Safe handling of bodily fluids after cancer therapy
Dear OncoLink "Ask The Experts,"
After chemotherapy treatment, are there recommendations for safe handling of patient secretions, urine, etc after the patient returns home?
Carolyn Vachani RN, MSN, AOCN, OncoLink's Nurse Educator, responds:
In most cases, chemotherapy is excreted in the body fluids for up to 48 hours after treatment, although some agents can be found in excrement for up to 7 days. This includes urine, stool, vomit, semen, and vaginal fluid. If a person has to clean up any patient body fluids during the 7 days after treatment, it is recommended that he or she wear gloves (household gloves would be fine) and clean the area thoroughly with a cleaning solution. Contaminated linens should be washed separately, and one should consider keeping the toilet lid closed if pets or children are likely to drink or play in the water. Some groups recommend double flushing the toilet, although this has not been proven beneficial. Despite all of these recommendations, there is little data as to what danger this limited exposure causes to family members and friends. This is really a cautious approach with little data to back it up. There IS data to show that chronic exposure, as in pharmacists or nurses, may lead to problems with reproductive health (i.e. increased rates of stillbirths, miscarriages, and malformations). As for semen and vaginal fluids, condoms should be used for any sexual activity within the 7- day time frame to avoid exposure. Protection should also be used while on treatment to prevent a pregnancy, as there is risk of mutation and damage to the sperm and egg from chemotherapy.
In the case of patients who are receiving treatment with radio-immunotherapy, there are some more specific recommendations. The medications used in radioimmunotherapy are Bexxar and Zevalin. Zevalin emits radiation in the form of short-distance beta rays, and therefore the radiation is mostly confined to the body. These patients are told to wash hands thoroughly after urinating, to clean up any spillage of urine with soap and water immediately, and to abstain from having sexual intercourse for one week.
Bexxar is different in that it releases radiation in the form of both gamma rays and beta rays, and therefore actively emits radiation from the body. These patients are given more isolating instructions. These include: sleeping alone (for 5 days), no kissing or sexual intercourse (7 days), minimization of time with pregnant women and children (5 days), and minimization of close contact with others (5 days). They are also instructed to drink plenty of fluids (5 days); flush the toilet 2-3 times after each use and wash hands thoroughly; if possible, use a separate bathroom from others (5 days); use disposable eating utensils (5 days); use separate bath linens and launder them separately (7 days); maintain a separate toothbrush holder (5 days); and wipe the telephone mouthpiece with a tissue after each use (5 days).
One other special case is the treatment of bladder cancer with BCG immunotherapy. BCG is essentially a preparation containing live bacteria, and can therefore infect others. Healthcare workers are at risk of infection by these bacteria while they are preparing the medication for instillation into the bladder, and so it should be prepared with aseptic technique. After treatment, these patients are advised to urinate while sitting down to avoid splashing of urine. For the first six hours after treatment, urine should be mixed with an equal amount of bleach for 15 minutes to disinfect before flushing. Patients should increase their fluid intake for 24-48 hours to flush the BCG from the bladder.