COSHH Nursing Procedure

BARNSLEY PRIMARY CARE TRUST
C.O.S.H.H.
Procedures
The Control of Substances Hazardous to Health Regulations 1999
Chemicals, Handling of Medicinal Drugs

and Biological Agents encountered
in Nursing Services
Sue Wing/COSHH Team

April 2002
CONTENTS 1
OBJECTIVES OF COSHH 5
FIRST AID SUMMARY OF STANDARD TREATMENTS 6

Splashes of the eye
Splashes of the skin
Ingestion of poisonous substances
Inhalation accidents
GENERAL GUIDANCE 8
Chemical Exposure
Disinfectants
Microbiological Hazards
References
COSHH PROCEDURE 1 10
HANDLING OF AEROSOLS
1. General Description
2. Substances and Hazards
3. Risk Considerations
4. Standard Operating Procedure
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF CAPSULES/LOZENGES/TABLETS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF CREAMS/OINTMENTS/PASTES
INCLUDING OPHTHALMIC OINTMENTS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF ENEMAS/PESSARIES/SUPPOSITORIES
5. Spillages
6. Waste
7. First Aid
8. Conclusion
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CONTENTS 2
HANDLING OF EXTERNAL LIQUID MEDICINAL PRODUCTS
(INCLUDING INFLAMMABLE PREPARATIONS)
5. Spillages
6. Waste
7. First Aid
8. Conclusion
COSHH PROCEUDRE 6 21
HANDLING OF INTERNAL LIQUID MEDICINAL PRODUCTS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF FORMALDEHYDE SOLUTIONS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF INJECTABLE MEDICINAL PRODUCTS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF VACCINES
5. Spillages
6. Waste
7. First Aid
HANDLING OF PHENOLIC DISINFECTANT E.G. STERICOL
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CONTENTS 3
5. Spillages
6. Waste
7. First Aid
8. Conclusion
CYTOTOXIC DRUGS
TABLETS AND CAPSULES
5. Spillages
6. Waste
7. First Aid
CYTOTOXIC DRUGS
INJECTABLE PRODUCTS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
HANDLING OF BODY FLUIDS
4. Incidents
HANDLING OF CONTAMINATED NEEDLES AND SYRINGES AND OTHER
SHARP IMPLEMENTS
5. Spillages
6. Waste
7. First Aid
8. Conclusion
REFERENCES 43
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NURSING SERVICES
CONTROL OF SUBTANCES HAZARDOUS TO HEALTH (COSHH)
Objectives of COSHH
To ensure that employers protect their staff and others from hazardous substances by
eliminating or minimising exposure through risk assessment and appropriate control.
What is Hazardous under COSHH within the Nursing Services
1. Any chemical substance which may carry one or more of the following labels:-
Toxic or Very Toxic Harmful or Irritant Corrosive
Explosive Highly or Extremely Flammable Oxidising
1.a) a hazardous situation that

presents a biological agent should
display the following sign:-
Dangerous for the Environment Bio Hazard
N.B. The absence of a symbol/sign does not guarantee that a substance is non-
hazardous. Good practice directs that care should be taken when handling any
substance.
2. Any substance with a Maximum Exposure limit (MEL) or Occupational

Exposure Standard (OES). For further advice see general guidance on page 7.
3. Any micro-organism arising from work under the control of the employer
which creates a health hazard to any person.
N.B. This does not include incidental infections caught from other people.
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4. Any dust at a substantial concentration in the air.
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FIRST AID
SUMMARY OF STANDARD TREATMENTS
Splashes of the eye
1. Flood the eye thoroughly with large quantities of gently running water, either
from a tap or from an eyewash bottle and continue for at least 10 minutes,
pouring away from the unaffected eye.
2. Ensure the water bathes the eyeball by gently prising open the eyelids and
keeping them apart until the treatment is completed.
3. A doctor should see all eye injuries (from chemicals). Supply

information of the substance responsible with brief details of the treatment
already given, to accompany casualty to the Accident & Emergency
Department.
4. Report using the Trust incident Form.
Splashes of the skin
1. Flood the splashed surface thoroughly with large quantities of running water
and continue for at least 10 minutes, or until satisfied that no substance
remains in contact with the skin.
2. Remove all contaminated clothing, taking care not to contaminate yourself in

the process. DO NOT remove any clothing stuck to the skin.
3. If the situation warrants it obtain medical advice. Provide information on the

substance responsible to accompany the casualty to the Accident & Emergency
Department with brief details of the first aid treatment.
Ingestion of poisonous substances
1. If the substance has been confined to the mouth give large quantities of water
as a mouth wash. Ensure the mouth wash is not swallowed.
2. If the substance has been swallowed, give about 250 ml. of water or milk to
dilute it in the stomach.
3. Do not induce vomiting as a first aid procedure.
4. Arrange for transport to the Accident & Emergency Department. Provide

information to accompany the casualty on the substance swallowed with brief
details of the treatment given and if possible an estimate of the quantity and
concentration of the substance consumed, and the time elapsed since the
emergency occurred.

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Inhalation accidents
1. Remove the casualty out of the danger area after first ensuring your own
safety.
2. Loosen clothing.
3. If the casualty is unconscious place in recovery position, ensuring the

airway is clear.
4. If breathing has stopped, apply artificial respiration taking precautions not to

inhale the casualty’s exhaled breath.
5. If the emergency warrants it, remove the patient to Accident & Emergency and
provide information on the substance responsible with brief details of the first
aid treatment given.
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GENERAL GUIDANCE
Definition of a Substance Hazardous to Health
Any substance (including any preparation) which is:-
listedin part 1 of the Health & Safety Commission’s approved list, being dangerous
for supply within the meaning of the ‘Chemical (hazard information and packaging for
supply) regulations 1994’ (and 1997 amendment). The relevant indications are very
toxic, toxic, harmful, corrosive or irritant.
specified in schedule 1 of COSHH, which lists substances assigned maximum

exposure limits, for which the Health & Safety Commission has approved an
occupational standard.
a biological agent (any micro organism, cell culture, or human endoparasite,

