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USP 800

  • 1.  USP 800

    Posted 08-05-2019 19:44
    I have a question on the bleach cleaning of pt rooms and equipment at end of day. Is your RN staff participating in any of that activity? If so, how do you justify cost compared to housekeeping management?

    Kathryn Hoffmann


  • 2.  RE: USP 800

    Posted 08-06-2019 12:44
    Hi
    No, we still rely upon housekeeping. And USP <800> provides no guidance for Infusion rooms and equipment. The section on cleaning/deactivation etc. is geared toward pharmacy compounding.

    That being said, housekeeping should be knowledgeable about what NOT to do when cleaning areas where chemotherapy is compounded and infused. This is based on wipe test studies and not on USP.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 3.  RE: USP 800

    Posted 08-06-2019 15:43
    Thank you!

    Kathryn Hoffmann






  • 4.  RE: USP 800

    Posted 08-07-2019 18:02
    Hi Seth,

    After a spill, we had a recommendation to decontaminate/deactivate the chemo prior to our housekeepers cleaning the room. We recently had our first wipe testing completed, and we had our vendor wipe an area where we had a chemo spill 2 weeks prior to the wipe testing. The results came back that chemo was still detectable in the area above the "safe" limits. We are reviewing our process to see if there is a more effective way to deactivate/decontaminate after a spill. Right now we are using the same wipes pharmacy uses for their hoods (which are the size of a wet nap you get at a restaurant). We have looked at other products, but they all come in bulk bottles, or are geared more towards pharmacy staff. We are also trying to determine if there is a better product that our housekeepers can use to decontaminate after a spill. Any recommendations or guidance is always appreciated!
    Mary

    ------------------------------
    Mary D. Molloy MSN, RN, OCN
    Patient Care Manager, Heme/Onc
    Northwestern Memorial Hospital
    Chicago, IL
    312-472-1405
    ------------------------------



  • 5.  RE: USP 800

    Posted 08-07-2019 19:56
    Do you use bleach wipes?

    Kathryn Hoffmann




  • 6.  RE: USP 800

    Posted 08-07-2019 20:24
    Hi
    Not sure what wipes (from pharmacy) you are using. A few wipe facts:
    1. Normal germacidal bleach wipes (e.g., Clorox) do not neutralize HDs. Neither do any other antimicrobial wipes.
    2. SurfaceSafe, if used correctly, can effectively neutralize about 20 different drugs. They're best reserved for spills as they're too small (and too expensive) for doing an entire department. Wipedown 1-2-3 is also effective.
    3. HD Clean is designed to remove (but not neutralize)
    4. Peridox RTU can also be used. More info on that can be found HERE. Note that it does have a pretty strong smell, as do the 2 other sodium hypochlorite-based products.

    There is no single product that will do all of the currently used HDs so any product will be a compromise.

    More information on deactivation can be found HERE.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 7.  RE: USP 800

    Posted 08-07-2019 20:41
    Seth, do you have a special role in this endeavor? Very valuable information.

    Kathryn Hoffmann




  • 8.  RE: USP 800

    Posted 08-07-2019 20:48

    Special role?

    Not really. I'm just a nurse who gives these drugs and has made this my "one thing" (to quote from Curly from City Slickers).

     

    Seth






  • 9.  RE: USP 800

    Posted 08-07-2019 21:10
    So you have had this as a focus and have gained a lot of knowledge. You are a good resource!

    Kathryn Hoffmann




  • 10.  RE: USP 800

    Posted 01-08-2020 09:47
    I think you are too modest Seth, I have read and followed much of your guidance and would very much appreciate input regarding some of the same content as above. I am just not clear.  Im kind of a one woman band on the clinical end, for all risk areas, all department, etc.  I have, of course deferred to USP guidelines ( and the correlating ONS).  However, it was not clear to me that the "spill" management portion was specific to pharmacy.  I have meet with our ( 200plus bed community hospital with in and outpatient chemotherapy as well as special procedures) environmental managers... and our undertanding is that a spill must be managed immediately.  Where I run into issues is the very minimal times we have a chemo patient in critical care... ( chemo nurses manage but do not stay for infusions)... if a spill occurs... I have to teach all of them how to manage... that is HUGE>.. Do you have other suggestions?  Same for OR and surgery center where they do intravesical? Overwhelming.. Thank you in advance...
    Also ... is it overkill for nurses/na's to glove/gown/and wear face gear for disposing of body fluides?  eg. catheter/urinal contents?

