Pre‐procedure

ActionRationale

1. 1.Show
   Act immediately. Assess the level of exposure of any individual and isolate them from the spill.
   Any spillage may become a health hazard (Polovich et al. [194], C).
2. 2.Show
   Collect spillage kit.
   It contains all necessary equipment (Polovich et al. [194], C).
3. 3.Show
   Put on both pairs of gloves, goggles and a gown and then a disposable plastic apron over the gown (see Action figure 3).

   • If there is visible powder spill, put on a good‐quality particulate respirator mask.
   • If spillage is on the floor, put on overshoes.
   To provide personal protection. E

   To prevent inhalation of powder. E

   For protection and to minimize the spread of contamination. E

Procedure

1. 4.Show
   Wipe up powder spillage quickly with well‐dampened paper towels, starting at the outer edge of the spill area and working in a circular motion towards the middle to contain spill (Weinstein and Hagle [265]), and dispose of the towels as ‘high‐risk’ waste.
   To prevent dispersal of powder. To prevent spread of contamination to a wider area. To protect others and ensure safe disposal by incineration (DH 2012, C; Weinstein and Hagle [265], E).
2. 5.Show
   Mop up liquids that have been spilled on a hard surface with paper towels, starting at the outer edge of the spill area and working in a circular motion towards the middle to contain spill (Ferguson and Wright [74]), and dispose of the towels as ‘high‐risk’ waste.
   To prevent spread of contamination to a wider area. To protect others and ensure safe disposal by incineration (DH 2012, C).
3. 6.Show
   Wash hard surfaces at least twice with copious amounts of cold, soapy water and dry with paper towels. The floor should then be given a routine clean as soon afterwards as possible. If spillage has occurred on a carpet, it will require cleaning as soon as possible.

   • If spillage is on clothing, remove it as soon as possible and treat as ‘soiled linen’.
   • If spillage has penetrated clothing, wash contaminated skin liberally with soap and cold water.
   • If spillage is on bedlinen, put on gloves and an apron, change it immediately and treat as ‘soiled linen’.
   • If an accident or spillage involving direct skin contact occurs, the area should be washed thoroughly with soapy water as soon as possible. In the event of a cytotoxic splash to the eye, irrigate thoroughly with 0.9% sodium chloride or tap water for at least 15 minutes.
   To remove residual contamination. E

   • To decontaminate clothing without hazard to laundry staff. E
   • To decontaminate skin and prevent drug absorption. E
   • To protect the patient and the laundry staff. E
   • To decontaminate the area and minimize the risk of drug absorption and damage (Weinstein and Hagle [265], E).

Post‐procedure

1. 7.Show
   Any accident or spillage by nursing staff involving direct skin contact with a cytotoxic drug must be reported to the occupational health department and manager as soon as possible after the first aid is performed and appropriate documentation completed (see Box 23.2).
   To ensure that details of accidental contact are entered in the nurse's health record and appropriate follow‐up is initiated (Polovich et al. [194], C).