Guidelines

Intravesical instillation with mitomycin C and bacillus Calmette-Guérin in non-muscle-invasive bladder cancer (2026)

Want to read the guideline in your own time? Download the PDF

Download full guideline

Appendix 4

Examples safety guidelines for handling hazardous drugs Instructions for cleaning spills of liquid hazardous waste

  • 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 Storeroom at 681-5364), including:

  • Protective gown or coveralls
  • Shoe covers
  • Splash goggles
  • 2 pairs chemotherapy tested disposable gloves
  • Absorbent pads
  • Scoop with detachable scraper for collecting glass fragments
  • 2 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.
  2. If the spilled drug got on anyone’s skin, eyes, or clothing, see supplemental info information 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 waste disposal (Improper disposal can mean large fines).

Nursing & Medical Research: If the drug is listed below, determine a location where the bag can be left for a few days without being moved or thrown in the trash. Contact the Occupational and Environmental Safety Office (OESO) at 684-2794 to arrange for waste pick-up. 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. Fill in the blanks on the “Hazardous Drug Waste” labels and put them on the bag, then put bag in location described to OESO.

These are the drugs that must be treated as described above:

  • Chlorambucil (Leukeran)
  • Cyclophosphamide (Cytoxin)
  • Daunorubicin (Daunomycin, Cerubidine)
  • Melphalan (Alkeran)
  • Mitomycin (Mitomycin C, Mutamycin)
  • Streptozocin (Zanosar, Streptozotocin)
  • Uracil mustard (Uramustine, U-8344)
  • Arsenic Trioxide
  • Diethylstilbestrol

If the drug is not on the above list, put the knotted bag of spill waste directly into a biohazard container (WITHOUT labels). Call the Pharmacy Storeroom at 681-5364 to obtain a replacement chemotherapy/ hazardous drug spill kit. Nursing staff should bag and label any contaminated pumps and send to Pharmacy. Follow reporting procedures in the supplemental info below(**).

Supplemental Information for Employees Cleaning up Spills of Hazardous Drugs

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

  1. Remove contaminated gloves or clothing (if applicable).
  2. 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.
  3. For direct skin or eye contact:
    • Obtain medical attention as soon as possible. Employees should go to Employee Occupational Health and Wellness or the Emergency Dept.
    • 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 970-2494) and Risk Management (pager 970-2404) immediately.
      • If a visitor is exposed, notify Risk Management.
    • 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.