    THANK YOU IN ADVANCE!

    ------------------------------
    Roberta Price MSN RN
    Clinical Educator
    Kingston PA
    ------------------------------



  • 11.  RE: USP 800

    Posted 01-09-2020 09:51
    Hi all,

    I am also facing the same issue as Roberta, the USP-800 guidelines are not clear on exactly who should be educated on HD spill management. It is obvious that the RNs and pharmacists who prepare and administer chemotherapy need to be, but should this education also be rolled out to all units in the hospital or all RNs working on oncology units? We also have the occasional occurrence of a patient receiving chemotherapy in the ICU where an oncology nurse does not stay throughout the entire infusion.

    Also, we just started meeting about initiating a medical surveillance program. Has anyone started this at their facility? How are you doing this?
    Thanks in advance!

    Amanda Fletcher BSN, RN, OCN
    Oncology Nurse Educator
    Pennington, NJ

    ------------------------------
    Amanda Fletcher RN OCN BSN
    Registered Nurse
    Capital Health Medical Center
    Florence NJ
    ------------------------------



  • 12.  RE: USP 800

    Posted 08-08-2019 07:57
    Hi Seth,

    We are using the surface safe wipes. We are going back and forth on should the nurse be the one to use the wipes or should our housekeepers deactivate/decontaminate. With the wipes being so small, we are concerned we aren't effectively cleaning the area.

    ------------------------------
    Mary D. Molloy MSN, RN, OCN
    Patient Care Manager, Heme/Onc
    Northwestern Memorial Hospital
    Chicago, IL
    312-472-1405
    ------------------------------



  • 13.  RE: USP 800

    Posted 08-08-2019 15:07
    Hi Molly
    I am assuming that you are using the product as directed (3 pairs of wipes, waiting 30 seconds between each wipe).
    What drug(s) came back positive?

    As far as who does the actual cleaning, much depends on your system. For out department, the nurse involved with the spill does the Surface Safe wipes, as there might be a delay of 5-10 minutes before housekeeping can get there and I don't want the contaminated area left unattended. And housekeeping staffing is quite limited on weekends, holidays and evenings, so it makes sense in our system for the RN to do it.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 14.  RE: USP 800

    Posted 08-09-2019 07:41
    Thanks Seth! All of this information is helpful! I haven't gotten our official report, but the company did call to alert us to suggest closing the room that had the spill until we could reclean the room. The rest of our surfaces tested did not have detectable levels of HD's.

    Thank you!
    Mary

    ------------------------------
    Mary D. Molloy MSN, RN, OCN
    Patient Care Manager, Heme/Onc
    Northwestern Memorial Hospital
    Chicago, IL
    312-472-1405
    ------------------------------



  • 15.  RE: USP 800

    Posted 08-09-2019 21:50
    I you don't mind sharing, what is your procedure for day to day cleaning of chemo administration areas?
    IV pumps?
    Tables/chairs?
    How do you clean between patients?

    After initial containment of a spill in chemo admin area, what are you cleaning with?

    Any responses would be greatly appreciated

    ------------------------------
    Jessica Taylor
    Altoona PA
    ------------------------------



  • 16.  RE: USP 800

    Posted 08-10-2019 15:41
    Hi
    We clean with Sani-Cloth (black top) for most surfaces. Some of our equipment requires bleach wipes, which we also use for enteric contact isolation rooms. Other departments are using hydrogen peroxide wipes, but we switched because of the fumes (irritating to some employees) and the cause terrible streaking on stainless steel surfaces. Of course, none of these products will get rid of HD contamination. This is strictly for infection prevention.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 17.  RE: USP 800

    Posted 08-12-2019 09:25

    We use Cavicide. WE clean the chairs, Alaris infusion pumps, poles, table tops etc.