including any which have been genetically modified, which may cause infection,
allergy toxicity or may otherwise create a hazard to human health).
dust of any kind, when present at substantial concentrations in air.
any other substance that creates a hazard to the health of any person comparable
with the hazards created by the substances defined specified above.
Chemical Exposure
There is a general rule to the effect that exposure to any hazardous substance should
be eliminated or reduced to a minimum, as far as is reasonably practicable.
a) Storage
Store in accordance with national and Trust Guidelines. Drugs and hazardous
substances should be stored in a locked cupboard to prevent unauthorised access.
b) Labelling
Labels should conform to the Chemicals, Hazard Information and Packaging for
Supply Regulations 1994 (as amended) (CHIP).
c) Transport
Staff should be alert to the danger of spillages during transportation and in the event
of spillage occurring, refer to the relevant assessment and Trust Waste Management
Policy.
d) Use
All drugs, chemicals, ‘sharps’, substances must be kept away from the reach of
children. Following the procedures contained in this guidance will reduce the
likelihood of exposure to drugs during their administration to patients.
e) Waste Disposal
Waste material - refer to appropriate assessment contained in the document and Trust
Policy on Waste Management.
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f) Provision of Personal Protective Equipment
Appropriate protective equipment must be used when specified in risk assessment.
See risk assessment for specific details.
g) Health Surveillance
Where a COSHH assessment reveals that employees are exposed to substances
contained in schedule 6 of COSHH 1999 where exposure is such that identifiable
disease or adverse health may result, the Occupational Health Department will
respond by carrying out a programme of health surveillance. Records of such
surveillance will be kept for 40 years.
h) Ventilation
Certain substances may require special ventilation - see specific risk assessment for
details.
Disinfectants
When handling concentrated solutions (e.g. during the preparation of dilute solutions),
gloves, and plastic aprons must be worn. Eye protection may be necessary in extreme
circumstances.
Incidents
Report all incidents using the Trust incident Form and in accordance with the
Accident and Incident Reporting Policy.
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COSHH PROCEDURE 1
HANDLING OF AEROSOLS
1.1 Aerosols (including inhalers, nasal aerosols, etc) dispensed to the

wards/departments from the Pharmacy Department in labelled containers.
1.2 Aerosol preparations are labelled with the ‘Approved Drug Name’ (Non
proprietary name) or ‘Trade Name’ (Proprietary name) if a combination
preparation and any additional warning labels.
1.3 Aerosol preparations are either given to the patient for self administration or
administered to the patient by nursing staff.
2.1 Aerosol preparations consist of a solution or a suspension of a drug in a

pressurised pack.
2.2 The ingredients of aerosol preparations may include substances which are:-
a) potent/toxic e.g. steroids

b) caustic
c) irritant
d) capable of causing sensitisation e.g. antibiotic sprays/iodine sprays
2.3 However, since they are designed for administration to patients for therapeutic
purposes, aerosol preparations themselves pose little potential hazard to the
health of nursing staff from the point of view of toxicity, although they may
still have caustic, irritant of sensitising properties.
2.4 Data sheets are held in the Pharmacy Department on all aerosols potentially
hazardous to health that are currently stocked.
3.1 Potential risks to health are associated with:-
a) contact with the skin

b) absorption through the skin
c) inhalation
d) spraying into the eye(s)

Always follow manufacturer’s instructions.
4.1 All aerosols are dangerous if not used and disposed of correctly.
4.2 Directions for use

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Where possible inhalant Aerosols e.g. Ventolin Trinitrate should be
administered by the patients themselves.
4.3 For all aerosols
Always shake the container thoroughly, remove cap and check direction of the
spray nozzle.
Use in a well-ventilated area.
4.4 Precautions
Immediately wash off any aerosol preparation that comes into contact with
skin
Avoid inhalation of side spray whilst administering drugs to patients.
Avoid spraying into your eyes.
Keep aerosols away from naked flames.
Pressurised containers - protect from sunlight.
Do not pierce or burn even when empty.
4.5 FOR AEROSOLS OTHER THAN INHALERS:

e.g. Providine Iodine spray
Protective aprons, and disposable gloves must be worn. For pregnant or
nursing mothers, a facemask must also be worn.
5. Spillages
5.1 Leaking Aerosol preparations MUST be immediately returned to the Pharmacy

Department for disposal using a clear plastic bag, sealed and labelled.
5.2 Report using a Trust incident Form.
6. Waste
6.1 Refer to Trust Waste Management Policy
7. First Aid
7.1 Avoid Inhalation – if inhalation does occur, obtain medical attention. If any
aerosol substance is sprayed into the eyes, irrigate thoroughly with water for at
least 10 minutes and obtain medical attention.
8. Conclusion
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8.1 By following the standard operating procedure there should be no significant
risk to health from the administration of Aerosol Preparations to patients.
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COSHH PROCEDURE 2
HANDLING OF CAPSULES/LOZENGES/TABLETS
1.1 Capsules/lozenges/tablets are dispensed from the Pharmacy Department to the

wards/departments in labelled containers.
1.2 Capsules/lozenges/tablets are labelled with the ‘Approve Drug Name’ or

‘Trade Name’ if a combination preparation and any additional warning label
e.g. ‘CYTOTOXIC DRUG’.
1.3 Capsules/lozenges/tablets are not handled directly by the nursing staff but
placed into a medicine measure using a non-touch technique and then
administered to the patient as laid down in drug administration procedures.
Where capsules/lozenges/tablets require to be counted, a triangular counting
tray or gloves may be used.
N.B Excludes penicillin-based drugs or powdery tablets
2.1 Capsules/lozenges/tablets contain medicinal substances, together with various

inactive, non-hazardous ingredients, in a solid dosage form. The majority of
capsules/lozenges/tablets pose little potential hazard to the health of nursing
staff during routine administration to patients. Nevertheless their ingredients
may include substances which are:-

b) capable of causing sensitisation e.g. Chlorpromazine, Antibiotics
c) capable of causing harmful effects through repeated low levels of
exposure e.g. cytotoxic drugs.
2.2 Comprehensive data sheets are held in the Pharmacy Department and local
pharmacies on all capsules/lozenges/tablets potentially hazardous to health that
are currently stocked.
a) ingestion
b) contact with the skin
c) absorption through the skin
d) inhalation.
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Capsules/lozenges and tablets must not be handled directly by nursing staff.

