Chemotherapy & Cytotoxic Waste – Care in the Home

Just recently, a friend of the family commenced chemotherapy. After receiving the cocktail of chemicals, designed to kill cancer cells, she was sent home to recuperate.

This is common – who wants to remain in hospital anyway? What concerned me though, was the lack of information and education provided to the family on what they needed to do to protect themselves from these chemicals while the patient remained in a cytotoxic state. After all, the chemicals are harmful to healthy cells as well.

This is not an isolated case either; in many cases, care staff are not being informed of a client’s cytotoxic condition. Whether this is because case managers do not understand the condition, or they have a misguided sense of protecting the privacy of the individual, I am not sure. According to work place health and safety guidelines, an organisation has a duty of care to alert a staff member that a client they are caring for is undergoing chemotherapy and to provide relevant training on the correct handling of waste.

All care workers need to be diligent in noting occasions where they may be placed in a potentially harmful situation and alerting their manager if they have concerns. It is also a reminder that care staff should always follow standard work health and safety practices and wear personal protective equipment (PPE) whenever carrying out their duties in the home. Any staff member who is supporting a person undergoing chemotherapy needs to be informed of the situation and provided with information, education and specific cytotoxic PPE that allows them to protect themselves and other people.

Cytotoxic – what does this mean?

The drugs used to treat many types of cancers are cytotoxic, which means the treatment can kill cancer cells, but can also be harmful to healthy cells. The length of time that a client is in a ‘cytotoxic state’ will vary, so all care staff need to be aware that ‘chemotherapy’ or ‘cytotoxic waste’ could be harmful to them and taking particular precautions is essential when working in the home.

Cytotoxic Waste – what is it?

Community care workers who support clients in their own homes may be at risk of exposure to cytotoxic waste during the provision of client care activities. Cytotoxic waste includes body substances such as urine, faeces, vomit and blood.

Where there is a risk of care staff being exposed to these substances, such as when handling or emptying a client’s bedpan, urinal bottle, catheter or vomit bag, standard precautions should be maintained. In some instances, bed linen may be soiled with a client’s body substance and again, adopting standard precautions is essential.

When cleaning in the home, the staff member should ensure that areas that receive direct contact by the individual undergoing chemotherapy need to be cleaned, and cleaning cloths disposed of correctly. This would include areas such as the toilet seat and grab rails used by the person. Soiled linen, such as sheets, towels and face cloths, need to be handled with care. Family members, particularly other elderly people living with the person, should be made aware of the need to protect themselves from cytotoxic waste, to keep them safe and healthy.

Disposing of Cytotoxic Waste

There are legal requirements that must be followed when handling or disposing of cytotoxic related waste, and the Community Care organisation has a duty of care to ensure the health and safety of their workers.

Organisations must conduct a risk assessment where necessary and implement appropriate control measures to minimise the risk of a cytotoxic accident occurring.

Information and training must be provided to care staff regarding the following points:

• How to maintain a safe work environment when working with cytotoxic waste
• Following specific care instructions – which may differ from standard practices
• Being provided with and using the correct safety equipment such as Personal Protective Equipment (PPE) and disposal containers for contaminated waste
• Protecting themselves, other clients and their families from contamination

To ensure the safety and well-being of care workers, the following should also be provided:

• Personal Protective Equipment (e.g. cytotoxic gloves, gowns, masks and safety glasses)
• Directions for laundering soiled linen, towels or clothing of a client undergoing chemotherapy
• Directions for rubbish disposal (e.g. incontinence aids, etc.)

All direct care staff should be educated regarding the potential risks associated with working with cytotoxic clients. Training should include information about the health risks associated with exposure to cytotoxic drugs or related waste, how this exposure may occur and safe handling protocols used to minimise the risk of exposure.

If organisations adopt these tips, their care workers will be better prepared to work with clients receiving chemotherapy and adverse incidents should be minimal.

For more information, the Office of Industrial Relations QLD – Workplace Health and Safety, have developed a ‘Guide for handling cytotoxic waste'.