To Reduce the Environmental Exposure Risks for all SACT trained staff (and any everyone else) in CTOPD

Quality Improvement Poster Download

Background & Problem

There is a recognised occupational risk to Health Care Professionals (HCP) who prepare, handle and administer hazardous drugs including Systemic Anti-Cancer Therapies (SACT). NIOSH (2004) issued a warning: Working with or near hazardous drugs in health care settings may cause skin rases, infertility, still births, miscarriage, birth defects, menstrual dysfunction, and leukaemia or other cancers.

Vandenbroucke and Robays (2001) found cytotoxic contamination was caused in 25% of cases when spiking IV bags but 100% of cases when removing spikes from completed infusions. The NHS (2018) recommend that the practice of de-spiking “empty” bags of cytotoxic chemotherapy should be stopped as it provides unacceptable exposure risks for staff, other patients and visitors.

Aim

Evidence suggests both educational interventions and Closed Systems should be implemented to reduce occupational exposure risks. A closed system is a physical system that does not allow vapours and aerosols in or out of the system reducing contamination risks.

Method

CTOPD had a deep clean, and then the environment was swabbed to measure environmental contamination. A 4 week educational interventional program followed involving staff and encouraging them to identify risks, own the changes and improve their practice, use of PPE cleaning and awareness. A second swabbing occurred and another deep clean, then closed systems were trialled for 4 weeks and a third swabbing occurred to monitor which intervention reduced contamination.

Results

The swab results showed that low levels of contamination are present in the patient treatment area in CTOPD. The floor, blue trays and arms of patient chairs were the most contaminated areas. The educational interventions importantly did significantly reduce levels in the staff room, protecting staff from the risk of accidental ingestion.

Implications

Even after Closed Systems were introduced contamination still remained which implies that they cleaning methods within the CTOPD need to be reviewed and there is a plan to swab before and after deep cleaning to test the effectiveness of current methods. The results will be shared with Clinical Governance and Trust Board.