A non-touch technique must be used as instructed in the Administration of
Medicines procedure.
5. Spillages
5.1 In the case of accidental spillage of capsules/tablets the nursing staff are
directed to use tweezers or to wear disposable gloves before picking up the
capsules/tablets with disposable tweezers and placing them in the waste
pharmaceutical container for incineration.
Report on a Trust incident Form.
6. Waste
6.1 Return all used tablets/capsules to the Pharmacy Department for disposal.
(Community staff to advise patients to return to their local dispensing
Pharmacy for disposal).
7. First Aid
(see First Aid section)
8. Conclusion
By following the standard operating procedure, there should be no significant

risk to health from the handling of capsules/lozenges/tablets for the
administration to patients.
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COSHH PROCEDURE 3
HANDLING OF CREAMS/OINTMENTS/PASTES
INCLUDING OPHTHALMIC OINTMENTS
1.1 Creams/ointments/pastes are dispensed to the wards/departments in

labelled containers.
1.2 Creams/ointments/pastes are labelled with the ‘Approved Drug Name’ or

‘Trade Name’ if a combination product and any additional warning labels
i.e. ‘CYTOTOXIC DRUG’.
1.3 Creams/ointments/pastes are not handled directly by the nursing staff but
applied to the patient using a wooden spatula, gloved hand or as laid
down in the nursing clinical procedures.
2.1 In general creams, ointments and pastes pose little potential hazard to health
since they are in a semi-solid form and are designed for application to patients
for therapeutic purposes. Nevertheless their ingredients may include
substances which are:-

b) caustic
c) irritant e.g. dithranol
d) capable of causing sensitisation e.g. antibiotics, povidone-iodine,
salicylic acid and sulphur cream
e) capable of causing harmful effects through repeated low levels
of exposure.
2.2 Data sheets are held in the Pharmacy Department on all creams, ointments
and pastes potentially hazardous to health that are currently stocked.
a) ingestion
c) absorption through the skin.
Follow instructions on pack or in literature supplied by the Manufacturer/

Pharmacy Department.
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Use in a well ventilated area.
4.2 Precautions
Wear disposable apron.
Avoid ingestion.
Avoid contact with your skin.
Wear gloves or use a spatula.
Wash off immediately any substance that comes into contact with your skin.
Launder clothing/uniform as soon as possible if it has become contaminated.
Store all substances according to the manufacturer’s instructions.
5. Spillages
5.1 Incidents - report on a Trust incident Form.
5.2 Wearing gloves and an apron wipe up any excess using disposable paper
towels/gauze as appropriate. Dispose of as clinical waste.
5.3 Glass/sharp items must be placed in a ‘sharps’ container. Final disposal

is by incineration.
6. Waste
6.1 Return all unused creams/ointments/pastes to the Pharmacy Department at

Barnsley District General Hospital or local dispensing Chemist.
6.2 Refer to the Trust Waste Management Policy.
7. First Aid
(see First Aid section).
8. Conclusion
8.1 By following the standard operating procedure, there should be no significant

risk to health from the application of creams/ointments/pastes to patients.
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COSHH PROCEDURE 4
HANDLING OF ENEMAS/PESSARIES/SUPPOSITORIES
1.1 Enemas/pessaries/suppositories are dispensed from the Pharmacy Department

to the wards/departments in labelled containers and in community from the
local Pharmacy specifically for individual clients.
1.2 Enemas/pessaries/suppositories are labelled with the ‘Approved Drug Name’

or ‘Trade Name’ if a combination product and any additional warning labels.
2.1 a) Enemas are liquid preparations where the medicament is dissolved,

emulsified or suspended in the vehicle.
b) Pessaries are solid unit dosage forms suitably shaped for vaginal
administration.
c) Suppositories are solid unit dosage forms suitably shaped for insertion into
the rectum.
2.2 The ingredients of enemas, pessaries and suppositories may include substances
which are:-

b) caustic
c) irritant e.g. paraldehyde enema
d) capable of causing sensitisation e.g. Chlorpromazine suppository
e) capable of causing harmful effects through repeated low levels of
exposure.
2.3 Data sheets are held in the Pharmacy Department on all

enemas/pessaries/suppositories potentially hazardous to health that are
currently stocked.
a) ingestion
c) absorption through the skin.
4.1 Follow instructions on pack or in literature supplies by the Manufacturer/

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4.2 Precautions
Always wear disposable gloves and apron when administering enema

solutions.
Use disposable gloves or tweezers when picking up spilled soiled products.
Avoid splashing enema solutions onto skin, into eyes or onto clothing.
Wash off immediately with water any product that comes into contact with
the skin.
Launder clothing/uniform as soon as possible when splashes have occurred.
5. Spillages
5.1 Wearing gloves and an apron, any waste from enema preparations should be
wiped up using disposable paper towels/gauze as appropriate. Dispose of as
clinical waste. Glass/sharp items must be placed in a ‘sharps’ container. Final
disposal is by incineration.
5.2 Refer to the Trustwide Waste Management Policy.
5.3 In the event of accidental spillage of pessaries/suppositories nursing staff must

wear disposable gloves to pick up the pessaries/suppositories and place in a
waste pharmaceutical container for disposal.
5.4 Report on a Trust incident Form.
6. Waste
6.1 Return all unused enemas/pessaries/suppositories to the Pharmacy Department

for final disposal.
7. First Aid
7.1 If any enema solution is sprayed into the eyes, irrigate thoroughly with water
for at least 10 minutes and obtain medical attention
8. Conclusion

risk to health from the administration of enemas/pessaries/suppositories to
patients.
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COSHH PROCEDURE 5
HANDLING OF EXTERNAL LIQUID MEDICINAL PRODUCTS