     

     

    Jaime L. Kist RN, MSN,RN-BC, ONC

    Clinical Educator II

    Trihealth Cancer Institute

    Outpatient Clinics

    513-503-8605

     

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  • 18.  RE: USP 800

    Posted 08-12-2019 11:56
    Good question, are nurses in your institutions cleaning up post spills or just containing spill and housekeeping staff doing cleaning?

    Dee Ann Omatsu, APRN, PNP, CPON
    Clinical Oncology Educator

    Sent from Dee's iPhone😊




  • 19.  RE: USP 800

    Posted 08-12-2019 19:52
    In my facility, the nurses are the spill team.
    Seth 
    Sent via mobile. 





  • 20.  RE: USP 800

    Posted 08-13-2019 01:33
    What type of education do you give for chemo spill and annual competency?

    Dee Ann Omatsu, APRN, CPON




  • 21.  RE: USP 800

    Posted 08-15-2019 23:31
    I used to do  in-person training every year. This year we switched to an LMS system. It's essentially a guided tour of the spill kit, and step-by-step how to use it.

    All new hires get the "in-person" training initially.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 22.  RE: USP 800

    Posted 08-26-2019 15:18
    Which products do you use when cleaning up a spill?​

    ------------------------------
    Kennia Fraire RN
    El Paso TX
    ------------------------------



  • 23.  RE: USP 800

    Posted 08-28-2019 19:22
    Surface Safe, if the spilled drug is on the list of drugs that can be safely neutralized.

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 24.  RE: USP 800

    Posted 01-08-2020 10:30
    Seth
     Can I ask if your facility has a medical surveillance.program ? I am trying to assist my manager in starting a protocol .
                  Thank you Tanya

    ------------------------------
    Tanya Camacho BSN,RN ,OCN
    Infusion
    Orange Regional Medical Center
    Middletown NY
    ------------------------------



  • 25.  RE: USP 800

    Posted 01-09-2020 10:21
    Hi
    I am still working on a medical surveillance program, which will strictly be for after an exposure (e.g., spill cleanup). There's really no compelling data to do annual CBCs on every employee, (in my opinion), so we're looking specifically at who is at the highest risk. I have a meeting scheduled for this coming up in March and we will see where it goes.

    This of course is different from environmental wipe testing, which does have a sound rationale and is recommended in USP. I just got the results of our bathroom wipe testing project and will be presenting a poster on it at Congress (along with a CJON article).

    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 26.  RE: USP 800

    Posted 01-09-2020 10:44
    Thank you Seth,
    At this time I was thinking follow up with "cause", aka spill clean up.  My only concern is there is no internal baseline. Therefore it may not be a bad idea to to recommend a CBC for all nurses Hired / Transferring to Oncology and/or Infusion Center.  Thoughts?

    And of course I am still struggling with the education of Training nearly 100 Nurses and nursing assistants in non-oncology areas who "may" me exposed to a chemo patient once a year... to manage spills and handle / appropriately garb for for body fluides...

    ------------------------------
    Roberta Price MSN RN
    Clinical Educator
    Kingston PA
    ------------------------------



  • 27.  RE: USP 800

    Posted 01-14-2020 21:48
    Hi
    I guess my reservation about baseline CBC upon hire is that if the spill/exposure occurs 1 year later, we have no idea what's been going on with that employee's counts after the initial CBC; maybe they had a viral infection 2 months ago and it shows up "low" after an exposure. We'd have no way of knowing if it was abnormal from the exposure or from some other event. That's why my opinion is to get a baseline immediately AFTER the exposure (before anything can occur), and then 10-14 days later.

