how to clean a spill correctly.

Cytotoxic waste requires special handling to safeguard public health and the environment. The disposal of medications and needles will be the responsibility of the specialised team, most likely in a hospital setting. Here’s a guide to correct waste disposal:

• Sharps Disposal: Dispose of needles, syringes, and broken glass in designated sharps containers.
• Medication Waste: Dispose of empty vials, containers, and unused medication in designated cytotoxic waste containers/ sharps bins.
• Contaminated Materials: Dispose of contaminated PPE, cleaning materials, and any other contaminated items such as sanitary pad, incontinence pads etc as cytotoxic waste, double bagging contaminated items in plastic leakproof bags.
• All Body fluids, flush the toilet twice after use, with the lid down to avoid splashing.
• Local Regulations: Always follow local regulations for cytotoxic waste disposal. Your healthcare provider can provide specific instructions and resources.

Cytotoxic contamination will include laundry items, demanding careful handling. Follow these guidelines to protect yourself and others:

• Separate Handling: Always handle contaminated laundry separately from other household laundry to prevent cross-contamination. When handling contaminated linen, carers should use appropriate PPE.
• Protective Measures: Wear gloves and other necessary PPE while handling contaminated linen.
• Washing Instructions: Wash soiled contaminated items, separately. Washing will most often be done using a domestic machine so use a hot water full cycle, and regular washing detergent. Wash clothing, sheets and towels twice. Follow specific recommendations from healthcare providers. Other laundry can be completed as usual, more likely by the patient.
• Drying: Potential aerosolisation can be hazardous when drying contaminated linen in a dryer. Contaminated linen should be air-dried.

Maintaining a clean home environment is essential, especially when handling cytotoxic drugs. Focus on these key areas:

• Risk Assessment: Identify areas that require special cleaning due to potential contact with cytotoxic drugs. This might include surfaces in the bathroom, bedroom, or areas where medication is prepared and administered.
• Cleaning Solutions: Detergent solutions (soap and water) are usually recommended for general cleaning. Consult local guidelines for specific recommendations, as the effectiveness of certain chemicals in deactivating hazardous drugs can be conflicting.
• PPE for Cleaning: Always wear appropriate PPE, including gloves and a mask, when cleaning areas that may have come into contact with cytotoxic drugs (including spills).
• Disposal: Dispose of cleaning materials correctly as cytotoxic waste, including double bagging, following local policy and procedure.

Open communication is essential for successful home care. Regularly communicate with the patient, healthcare providers, and home care agencies to ensure everyone is informed and supported.

• Patient Communication: Discuss safety concerns openly with the patient, ensuring they understand the importance of precautions and their role in maintaining a safe environment. Patients and carers should be given 24-hour medical and nursing contact information.
• Healthcare Provider Communication: Don't hesitate to ask questions, clarify instructions, report any concerns, and seek guidance from healthcare providers.
• Home Care Agency Communication: If a home care agency is involved, maintain open communication regarding medication delivery (at home or in a specialised unit), training requirements, and any challenges you face.

Comprehensive training is crucial for safe and effective home care. Healthcare providers and home care agencies should provide:

• Initial Training: Thorough instruction on all aspects of safe handling, administration, and disposal of cytotoxic drugs and waste products. Anyone who handles and administers cytotoxic drugs, and related waste must receive training to reduce the risk of contamination to other personnel, themselves, equipment, and the surrounding environment.
• Ongoing Education: Regular updates on best practices, new guidelines, and specific drug information.
• Specialised Training: Instruction on administering specific cytotoxic drugs and managing complex situations.
• Refresher Training: Periodic reinforcement of protocols on safety and skills.

Connect with available support networks to access valuable information, practical assistance, and emotional support.

• Homecare Agencies: These agencies can coordinate medication delivery, offer respite care services, and be able to connect you with support groups or counselling services.
• Support Groups: Connecting with other carers, either in person or online, allows you to share experiences, advice, and emotional support.
• Government Resources: Explore government agencies or organisations that offer information and support services for carers of cancer patients.
• Online Resources: Reputable websites and online communities can provide valuable information, guidance, and support.

Caring for a loved one undergoing cancer treatment can be physically and emotionally demanding. Remember to prioritise your well-being to avoid burnout and provide the best possible care.

• Recognise the Demands: Acknowledge the challenges of caregiving and its impact on your physical and emotional health.
• Stress Management Techniques: Practice stress management techniques like mindfulness, relaxation exercises, regular physical activity, healthy eating, and adequate sleep.
• Seek Emotional Support: Talk to friends, family, or a therapist about your feelings. Join support groups to connect with others who understand your experiences.
• Respite Care: Utilise respite care services to take breaks, recharge, and prevent burnout. Homecare agencies can offer respite care services.

Carers play a vital role in ensuring the safe handling of cytotoxic drugs in home care settings. By diligently following safety protocols like using proper PPE, managing spills effectively, and adhering to waste disposal guidelines, carers can protect both patients and themselves from potential risks. Open communication with healthcare providers and access to ongoing training and support enables carers to confidently manage the demands of providing care.

Ultimately, safe and supportive home care relies on a collaborative approach where patients, carers, and healthcare providers work as a team. What steps are you taking to enhance safety in your home care environment? Share your experiences and insights in the comments below.

For more information and resources on cytotoxic drug safety in home care, explore related articles on our website or subscribe to our newsletter for the latest updates in home care best practices

Further reading

https://www.worksafe.govt.nz/topic-and-industry/healthcare/cytotoxic-drugs/

https://www.worksafe.govt.nz/dmsdocument/35443-cytotoxic-drugs-keeping-workers-safe-when-handling-cytotoxic-drugs-and-related-waste/latest

http://www.safework.nsw.gov.au/__data/assets/pdf_file/0005/287042/SW08559-Cytotoxic-drugs-and-related-risk-management-guide.pdf