An estimated 8 million oncology healthcare practitioners in the United States are potentially exposed to hazardous drugs, most of which are antineoplastic drugs. Health risks associated with occupational exposure to these life-saving drugs include increased risk of leukemia and other cancers, and adverse reproductive outcomes. National safe handling guidelines have been available since the mid 1980’s when health risks first became a recognized health and safety concern. This presentation describes precautionary practices to minimize risk of exposure to antineoplastic drugs during compounding and administration activities.
METHODS:
Two modules of the web-based NIOSH Health and Safety Practices Survey of Healthcare Workers were targeted to members of professional practice organizations: one to pharmacists, pharmacy technicians and oncology nurses who compound antineoplastic drugs and the other to oncology, hematology/oncology and infusion nurses who administer them. Respondents who reported that they compounded or administered antineoplastic drugs in the past seven days prior to the survey were eligible to complete these modules.
RESULTS:
The modules on compounding (C) and administration (A) were completed by 424 and 2069 respondents, respectively. Findings show lack of universal adherence to precautionary guidelines and other best practices by employers and oncology practitioners. Examples of practices which increase exposure risk, expressed as percent of respondents, included: not always wearing double chemotherapy gloves (68%-C; 80%-A), not always wearing non-absorbent gown with closed front and tight cuffs (30%-C; 42%-A); priming intravenous tubing with antineoplastic agent (8%-C; 6%-A); potentially contaminated clothing taken home (17%-C; 12%-A); lack of hazard awareness training (11%-C; 4%-A); lack of safe handling procedures (16%-C; 6%-A), and absence of a medical surveillance program (75%-C; 77%-A). The most common reasons for not wearing gloves or gowns was “skin exposure was minimal” or “not part of our protocol”; however, 8% of respondents who compounded and 4% who administered antineoplastic drugs reported skin contact. Reasons for not wearing protective gloves and gowns suggest a mindset that incidental skin contact is acceptable and part of the job.
CONCLUSIONS: Despite the longstanding availability of national guidelines on safe handling of antineoplastic drugs, recommended practices are not always followed by employers and oncology practitioners. This is highly noteworthy since there is no safe level of exposure to antineoplastic drugs. Better risk communication is needed to ensure that employers and healthcare workers are fully aware of the hazards and precautionary measures to minimize exposure to these highly toxic drugs