    Just my opinion!
    Seth

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------



  • 28.  RE: USP 800

    Posted 01-10-2020 15:43
    Seth,
    The institution where I work has determined that using bleach wipes (orange top- active ingredient is sodium hypochlorite 0.63%) will be the standard for decontamination.  The procedure is to wipe down IV pump, pole, chair, computer after patients treatment.  Some of the clinics are open bay treatment areas and there is some concern about the smell of bleach and the exposure to patients.  The recommendation in the USP 800 chapter for deactivating, decontaminating, cleaning and disinfecting states:
    "All areas where HD's are ​handled and all reusable equipment and devices must be deactivated, decontaminated and cleaned."  This statement is what the team used to determine this step in the process.
    Does anyone have any recommendations or are you willing to share what your institution has outlined as practice for decontamination in the treatment area- just with day to day cleaning- not after a spill?
    Is cleaning with bleach after every patient safe?
    What about computer equipment- keyboards and scanners? do you use any protective coverings (plastic coverings or keyboard protection) on the computers that are used in administration?

    Any feedback would be appreciated.

    ------------------------------
    Stephanie Hammontree RN MSN
    Oncology Education Specialist
    University of Kansas Cancer Center
    Olathe KS
    ------------------------------



  • 29.  RE: USP 800

    Posted 01-14-2020 18:45
    Hi Stephanie
    In the interest of discretion, I will simply say that the commercial bleach wipes will not decontaminate HD residue. First, the testing data (and I can provide those resources if you'd like) were all done with 5-6% hypochlorite, which is essentially the same as household bleach. When Surface Safe came out, Bob Dorr had to go with 2% wipes because the higher concentration would eat through the packages; hence the rationale for doing it 3 times with each wipe (3x2%=6%).

    One of the wipe test studies I did tested tried disinfectant bleach wipes (1%) and it came back quite contaminated with cyclophosphamide. So I am quite skeptical that your hospital will achieve any better decontamination than if they were using a regular disinfectant wipe (e.g, SaniCloth AF)

    Again, one of the problems with USP <800>'s wording is that it is intended for compounding, with equipment made of stainless steel, and covering small areas (e.g., biologic safety cabinet).

    There is one liquid product that just released testing data to show it will neutralize HD residue and can be used for large areas like an Infusion department, but here the issue is what effect it would have on equipment. Your pump manufacturer has strict recommendations for cleaners, and using anything else will void your warranty if it starts cracking the outside casing.

    I plan to do some testing with this product to see how it smells and how well it works (with followup wipe testing), later in the year.

    We DO use bleach wipes regularly for patients in certain types of enteric contact isolation. Yes, it does cause premature wear on computer keyboards and mice, but it's not terrible and those are relatively cheap to replace (especially compared with IV pumps).

    Our pump manufacturer specifies bleach for cleaning, so that's what we use for all pumps in every one of our 62 infusion bays. Yes, it smells, but it's gone by the time the next patient gets into the bay.

    This is a great topic and right now we don't have all of the answers. But its good that people are asking the questions!

    Seth


    Seth,
    The institution where I work has determined that using bleach wipes (orange top- active ingredient is sodium hypochlorite 0.63%) will be the standard for decontamination.  The procedure is to wipe down IV pump, pole, chair, computer after patients treatment.  Some of the clinics are open bay treatment areas and there is some concern about the smell of bleach and the exposure to patients.  The recommendation in the USP 800 chapter for deactivating, decontaminating, cleaning and disinfecting states:
    "All areas where HD's are ​handled and all reusable equipment and devices must be deactivated, decontaminated and cleaned."  This statement is what the team used to determine this step in the process.
    Does anyone have any recommendations or are you willing to share what your institution has outlined as practice for decontamination in the treatment area- just with day to day cleaning- not after a spill?
    Is cleaning with bleach after every patient safe?
    What about computer equipment- keyboards and scanners? do you use any protective coverings (plastic coverings or keyboard protection) on the computers that are used in administration?
    Any feedback would be appreciated.
    ------------------------------
    Stephanie Hammontree RN MSN
    Oncology Education Specialist

    University of Kansas Cancer Center
    Olathe KS

    ------------------------------
    Seth Eisenberg RN ASN OCN BMTCN
    PROFESSIONAL PRACTICE COORDINATOR, INFUSION SERVIC
    Seattle Cancer Care Alliance
    Federal Way WA
    ------------------------------