U.S. Department of Health and Human Services

Part 3, Chapter 27: Manual Exhibit 3-27-C

EXHIBIT 3-27-C – SPILL MANAGEMENT AND CONTROL
Sec.

1. Spill Kit Requirements
2. Staff Response and Protection
3. Spills in Containment Primary Engineering Controls
4. Spills of Less Than 5 Milliliters (mL) or 5 Grams (g) Liquids or Powders Outside a C PEC
5. Spills of More than 5 mL or 5 g outside a C-PEC
6. Spills on Carpet/Upholstery
7. Spills on Linen

SPILL KIT REQUIREMENTS
1. Location of Spill Kits. Spill kits should be located in all the immediate areas where exposures may occur.
2. Spill Kit Contents. Each spill kit must contain the following items (commercial chemotherapy spill kits may also be used):
  1. Absorbent pads with impermeable backing,
  2. Disposable dust pan and scoop,
  3. Eye protection (i.e. goggles),
  4. Chemotherapy gloves (2 pairs),
  5. Respirator(s), (Assortment as appropriate to fit-tested staff)
  6. Hazardous drug disposal bags (2),
  7. Protective lint free gown with cuffs and back closure,
  8. Shoe covers, and
  9. Signs to restrict access to spill area.

STAFF RESPONSE AND PROTECTION
1. Responsible Staff. Due to their specialized training and experience working with hazardous drugs, pharmacy, nursing, and/or environmental services staff will be responsible for cleaning up hazardous drug spills. Only individual staff who have received formal spill response training are permitted to clean up spills of hazardous drugs.
2. Appropriate Personal Protective Equipment (PPE). Wear appropriate PPE as described in the Indian Health Manual Part 3, Chapter 27, Section 8.

SPILLS IN CONTAINMENT PRIMARY ENGINEERING CONTROLS
1. Extensive spills within a Containment Primary Engineering Control (C-PEC) necessitate decontamination of all interior C-PEC surfaces after completion of the spill clean-up.
2. If the spill contaminates the C-PEC high-efficiency particulate filter, the unit must be labeled and sealed in plastic until the filter can be changed and disposed of properly by trained personnel wearing appropriate PPE.

SPILLS OF LESS THAN 5 MILLILITERS (mL) OR 5 GRAMS (g) LIQUIDS or POWDERS OUTSIDE A C PEC. Spills of less than 5 ml or 5 g outside a C-PEC should be cleaned up immediately by trained personnel wearing gowns, double chemotherapy gloves, respirator, and eye protection (if splashing is possible).
1. Immediately notify other employees in the area that a hazardous drug spill has occurred and prevent anyone from entering the area of the spill.
2. Liquids should be wiped up with an absorbent gauze pad with an impermeable backing; solids should be wiped up with wet absorbent gauze with an impermeable backing. The spill area(s) must be deactivated, decontaminated, and cleaned according to facility policy and manufacturer guidelines.
3. Any broken glass fragments shall be picked up using a small scoop (never the hands) and placed in a hazardous drug sharps container.
4. It is recommended that used spill kit items be disposed of and replaced after use. If not disposed of/replaced, then they must be deactivated, decontaminated, and cleaned according to spill kit instructions.
5. Place all contaminated absorbent pads and other materials in a bulk hazardous drug waste container.
6. After removing PPE, wash hands, arms, and face.
7. Reusable PPE will be cleaned appropriately after each use. If respirator filter cartridges are used during spill clean-up, they must be disposed of as trace hazardous waste.

SPILLS OF MORE THAN 5 mL OR 5 g OUTSIDE A C-PEC. For spills of amounts larger than 5 ml or 5 g, the area should be isolated and aerosol generation avoided.

NOTE: Staff who are required to wear respirators must meet other requirements under Title 29, CFR, Section 1910.134 including annual medical evaluations, fit testing, and training.
1. Immediately notify other employees in the area a spill has occurred. Prevent anyone from entering the area of the spill so it is not tracked to other areas.
2. Use a chemotherapy spill kit to clean up hazardous drug spills.
3. Don a gown, double chemotherapy gloves (one glove under the cuff and one glove over the cuff of the gown), eye protection, shoe covers, and appropriate respiratory protection.
4. Limit liquid spread by covering the hazardous drug spill with absorbent sheets or spill control pads or pillows. If a powder is involved, damp cloths or towels should be used.
5. Pick up any broken glass fragments using a small scoop (never the hands) and place in a sharps container. Dispose of the sharps container and all hazardous drug clean up material (absorbent pads, PPE, etc.) as bulk hazardous drug waste.
6. Thoroughly deactivate, decontaminate and clean all contaminated surfaces according to manufacturer guidelines.
7. Place all contaminated absorbent pads and other materials in a bulk hazardous drug waste container.
8. Wash hands, arms, and face.
9. Protective goggles and respirators must be cleaned with mild detergent and water after each use. If respirator filter cartridges are used during spill clean-up, they should be disposed as trace hazardous waste.

SPILLS ON CARPET/UPHOLSTERY. Secure the area and use an absorbent powder to absorb the hazardous drug spill. Use a vacuum cleaner with a HEPA filter that is designated solely for hazardous drug cleanup to remove the powder. The surface is to be appropriately decontaminated according to manufacturer guidelines for the specific hazardous drug. If modular carpeting is involved, the facility should consider removal, disposal, and replacement of the affected section. Notify your facility safety officer as soon as possible that a hazardous drug spill has occurred and has been cleaned up.

SPILLS ON LINEN. For inpatients receiving hazardous drug treatment, disposable linen should be used where possible. If minimally contaminated, linen can be disposed of as trace hazardous drug waste. Appropriately trained staff handling contaminated linen should wear gloves, a gown, and eye protection. Re-usable linen contaminated with hazardous drugs will be immediately removed from service, placed in a specially marked laundry bag, and a second impermeable bag. Linens will be pre-washed separately from other linen, then washed a second time along with other linens if allowed per local policy or contract laundry provider.