Plus-Hex CLINICAL
• Hazardous waste bags
• Hazardous waste sharps container
• Absorbent granules
• Disposable scoop / tweezers.
is used, this again should be purple and / or labelled with the EWC and HP codes [ 17 ]. Ideally, cytotoxic waste should be placed in a bin operated with a foot pedal to help prevent contamination of the bin lid with cytotoxic waste [ 3, 13 ].
In the event that a spillage occurs, the VN should warn colleagues immediately and not leave the area [ 16 ]. PPE must be donned first, before attempting to clean up the contamination from a spillage.
The spillage should be cleaned from the area of least to most contamination. All broken parts of any vials should be removed with the disposable scoop or tweezers and placed in the sharps container. Next, the absorbent granules( if available) should be used to soak up the spilled liquid. An absorbent pad should be moistened, to decrease the risk of aerosolisation of the spilled drug, and used to‘ wipe’ the remaining liquid from the outer edge( where there is least contamination) to the centre( where there is most contamination) [ 3 ], collecting the granules smoothly as the pad is moved. Once in the centre, the used pad and granules should be carefully placed into the hazardous waste bag. The process of wiping up the spill and any granules should be repeated, using fresh moistened absorbent pads, until all the liquid has been cleaned up and disposed of.
Each spill should be documented in the practice ' s health and safety records and reviewed to improve practice.
Cytotoxic waste
All materials contaminated during chemotherapy administration, including PPE, syringes, cannulas and chemotherapy drug vials, must be segregated from general practice waste and disposed of as cytotoxic waste. Cytotoxic waste is classified as hazardous and assigned the European Waste Catalogue( EWC) code 18 02 07, with hazardous property( HP) code HP7( carcinogenic) [ 17 ]. This waste must be placed in appropriately marked containers, typically purple bins bearing the cytotoxic symbol, and collected by licensed specialist contractors, some of whom may be associated with veterinary crematoria.
Figure 4. A cytotoxic waste bin.
In-patient kennel set-up
Once the cytarabine CRI has been made up, it needs to be attached to the patient in the ward. It is extremely important to prepare the hospital environment in advance to reduce the risk of environmental contamination and to minimise the handling of the patient. The designated kennel( Figure 5) should be in an area with minimal traffic to help keep any cytotoxic waste separate from the rest of the ward.
Transport of cytotoxic waste between practice branches is prohibited unless undertaken in licensed vehicles; it is illegal for unlicensed transport to carry hazardous materials [ 17 ]. Consequently, all chemotherapy procedures should be conducted at a single site; if this is not feasible, each site must arrange separate specialist collections to ensure compliance with hazardous waste regulations.
Cytotoxic waste is collected in a purple-lidded hazardous waste bin( Figure 4), and sharps used in the administration of cytotoxic drugs are collected in a purple sharps container. If a hazardous waste bag
Figure 5. An inpatient kennel set-up( courtesy of Viki Weigh, RVN).
Volume 40( 4) • August 2025
49