(INCLUDING FLAMMABLE PREPARATIONS)
1.1 External liquid medicinal products are dispensed from the Pharmacy
Department and local pharmacies to the wards/departments/community in
1.2 The preparations are labelled with the ‘Approved Drug Name’ or ‘Trade
Name’ if a combination preparation and any additional warning labels.
1.3 External liquid medicinal products are not handled directly but poured into
a smaller container e.g. a gallipot, before application to the patient, as laid
down in the clinical nursing procedures.
2.1 a) Applications, lotions, surgical scrubs usually consist of solutions,

suspensions or emulsions in water or other suitable vehicle.
b) Eye drops are sterile aqueous, oily solutions or suspensions.
c) Ear and nasal drops usually consist of solutions, or suspensions in

water or other suitable vehicle.
2.2 The ingredients of external liquid medicinal products may include substance
which are:-

b) caustic
c) irritant
d) capable of causing sensitisation e.g. povidone iodine solution.
2.3 The ingredients of some external liquid medicinal products are volatile
e.g. those containing alcohol.
2.4 Data sheets are held in the Pharmacy Department on all external liquid
medicinal products potentially hazardous to health that are currently stocked.
3. Risk Consideration

a) ingestion
c) inhalation
d) absorption through the skin
e) splashing in the eye.
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3.2 The risk is enhanced in the case of any untoward occurrence such as spillage.
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There are many external liquid preparations in use e.g. ear/nose drops,
antiseptic solution, disinfectant solutions and they all carry individual
instructions.
4.2 Precautions
Always read manufacturer’s instructions before use.
Always observe manufacturer’s precautions.
Never apply solutions (excluding drops) direct from the bottle. Always pour
a small amount into a gallipot or bowl.
Avoid ingestion.
Use gloves, apron and mask to avoid contamination of skin and clothing.
Wash off immediately any external liquid preparations that come into contact
with the skin.
Avoid splashing into the eyes. If splashing occurs irrigate thoroughly with
water for at least 10 minutes and obtain medical attention
Launder contaminated clothing as soon as possible.
5. Spillages
5.1 Where a spillage of a substance containing alcohol occurs, ensure there is

adequate ventilation and evacuate the area (see Trust Waste Policy for
full details).
5.2 Wearing gloves and an apron, any excess/spillage should be wiped up using
disposable paper towels/gauze as appropriate. Dispose of as clinical waste.
Glass/sharp items must be placed in a ‘sharps’ container. Final disposal is by
incineration.
6. Waste
6.1 Return all unused external liquid medicinal products to the Pharmacy
Department for final disposal.
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7. First Aid
(see First Aid section)
8. Conclusion
8.1 By following the standard operating procedure there should be no significant

risk to health from the handling of external liquid medicinal products for the
application to patients.
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COSHH PROCEDURE 6
HANDLING OF INTERNAL LIQUID MEDICINAL PRODUCTS
1.1 Internal liquid medicinal products are dispensed from the Pharmacy
Department or local pharmacies to the wards/departments/community in
1.2 The preparations are labelled with the ‘Approved Drug Name’ (Non-
proprietary name) or the ‘Trade Name’ (Proprietary name) if a combination
preparation and any additional warning labels.
1.3 i) Internal liquid medicinal products are dispensed by pouring onto a 5 ml

medicine spoon, into a medicine measure or by means of an oral syringe
before administration to the patient, as laid down in nursing procedures.
ii) Cytotoxic mixtures/suspensions are dealt with under Procedure No. 11.
iii) Particular care should be taken when handling powdered materials such as
antibiotic syrups. Antibiotic syrups should be reconstituted in a locally
designated area (e.g. treatment room) before administering to the patient.
Refer to the Trustwide Drugs Policy.
2. Substance and Hazards
2.1 a) Internal liquid medicinal products consist of one of more drugs dissolved or
suspended in an aqueous or non-aqueous fluid.
b) Antibiotic syrups in powder form are reconstituted by the addition of

sterile water.
2.2 The ingredients of internal liquid medicinal products may include substances
which are:-

b) capable of causing sensitisation e.g. antibiotics, chlorpromazine
c) capable of causing harmful effects through repeated low levels of
exposure e.g. Cytotoxic drugs.
2.3 Data sheets are held in the Pharmacy Department on all internal liquid
medicinal products potentially hazardous to health that are currently stocked.
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a) ingestion
d) inhalation e.g. reconstitution of antibiotic syrups
e) splashing in the eye(s).
3.2 This possible risk is enhanced in the case of any untoward occurrence such
as spillage.
There are many internal liquid preparations in use e.g. ear/nose drops,
antiseptic solutions, disinfectant solutions and all carry individual instructions.
4.2 Precautions
Always read the manufacturer’s instructions before use.
Always observe the manufacturer’s precautions.
Never apply solutions (excluding drops) direct from the bottle. Always
pour a small amount into a gallipot or bowl.
Avoid ingestion.
Use gloves, apron and mask to avoid contamination of skin and clothing.
Wash off immediately any internal liquid preparations that come into contact
with the skin.
Avoid splashing into the eyes. If splashing occurs irrigate thoroughly with
Launder contaminated clothing as soon as possible.
If spillage occurs refer to the manufacturer’s instructions before cleaning up.

Dispose of any waste as per manufacturer’s instructions or the Trust Waste
Management Policy.
Cytotoxic internal liquid medicinal products are dealt with under

Procedure No. 11.
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5. Spillages
5.2 Wearing gloves and an apron any excess/spillage should be wiped up using
disposable paper towels/gauze as appropriate. Dispose of as clinical waste.
Glass/sharp items must be placed in a ‘sharps’ container. Final disposal is
by incineration.
6. Waste
6.1 Return all unused internal liquid medicinal products to the Pharmacy
Department for final disposal. Refer to the Trust Waste Disposal Policy.
6.2 Refer to the Trust Waste Management Policy.
7. First Aid
8. Conclusion
8.1 By following the standard operating procedure, there should be no

significant risk to health from the handling of internal liquid medicinal
products for dispensing purposes.
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COSHH PROCEDURE 7
HANDLING OF FORMALDEHYDE SOLUTIONS
1.1 Formaldehyde solutions required for biopsy samples must be obtained pre-
prepared.
2.1 Formaldehyde is a gas, which is supplied as an aqueous or saline solution.
2.2 The potential hazard to health in handling formaldehyde preparations may be:-
a) irritant
b) capable of causing sensitisation.
2.3 Data sheet is held in the Pharmacy Department.
3.1 In the use of formaldehyde solutions for preservation of biopsy samples etc.
there is a possible hazard to health from one or more of the following:-
a) ingestion
d) inhalation
3.2 This possible risk is enhanced in the case of any untoward occurrence such as
spillage.
Only to be used for the preparation of biopsy samples.
Always follow the manufacturer's instructions.
Always use Personal Protective Equipment when handling formaldehyde

solutions.
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4.2 Precautions
Protect against splashing by wearing gloves and apron.
Wash off under running water any solution that comes into contact with skin.
If splashing in the eyes occurs irrigate thoroughly with water for at least 10
minutes and obtain medical attention from the Accident and Emergency
Department.
Launder contaminated uniform as soon as possible.
4.3 Nursing Alert
There is a significant risk to health from the use of formaldehyde solutions.

