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Difficulty: Very hardHandling Hazardous and Infectious Materials

The registered nurse is caring for a client who is on strict contact precautions for a Clostridioides difficile infection and is receiving a continuous intravenous infusion of a hazardous antineoplastic agent. Upon entering the room, the nurse observes that the intravenous tubing has disconnected at the hub, the antineoplastic medication is actively dripping onto the floor, and the client has just had a large episode of liquid stool incontinence. Which of the following actions should the nurse take? Select all that apply.

  1. Clamp the disconnected intravenous tubing immediately to halt the flow of the hazardous medicationAnswer
  2. B
    Assess the client's vital signs and abdominal status before intervening with the disconnected intravenous tubing
  3. Don a specialized chemotherapy gown, double chemotherapy gloves, and a face shield prior to cleaning the spillAnswer
  4. D
    Instruct the unlicensed assistive personnel (UAP) to immediately clean the incontinent stool while the nurse manages the medication spill
  5. Contain the liquid medication spill on the floor by carefully placing absorbent pads from a chemotherapy spill kit over itAnswer
  6. F
    Perform hand hygiene using an alcohol-based hand rub vigorously for 20 seconds after doffing all personal protective equipment

Answer

The correct actions are to clamp the intravenous tubing immediately, don specialized chemotherapy personal protective equipment (gown, double gloves, face shield), and contain the spill using absorbent pads from a chemotherapy spill kit.
The management of a combined infectious and hazardous material incident requires immediate prioritization of source control and appropriate protection. The nurse must first stop the active chemotherapy spill by clamping the tubing. Subsequently, the nurse must don appropriate specialized personal protective equipment (chemotherapy gown, double gloves, and face shield) and use a chemotherapy spill kit to contain the spill with absorbent pads. These actions minimize occupational exposure and environmental contamination.

Step-by-Step Solution

1
Identify the immediate hazards in the environment.
The nurse recognizes an active antineoplastic medication spill and a concurrent biohazard from Clostridioides difficile stool.
Rapid situational awareness determines the necessary safety priorities.
2
Stop the source of the hazardous spill.
The nurse immediately clamps the disconnected intravenous tubing.
Halting the flow of the hazardous medication prevents further environmental contamination and reduces exposure risk.
3
Don appropriate specialized personal protective equipment (PPE).
The nurse applies a chemotherapy gown, double chemotherapy gloves, and a face shield.
Standard contact precautions are insufficient for an antineoplastic spill; specialized PPE is legally and ethically required to protect the nurse from hazardous drug exposure.
4
Contain the spilled hazardous medication.
The nurse places absorbent pads from a chemotherapy spill kit over the liquid on the floor.
Containment prevents the hazardous drug from spreading or aerosolizing before full decontamination can be completed.
5
Perform appropriate hand hygiene after managing the situation.
The nurse washes hands with soap and water after removing PPE.
Alcohol-based hand rubs are ineffective against Clostridioides difficile spores, which must be physically washed away.

Key Concept

Management of combined hazardous drug spills and infectious biohazards
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Topics

Handling Hazardous and Infectious Materials

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