S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination
There are many potential hazards within the care home environment that can result in exposure, this is sometimes referred to as occupational exposure.
When incidents of exposure occur in a care home then the action is time critical to ensure the risk of harm is minimised as far as possible and the risk of transmission of infection and harm is reduced
An example of where an Occupational Exposure Incident requires management is if there were to be sharps incident. A sharp injury is where the skin has been visibly punctured by a needle or another sharp object contaminated with blood or other body fluid. Refer to SICP 9 for the Safe Disposal of Waste [including sharps] for the process of how to manage sharps within a care home environment.
A further example of an Incident that would require Occupational Exposure management is if someone living or working in a care home sustained a bite injury from another human. This is an example of where the mucous membranes are potentially broken and have been contaminated by blood/bodily fluid.
As an organisation there is a requirement to be able to protect the person as far as possible and reduce the risk from infections from bodily fluids when an incident of exposure occurs. This can be achieved by ensuring appropriate first aid interventions and following specific procedures when dealing with an incident of exposure.
The correct use of personal protective equipment is a key strategy in prevention of exposure management. Refer to SICP 4 Personal Protective Equipment for when to wear personal protective equipment when supporting people with any form of direct care.
Refer to the following page for the Best Practice for the Management of Occupational Exposure Incidents as detailed by the NHS National Services Scotland.
Safe Handling of Cytotoxic Drugs
What are Cytotoxic Drugs?
Cytotoxic drugs are used widely in healthcare settings as well as in the community in the treatment of cancers as well as other diseases.
Cytotoxic drugs (sometimes known as antineoplastics) describe a group of medicines that contain chemicals which are toxic to cells, preventing their replication or growth, and so are used to treat cancer. They can also be used to treat several other disorders such as rheumatoid arthritis and multiple sclerosis.
Cytotoxic drugs are hazardous substances, as defined by the Control of Substances Hazardous to Health Regulations 2002 (COSHH). HSE.gov.uk
What is the risk?
The toxicity of cytotoxic drugs means that they can present significant risks to those who handle them. Occupational exposure can occur when control measures are inadequate. Exposure may be through skin contact, skin absorption, inhalation of aerosols and drug particles, ingestion and needle stick injuries resulting from the following activities:
- drug preparation
- drug administration
- handling patient waste
- transport and waste disposal, or
- cleaning spills
Storage
The medication will be stored as per the medication policy in a locked unit within a locked room. If individual cytotoxic medications require special storage this will be achieved in line with the manufacture instructions within the secure clinical area for each home
Protection – Personal Protective Equipment
When handling Cytotoxic Medications an apron, gloves and a face mask are to be worn. If the preparation of the medication is in liquid form or injections, then a face visor is to be worn. PPE is to be worn when cleaning a spillage of a Cytotoxic medication.
The MAR charts for individual preparations of Cytotoxic medications are to be clearly marked so there is clear identification.
Delivery
Cytotoxic medications are not always delivered and dispensed by the homes named pharmacy. Individual medications can be delivered direct from the manufacture through a special delivery.
Waste
Some cytotoxic medications have safe waste disposal requirements, these will be dealt with on an individual basis within the home. The arrangements for disposal will be detailed as required for each individual medication as directed by the manufacture and prescriber.
Best Practice for the Management of Occupational Exposure Incidents
Occupational Safety: Prevention and Exposure Management and the Chain of Infection.
How does the Safe Disposal of Waste [including sharps] fit into the Strategy of S.P.I.C.E?
The prevention and exposure management strategies referred to under SICP 10 and others referenced in this policy focus on preventing an infectious agent leaving the reservoir, in this case this may be the needle used to administer an injection or the risk of infection being reduced as far as possible when the portal of entry has been established.
The actions taken when exposure occurs requires prompt action in order to be able to try and contain and potential infectious agent and eliminate it from the body