Correct use of protective clothing and equipment will minimise the risks.
5. Spillages
5.1 If spillage occurs refer to the manufacturer’s instructions before cleaning up.
Dispose of any waste as per manufacturer’s instructions or Trust Waste
Management Policy.
6. Waste
7. First Aid
8. Conclusion
8.1 FROM A CONSIDERATON OF THE HAZARDS, THERE IS A

SIGNIFICANT RISK TO HEALTH FROM THE USE OF
FORMALDEHYE SOLUTIONS.
8.2 THE CORRECT USE OF PERSONAL PROTECTIVE EQUIPMENT

WILL MINIMISE THE RISKS ASSOCIATED WITH THE HANDLING
OF FORMALDEHYDE SOLUTIONS.
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COSHH PROCEDURE 8
HANDLING OF INJECTABLE MEDICINAL PRODUCTS
1.1 Injections/infusions are dispensed from the Pharmacy Department and local
pharmacies to wards/departments in labelled containers, or specifically from
local dispensing chemists for identified clients.
1.2 Injections are labelled with the ‘Approved Drug Name’ (Non-proprietary
Name) or the ‘Trade Name’ (Proprietary Name) if a combination product, with
any additional warning labels e.g. ‘CYTOTOXIC DRUGS’.
2.1 Injectable products consist of solutions or emulsions in water or other suitable

vehicle, or as powders for reconstitution.
2.2 The ingredients of injectable products may include substances which are:-
a) potent/toxic e.g. steroid, alkaloidal salts such as those of atropine

and morphine
b) caustic e.g. phenol
c) irritant e.g. paraldehyde
d) capable of causing sensitisation e.g. antibiotics, chlorpromazine
e) capable of causing harmful effects through repeated low levels of
exposure e.g. cytotoxic drugs.
2.3 Data sheets are held in the Pharmacy Department on all injections potentially
hazardous to health that are currently stocked.

c) inhalation
d) splashing in the eye(s)
e) injection through the skin
4.1 Direction for use
There are many different types of injectable products each with their own
precautions.
ALWAYS FOLLOW MANUFACTUERS INSTRUCTIONS BEFORE

ADMINISTERING ANY INJECTABLE PRODUCT.
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4.2 Precautions
Avoid ingestion/inhalation/splashing in the eyes by wearing protective

clothing and equipment e.g. face mask (where appropriate), goggles, gloves
and an apron.
Wash off under running water any solution that comes into contact with the
skin.
If splashing in the eyes occurs irrigate thoroughly with water for a least 10
minutes and obtain medical attention
If accidental injection occurs, SEEK URGENT MEDICAL HELP.
5. Spillages
Dispose of any waste as per manufacturer’s instructions or Trust Waste
Management Policy. Where a spillage kit is available, use to clear up spillage.
6. Waste
6.1 Used ‘sharps’ must be placed in a ‘sharps’ container for disposal. Unused
injectable medicinal products must be placed in a ‘sharps’ container for
disposal.
7. First Aid
8. Conclusion

risk to health from the handling of injectable medicinal products.
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COSHH PROCEDURE 9
HANDLING OF VACCINES
1.1 The supplier or wholesaler delivers vaccines direct to the Health Centre or
Clinic.
2.1 Vaccines are preparations of antigenic materials in solution, suspensions or

freeze dried states.
2.2 Vaccines are either viral or bacterial in origin and consist of:-
a) Live vaccines prepared from attenuated forms of an active agent
(i) live viral vaccines e.g. measles, rubella, rabies, polio

(ii) live bacterial vaccines e.g. BCG.
b) Inactivated vaccines prepared from killed organisms
(i) inactivated viral vaccines e.g. influenza

(ii) inactivated bacterial vaccines e.g. typhoid.
c) Vaccines prepared from extract of or detoxified exotoxins produced

by micro-organisms
(i) bacterial toxoid e.g. diphtheria, tetanus.
2.3 The ingredients of vaccines may include substances which are:-
a) irritant
2.4 Data sheets are held in the Pharmacy Department on all injections
potentially hazardous to health that are currently stocked.
3.1 Provided manufacturer’s data sheet recommendations for administration are

followed together with COSHH Procedure 8 ‘Handling of Injectable
Medicinal Products’, there should be no risk to staff.
3.2 A possible risk to health arises in the case of breakage or leakage of

container, accidental spillage or accidental injection. The risk may arise
from:-
a) contact with the skin or eyes
d) inhalation
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e) injection
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3.2.1 If splashing the eye(s) occurs irrigate with large volumes of water for at
least 10 minutes.
Immediate medical advice should be sought.
The nursing staff must wash off immediately any constituent of injections that
come into contact with the skin.
3.2.2 To minimise the risk of inhalation the clinical procedures for

administration of injections must be strictly adhered to.
3.2.3 Vaccines MUST NOT be stored in domestic fridges along with

foodstuffs. They MUST BE stored in a secure drugs fridge between 2 and 80c.
4.2 Precautions
Refer to COSHH Procedure 8 ‘Handling of Injectable Medicinal Products.’
Protect from splashing by wearing gloves and apron.
Wash off under running water any solution that comes into contact with the
skin.
If splashing in the eyes occurs irrigate thoroughly with water for at least 10
minutes and obtain medical attention
If accidental injection occurs, SEEK URGENT MEDICAL HELP.
Launder contaminated uniform as soon as possible following the prescribed

