Adherence to Safe Handling Guidelines by Health Care Workers Who Administer Antineoplastic Drugs

Abstract

The toxicity of antineoplastic drugs is well documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE), and barriers to using PPE, the National Institute for Safety and Health (NIOSH) conducted a web survey of health care workers in 2011. The study population primarily included members of professional practice organizations representing health care occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers, and physician offices, respondents reported that they had collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide, and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic drug by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic drug during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was “skin exposure was minimal”; 4% of respondents, however, reported skin contact during handling and administration. Despite the longstanding availability of safe handling guidance, recommended practices are not always followed, underscoring the importance of training and education for employers and workers.

Cytotoxic Drugs Safety Guidelines: Its Effect on Awareness and Safe Handling Practices of Oncology Nurses

“…This result is in accordance with Boiano, Steege and Sweeney, (2014) [24] who stated that recommended practices are not always followed, despite the availability of safety guidelines developed by professional practice organizations in their study that titled "adherence to safe handling guidelines by health care workers who administer antineoplastic drugs". In addition, VerStrate, (2015) [25] reported that although the toxicity of chemotherapeutic agents is well documented, the nurses that participated in the survey reported a low overall use of safety precautions when administering chemotherapy in his study that titled "exploration of chemotherapy safe-handling practices and identification of knowledge deficits among oncology nurses in the ambulatory care setting".…”

Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey

“…Because of recommended practices are not always followed, training and education for health care workers are required [34,35]. Training is essential both in terms of risk awareness and the appropriate response to exposure [36].…”

Causes of Health Care Workers’ Exposure to Antineoplastic Drugs: An Exploratory Study

“…27 Participants' responses suggested that such equipment was not always used, a finding that is consistent with other studies, which have concluded that health care workers' compliance with gloves and other personal protective equipment is inadequate. 18,30,31 One limitation of this study was that full identification of all contributing causes was not possible from participants' responses. In most cases, participants would not be aware of the less-visible factors that fall under the purview of an organization's management team, including organization-wide policies and procedures that concern training for safe drug handling and hazard notification (i.e., warning of the presence of antineoplastic drugs), which would have been beneficial to prevent some of the exposure incidents.…”