We use a closed system at our facility, except for connecting the BCG tubing to the catheter. What is the proper procedure for handling BCG waste? Does the room need to be closed off after instilling the drug into the bladder? If so, for how long?  — Name withheld on request

Bacillus Calmette-Guérin (BCG) waste should be handled as biohazardous waste, including the use of personal protective equipment when handling any parts of BCG as it is a live, attenuated mycobacteria.

Given that there have been reports of nosocomial infections reported in patients receiving parenteral drugs that were prepared in areas where BCG was reconstituted, best practices would agree to close off the room where BCG has been administered. Patients retain the BCG in their bladder for 2 hours after instillation then they void.

This is an infectious agent that can infect others. Patients are even instructed to disinfect voided urine with an equal volume of bleach for 15 minutes before flushing for the first 6 to 8 hours after instillation.1 Most institutions close off the room for 8 hours a day and that is inclusive of pre- and postprocedure.

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The US Food and Drug Administration (FDA)’s recommendations are that of standard safe handling practices without specific references of closing of areas of treatment. However, given the nature of this drug most institutions close off the area of BCG administration. 

Reference

1. Tice® BCG Live [package insert]. Roseland, NJ: Organon USA Inc; 2009. https://www.fda.gov/media/76396/download. Accessed August 23, 2019.