procedure i.e. temperature?
5. Spillages
5.1 In the case of accidental spillage nursing staff must wear disposable gloves and
apron before soaking up the spillage on suitably absorbent paper - the area
should be washed down with a 1 in 10,000 solution of sodium hypochlorite
(i.e. 1 x 1.8gm Haz-tab to 1 litre of water). The soiled absorbent paper should
be placed in a suitable container and sent for incineration.
5.3 Refer to Immunisation Against Infectious Diseases 1996.
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6. Waste
6.1 Used ‘sharps’ must be placed in a ‘sharps’ container for disposal. Unused
vaccine products must be placed in a ‘sharps’ container for disposal.
7. First Aid
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COSHH PROCEDURE 10
HANDLING OF PHENOLIC DISINFECTANT
1.1 Phenolic Disinfectant is issued from the Pharmacy Department.
2.1 Phenolic Disinfectant is a solution of phenol in water.
2.2 If the original container is broken or the product is used inappropriately/

incorrectly the potential hazards to health may be:-
a) caustic
2.3 A data sheet is held in the Pharmacy Department.
3.1 There is no risk to health from the normal handling of Phenolic Disinfectant in
its original container.
3.2 A possible risk to health arises only in the case of breakage of leakage from
the container or improper use of the product.
The risk may arise from:-
a) ingestion
d) inhalation
Always follow the manufacturer’s instructions.
4.2 Precautions
Storage - closed containers, protect from light.
Never apply solutions (excluding drops) direct from the bottle. Always pour a
small amount into a gallipot or bowl.
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Avoid ingestion by wearing a facemask.
Use in a well-ventilated area.
Use gloves, apron and mask to avoid contamination of skin and uniform.
Wash off immediately any external liquid preparations that come into contact
with the skin.
Avoid splashing into the eyes. If splashing occurs, irrigate thoroughly with
5. Spillages
Dispose of any waste as per manufacturer’s instructions or the Trust Waste
Management Policy.
6. Waste
6.1 Refer to Trust Waste Management Policy.
7. First Aid
8. Conclusion
From a consideration of the hazards, there is a risk to health from the use
of Phenolic Disinfectants.
The correct handling and use of personal protective equipment will

minimise the risk associated with the handling of Phenolic Disinfectants.
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COSHH PROCEDURE 11
CYTOTOXIC DRUGS
TABLETS AND CAPSULES
Refer also to the Clinical Procedures Manual Ref. CWI 1.5
This procedure covers the care components for usage of these products. For detailed
information on each individual drug see the specific drug literature available from the
1.1 Cytotoxic drugs are cytotoxic and mutagenic.
1.2 Cytotoxic drugs will be dispensed from the Pharmacy Department, in an

appropriate container and will have an additional warning label stating
‘Cytotoxic Drugs’.
2. Substance and Hazard
2.1 Oral dosage forms of cytotoxic drugs are supplied as tablets or capsules.
Tablets may or may not be film coated, capsules may be mono-component or
bi-component, soft or hard gelatin. These may be supplied loose or in blister
packs.
2.2 The potential hazard associated with intact tablets and capsules is negligible if
handled correctly. However, incorrect handling can lead to exposure of the
skin or inhalation of powder from capsules with possible absorption of
cytotoxic and mutagenic substances.
2.3 Should tablets or capsules become damaged then the exposure risk increases
significantly. Damaged capsules/tablets may liberate a spray or pool of liquid
(aerosol/capsule hazard) or liberation of powder, which may be inhaled
leading to systemic absorption of a drug as well as local contamination of skin
and eyes. A single exposure probably would not have significant risk associated
with it, unless the eyes were involved. Repeated exposure is a considerable
risk.
3.1 Cytotoxic drugs are capable of causing harmful effects through repeated low
levels of exposure via:-

b) absorption through the skin.
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There are many types of cytotoxic oral preparations.
ALWAYS READ MANUFACTURER’S INSTRUCTIONS BEFORE USING.
See directions on ordinary tablets.
4.2 Precautions
Use a none-touch technique when administering.
Treat spillage according to the manufacturer's instructions or Trust Waste

Management Policy.
Use disposable gloves or tweezers when picking up spilled tablets.
Pregnant staff should not handle cytotoxic drugs.
Counting trays must be washed thoroughly immediately after use (before using
for any other preparation).
5. Spillages
5.1 A cytotoxic spillage kit must be used for any liquid spillages.
6. Waste
6.1 Unused cytotoxic drugs must be placed in a cytotoxic container for disposal.
(Refer to Trustwide Drugs Administration Policy).
7. First Aid
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COSHH PROCEDURE 12
CYTOTOXIC DRUGS
INJECTABLE PRODUCTS
Refer also to the Clinical Procedures Manual Ref. CWI 1.5
This assessment covers the care components for usage of these products. For detailed
information on each individual drug see the specific drug literature available from the
1.1 Cytotoxic drugs are cytotoxic and mutagenic.
1.2 Cytotoxic drugs will be dispensed from the Pharmacy Department, ready
prepared and in an appropriate container and will have an additional warning
label stating ‘Cytotoxic Drugs’.
2. Substance and Hazard
2.1 Injectable products consist of solutions or emulsions.
2.2 The ingredients of injectable cytotoxic products may include substances which
are:-
a) potent/toxic such as alkylating drugs, cytotoxic antibiotics,

antinmetabolites, vinca alkaloids and other antineoplastic drugs.
3.1 Cytotoxic injectable products are capable of causing harmful effects through
repeated low levels of exposure via:-

c) inhalation
d) splashing in the eyes
e) injection through the skin
4.1 Direction for use
When it is necessary for nurses to administer such drugs in the community

setting, then the nurse must be in possession of a Certificate of Competence in
the preparation and administration of cytotoxic injectable products.
4.2 Precautions
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Always follow the manufacturer’s instructions before using such preparations.
The doctor or nurse administering such drugs must wear latex, or latex-free
gloves, mask and goggles.
When administering such drugs in the patient’s home then plastic sheeting
must be used as a precaution to contain any spillages.
Pregnant staff should not handle cytotoxic drugs.
Management of Spillages
1. Act immediately.
2. Use spillage kit and follow instructions supplied with kit.
3. Put on double latex or latex-free gloves and disposable apron.
4. If spillage is on hard floor put on plastic overshoes.
5. Wipe up powder spillage quickly with well-dampened paper towels

