SAINT LOUIS UNIVERSITY

SCHOOL OF NUSING
BAGUIO CITY

Operationalisation of "Chemotherapy Spill Kit"

in chemotherapy administration areas
Journal Study
REFERENCES:

MAIN: Sunita,K , Kaur,S , Patel, F. (2009) Operationalisation of

"Chemotherapy Spill Kit"
in chemotherapy administration areas. Nursing and Midwifery Research
Journal. Retrieved from http://medind.nic.in/nad/t10/i3/nadt10i3p93.pdf
RRL1: Great Ormond Street Hospital for Children (2006) Safe Practice
with Cytotoxic Drugs - Policy for Hospital Based Practice. London, Great
Ormond Street Hospital for Children NHS Foundation Trust.Retrived from
http://www.gosh.nhs.uk/health-professionals/clinical-guidelines/cytotoxicand-cytostatic-medication-safe-handling-andadministration/#References
RRL2: Joshi MC.(2007)Cytotoxic drugs -towards safer administration.
Indian
Journal
of
Cancer.
Retrieved
from
http://medind.nic.in/nad/t10/i3/nadt10i3p93.pdf
RRL3: Sunita,K , Kaur,S , Patel, F. (2013) USABILITY OF THE
CHEMOTHERAPY SPILL KIT AMONG NURSING PERSONNEL WORKING IN
THE CHEMOTHERAPY ADMINISTRATION AREAS: A FOLLOW UP STUDY.
Nursing
and
Midwifery
Research
Journal.
Retrieved
from
http://medind.nic.in/nad/t10/i3/nadt10i3p93.pdf

COLAS, ROCHELLE B
BSN IV F-3
OCTOBER 23, 2014

SUMMARY
The title of my journal is Operationalisation of "Chemotherapy Spill Kit" in
chemotherapy administration areas proposed by Kumari et al. which was
published on July 2010. Since nurses are involved both in the preparation and
administration of chemotherapy drugs, while preparing or administering cytotoxic
drugs there are possibilities of spillage which pose exposure not only to the person
handling the drugs but also to others in the unit, so this study was conducted to
operationalise the use of "Chemo therapy Spill Kit" in Radiotherapy ward and Day
Care Chemotherapy Rooms of PGIMER Chandigarh. Exposure "Chemotherapy spill
kit (CSK)" has been recommended by all the leading oncology nursing agencies. In
the study, Operationalisation of "CSK" was done to assess its use among nurses
employed in chemotherapy administration areas at a tertiary care hospital for one
month. The study was conducted in four phases - preparation phase in which kit
consisting of two parts personal protection part and spill management part was
prepared; information dissemination and demonstration phase; placement phase in
which Kit was placed in all the research settings for use; and lastly observation
phase in which the subjects were observed for the usage of "CSK". A total of 22
subjects posted in the chemotherapy administration areas (Radiotherapy ward &
Day care chemotherapy rooms) were observed for one month. The subjects were
observed for usage of the kit everyday however analysis of the same was done at
follow up 1 and 2 which was subject's first and the last day of using the kit
respectively.
As a result, all the subjects used personal protection part of the kit and 17 subjects
who experienced spills, used spill management part also. Total 43 small cytotoxic
spillages were experienced. Various problems expressed with the personal
protection part of "CSK" were, feeling suffocation with use of mask, feeling hot with
disposable cap and all goggle users had problems of headache and blurred vision
with goggles. Subjects who used spill management part expressed difficulty in using
dissecting forceps and also verbalized that spill cleaning is time consuming.
However as the usage of the "CSK" progressed among the subjects, the satisfaction
to the usage of various parts of "CSK" increased significantly from follow up 1 to
follow up 2 (p < .0001).
The study therefore concluded that Operationalisation of the "Chemotherapy Spill
Kit" " among nurses working in chemotherapy administration areas of a tertiary
hospital was successful. Hence provision of CMK was recommended in the areas
where Chemotherapy is administred and necessitating nursing administrators to
provide articles to maintain the kit in regular practice.Hence the usage of CSK was
recommended while chemotherapy administration

REVIEW OF RELATED LITERATURES

In a study quoted by Cancer network/guidelines (and agreed datasets)/

chemotherapy network site specific
group/guidelines for the management of spillage of cytotoxic drugs 2006, a
chemotherapy site specific group, antineoplastic drugs spillages occured during
handling and administration of these drugs. The spillages were observed at the site
of preparation, during priming of intravenous tubing's, removal of air from
parenteral systems and during connecting or disconnecting of the IV lines from the
patients24. In the study of Kumari also, the subjects experienced a total of 43 small
spills with a mean of 2.5 spills. Majority (77.3%) of the subjects experienced spills.
More than half of (52.9%) experienced spillage at the surface of preparation of
cytotoxic drug (table) and remaining (47%) over both surface of preparation and the
gloves worn by the subject.
In a retrospective study (Cytotoxic drugs -towards safer administration) of the
medical records of the patients in Bhaktapur cancer hospital regarding management
of and handling of cytotoxic drugs it was found that limited financial resources,
inadequate knowledge and lack of training of personnel handling drugs were the
contributing factors for inappropriate handling of cytotoxic drugs25. In the present
study also the similar findings were revealed before operationalising "CSK", however
after Operationalisation of the kit and providing the subjects with personal
protection and spill management articles a high usage of the kit by the subjects was
noticed in all the three areas. Using Mc Nemar's test a significant increase in the
satisfaction level as per the usage of various par ts of the kit was found among the
subjects from follow up 1 to follow
up 2 (P<.0001).
An update of this study entitled USABILITY OF THE CHEMOTHERAPY SPILL KIT
AMONG NURSING PERSONNEL WORKING IN THE CHEMOTHERAPY ADMINISTRATION
AREAS: A FOLLOW UP STUDY was published recently this November 2013. The study
revealed that non-maintenance and non-usability of CSK among the nursing staff
was observed in this follow up study which made the study recommend that regular
in-service education programmes should be conducted to enhance awareness about
the toxic effects of chemotherapy and its exposure and the effectiveness of
chemotherapy spill kit usage. Administration need to intervene by implementing
strict policies and regular checking for the usage of CSK.

REACTION
In the study, it was revealed that subjects who used spill management part
expressed difficulty in using dissecting forceps and also verbalized that spill
cleaning is time consuming. However as the usage of the "CSK" progressed among
the subjects, the satisfaction to the usage of various parts of "CSK" increased
significantly from follow up 1 to follow up 2 (p < .0001). Hence the usage of CSK
was recommended while chemotherapy administration. However in the follow up
study, reasons were explored for not maintaining the kit properly and not using it.
The result of the follow up study showed that there are problems occurred using the
CSK. The CSK was provided but the nurses did not use it for they say that it is a

waste of time and so I believe that there is a need for implementing strict policy for
using CSK and conduct seminars for nurses the effects of exposure to toxic drugs
and also, the effectiveness of the CSK.
In our institution, some nurses verbalized that there is no protocol to guide them in
times that they are spilled with cytotoxic drugs and there are times that they felt
burning sensation in their arms but they dont know how to address it because they
do not know if there is a protocol. There is also no CSK, so comparing to the study,
there is a high percentage of spillage events and many were accidentally spilled but
they do have CSK which they do not use for it is a waste of time according to them
but how much more in our institution, that we do not have a CSK and worst some
are spilled and exposed? I believe that there is a need for CSK in the hospital and a
guideline to be folled regarding spill management for nurses to follow because it is
for their own protection because we all know that chemotherapeutic drugs are
dangerous in ones health.