and dispose of them as high-risk waste.
6. Mop up liquid spillage quickly using dry paper towels and dispose of
them as high-risk waste.
7. Wash hard surfaces well with copious amounts of cold, soapy water
and dry with paper towels. Dispose of the towels as high-risk waste.
8. If spillage is on clothing or bed linen, remove it as soon as possible and

treat as soiled linen.
9. If spillage has penetrated clothing, wash contaminated skin liberally

with soap and cold water.
10. Any accident or spillage involving direct skin contact with a cytotoxic
drug for nurses or doctors must be reported to the Occupational Health
Department.
11. Report on a Trust incident Form.
5. Spillages in the patients home
5.1 If the spillage occurs in the patient’s home, then the nurse must use the
spillage kit supplied following the instructions.
6. Waste
6.1 Unused Cytotoxic drugs must be placed in a cytotoxic container for disposal.
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6.2 Disposal of waste
Contaminated plastic sheeting must be placed in waste disposal bags found in

the spillage kit.
‘Sharps’, IV sets and other relevant tubing must be placed in a ‘sharps’

container and disposed of according to the Hospital Policy.
Part doses of drug solutions may be flushed down the main drainage system in
the patients home using copious amount of water.
Unused doses of cytotoxic drugs must be placed in a cytotoxic container for

disposal.
Latex or latex-free gloves should be worn when disposing of excreta from

patients receiving cytotoxic drugs.
7. First Aid
8. Conclusion
From a consideration of the hazards, there is a risk to health from the handling
of injections/infusions containing cytotoxic drugs. The correct use of personal
protective equipment will minimise the risks.
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COSHH PROCEDURE 13
HANDLING OF BODY FLUIDS
1.1 Blood, urine, faeces, vomit, joint fluid, amniotic fluid, CSF, liquar, breast
milk, saliva, serous fluid and other body fluids.
1.2 Body fluids may contain pathogenic micro-organisms that are capable of
causing ill health.
2.1 All blood should be considered high risk and potentially contaminated with
micro-organisms.
2.2 Other body fluids should also be considered as potentially contaminated with
micro-organisms and treated accordingly.
3.1 When performing nursing duties, contact with blood and body fluids may
occur. There is a possible risk of micro-organisms being transmitted
according to the nature of the fluid and extent of the exposure. Exposure may
occur from one or more of the following:-
a) absorption through broken skin

b) needlestick or any other penetrating injury
c) splashing in the eye(s)
d) absorption through mucous membranes
e) inhalation may occur if the fluids become an aerosol
f) ingestion.
3.2 The risk is increased in the case of any untoward occurrence, e.g. spillage or
haemorrhage.
4. Incidents
4.1 Report all incidents on a Trust incident Form.
5.1 When contact with blood or body fluids is anticipated gloves and plastic apron
should be worn.
5.2 Open lesions on the skin must be covered with waterproof dressings.
5.3 Staff with open and severe dermatitis should avoid contact with blood and
body fluids.
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5.4 Hands and other skin contact must be washed and dried thoroughly following
each patient or blood and body fluid contact. Handwashing facilities are
provided and alcohol hand rub is available to all community staff.
5.5 If splashing into the face is likely, eye and mouth protection should be worn.
5.6 In order to prevent aerosol of body fluids and subsequent inhalation or

ingestion, fluids must be disposed of carefully and in the appropriate manner
as directed by Trust procedures.
5.7 Needles must not be resheathed unless absolutely essential then a resheathing
device must be used.
5.8 All sharp instruments/objects must be handled with extreme care in order to
prevent punctures of the skin.
5.9 Sharp objects and needles must be disposed of safely into the designated
sharps container following the waste disposal policy.
5.10 Waste contaminated with body fluids is classified as clinical waste and must
be disposed of carefully following the waste disposal policy.
5.11 Linen soiled with body fluids must be held away from the body and bagged
according to the laundry code.
5.12 Specimens must be handled with care in order to prevent contamination of the
outside of the container. Containers must be separated from the card and
transported in plastic sealed wallets. Specimens must then be transported to
the laboratories in a sound rigid container, which can easily be disinfected.
5.13 Specimens from the patients with a category three pathogen must be labelled
with a yellow sticker bearing black writing to read “Danger of Infection”.
5.14 Equipment contaminated with body fluids must be adequately cleaned and
disinfected.
5.15 Equipment requiring service or repair must be accompanied by a

decontamination certificate.
5.16 Spillages of body fluids must be cleaned with the appropriate cleaning
agent/disinfectant.
5.17 Blood spillage’s must be dealt with immediately and treated according to the
extent of the spillage, using the blood spillage kit and the relevant guidance.
5.18 If splashing in the eyes occurs, they should be washed out with copious
amounts of water following the first aid guidelines. Report the incident.
5.19 Should an accidental injury with a contaminated sharp object or needle occur,
encourage the wound to bleed, wash thoroughly but do not scrub, and follow
the needle injury procedure. Report the incident.
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6. CONCLUSION
From a consideration of the hazards, blood carries a higher risk although other body
fluids must also be considered potentially infectious.
The correct use of procedures and implementation of the control measures will
minimise the risk.
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COSHH PROCEDURE 14
HANDLING OF CONTAMINATED NEEDLES AND SYRINGES

AND OTHER SHARP IMPLEMENTS
1.1 Contaminated needles, blades, sharp instruments, trochar cannulas, any other
sharp implement, which may puncture the skin.
1.2 Sharp implements that are contaminated with body fluids may transmit micro-
organisms if allowed to puncture the skin and contamination with the contents
of the syringe may occur e.g. cytotoxic drugs.
1.1 and 1.2 will hereafter be referred to as ‘sharps’.
1.3 Used and contaminated syringes.
2.1 All contaminated ‘sharps’ and syringes must be considered high risk and
potentially contaminated with micro-organisms.
3.1 Handling ‘sharps’ and syringes poses a risk to health, depending on the extent
of the exposure.
3.2 Exposure is considered when an accidental percutaneous injury with a

contaminated needle or ‘sharps’ occurs.
3.3 Risk will be increased when a ‘sharps’ container is accidentally spilled or

when the control measures are not followed.
4.1 Needles should not be re-sheathed.
4.2 Blades should not be detached from the handle. If it is essential to remove the
blade a protective device must be used. On no account should blades be
removed by hand.
4.3 ‘Sharps’ must be handled with great care at all times. Should it be necessary
to pick up a ‘sharp’, wear gloves and always approach from the blunt end and
dispose of immediately into a designated ‘sharps’ container.
4.4 Never carry ‘sharps’ in the hand. Dispose of immediately into a designated
‘sharps’ container.
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4.5 Only designated Trust approved ‘sharps’ containers can be used. They must
meet the British Safety Standard.
4.6 For ‘sharps’ containers to fulfil their function, it is essential that they are
correctly assembled. Follow the direction of the manufacturer.
4.7 ‘Sharps’ containers must not be filled more than ¾ full. Once this level has
been reached, seal and dispose of according to the Trust Waste Management
Policy.
4.8 ‘Sharps’ containers must only be carried using the handle and must be kept
away from the body.
4.9 On no account must items be forced into a ‘sharps’ container.
4.10 Tape must not be applied to ‘sharps’ containers. This procedure will
significantly increase the risk of accidental exposure to sharp objects.
4.11 Should an accidental injury with a contaminated ‘sharp’ occur, encourage the
wound to bleed, wash the area thoroughly but do not scrub, cover the wound
and follow the needlestick exposure injury procedure.
4.12 Report the incident on the Trust incident Form.
5. Spillages
5.1 Should a container spill its contents then the accidental spillage procedure in
the Waste Disposal Policy must be followed. The incident must be reported
appropriately and an incident form completed (incident Form).
5.2 It there is any possibility of waste leaking the container must be placed into a
larger ‘sharps’ container and carefully sealed.
6. Waste
Refer to the Trust Waste Management Policy.
7. First Aid
7.1 Follow the Trustwide procedure regarding needlestick exposure injury.
8. Conclusion
Inappropriate handling of ‘sharps’ is a significant risk to the Health Care

Worker and others.
The correct use of procedures and implementation of the control measures will
minimise the risk.
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REFERENCES
Trustwide Accident and Incident Policy.
Trustwide Administration of Drugs Policy.
Trustwide Waste Management Policy.
Immunisation Against Infectious Diseases (Green Book) 1996.
Trustwide Infection Control Manual.
Chemicals (Hazard Information and Packaging for Supply).
Control Of Substances Hazardous to Health Regulations 1999.
The Chemical Incident Management Book. Chemical Incident Response

Service, Medical Toxicology Unit, Guy’s & St. Thomas’ Hospital Trust. 2000
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COSHH Nursing Procedure

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BARNSLEY PRIMARY CARE TRUST

The Control of Substances Hazardous to Health Regulations 1999

Chemicals, Handling of Medicinal Drugs

Sue Wing/COSHH Team

FIRST AID SUMMARY OF STANDARD TREATMENTS 6

CONTROL OF SUBTANCES HAZARDOUS TO HEALTH (COSHH)

What is Hazardous under COSHH within the Nursing Services

Toxic or Very Toxic Harmful or Irritant Corrosive

Explosive Highly or Extremely Flammable Oxidising

1.a) a hazardous situation that

Dangerous for the Environment Bio Hazard

2. Any substance with a Maximum Exposure limit (MEL) or Occupational

Splashes of the eye

3. A doctor should see all eye injuries (from chemicals). Supply

4. Report using the Trust incident Form.

Splashes of the skin

2. Remove all contaminated clothing, taking care not to contaminate yourself in

3. If the situation warrants it obtain medical advice. Provide information on the

4. Report using the Trust incident Form.

Ingestion of poisonous substances

3. Do not induce vomiting as a first aid procedure.

4. Arrange for transport to the Accident & Emergency Department. Provide

5. Report using the Trust incident Form.

3. If the casualty is unconscious place in recovery position, ensuring the

4. If breathing has stopped, apply artificial respiration taking precautions not to

6. Report using the Trust incident Form.

Definition of a Substance Hazardous to Health

Any substance (including any preparation) which is:-

specified in schedule 1 of COSHH, which lists substances assigned maximum

a biological agent (any micro organism, cell culture, or human endoparasite,

dust of any kind, when present at substantial concentrations in air.

1.1 Aerosols (including inhalers, nasal aerosols, etc) dispensed to the

2. Substances and Hazards

2.1 Aerosol preparations consist of a solution or a suspension of a drug in a

a) potent/toxic e.g. steroids

3.1 Potential risks to health are associated with:-

a) contact with the skin

4. Standard Operating Procedure

4.2 Directions for use

4.3 For all aerosols

Use in a well-ventilated area.

Avoid inhalation of side spray whilst administering drugs to patients.

Avoid spraying into your eyes.

Keep aerosols away from naked flames.

Pressurised containers - protect from sunlight.

Do not pierce or burn even when empty.

4.5 FOR AEROSOLS OTHER THAN INHALERS:

5.1 Leaking Aerosol preparations MUST be immediately returned to the Pharmacy

5.2 Report using a Trust incident Form.

6.1 Refer to Trust Waste Management Policy

1.1 Capsules/lozenges/tablets are dispensed from the Pharmacy Department to the

1.2 Capsules/lozenges/tablets are labelled with the ‘Approve Drug Name’ or

N.B Excludes penicillin-based drugs or powdery tablets

2. Substances and Hazards

2.1 Capsules/lozenges/tablets contain medicinal substances, together with various

a) potent/toxic e.g. steroids

3.1 Potential risks to health are associated with:-

4.1 Directions for use

Capsules/lozenges and tablets must not be handled directly by nursing staff.

Report on a Trust incident Form.

6.2 Refer to Trust Waste Management Policy

(see First Aid section)

By following the standard operating procedure, there should be no significant

1.1 Creams/ointments/pastes are dispensed to the wards/departments in