Better adherence to guidelines for safe handling of antineoplastic drugs is needed

Recommended safe handling practices for workers who administer antineoplastic drugs in health care settings are not always followed, according to a new study.

Researchers affiliated with the National Institute for Occupational Safety and Health (NIOSH) used data from the 2011 Health and Safety Practices Survey of Healthcare Workers. This is the largest federally sponsored survey of health care workers in the United States, and it addresses safety and health practices relative to the use of hazardous chemicals.

This paper, published in the Journal of Occupational and Environmental Hygiene (2014; doi:10.1080/15459624.2014.916809), presented findings on current administrative and engineering control practices, use of personal protective equipment (PPE), and barriers to using recommended PPE during administration of antineoplastic drugs. These findings came from a survey of nearly 2,100 oncology nurses and other health care personnel who completed a module addressing antineoplastic drug administration.

“Chemotherapy drugs save lives of cancer patients but also can result in adverse health outcomes in workers who are exposed to these drugs, including cancer, reproductive problems, and organ damage when recommended safe handling guidelines are not followed,” said NIOSH Director John Howard, MD. “Safeguarding health care workers from potential occupational hazards is an essential part of providing good jobs for these dedicated women and men, and furthering high-quality patient care.”

Findings suggest that best practices are not always used, and the researchers stated several examples. Among the respondents, 805 of the health care workers reported not always wearing two pairs of chemotherapy gloves, and 15% did not wear even a single pair. Failure to always wear nonabsorbent gown with closed front and tight-fitting cuffs was reported by 42% of workers. Furthermore, 6% reported priming intravenous tubing with antineoplastic drug instead of a nondrug containing liquid, and 12% reported that the pharmacy department had primed IV tubing that way.

The survey also found that 12% had taken potentially contaminated clothing home, 12% had experienced spill or leak of an antineoplastic drug during administration, 4% lacked hazard awareness training, and 4% had skin contact with an antineoplastic drug.

Despite the longstanding availability of authoritative safe handling guidelines (ASHP, NIOSH, ONS, OSHA), recommended exposure controls were not always used. According to NIOSH, this is highly noteworthy considering that there is no safe level of exposure to cancer-causing agents. Reported barriers to using PPE suggest that there is a perception that exposures are inconsequential or so rare that employers or workers feel PPE use is not justified.

The researchers concluded that better risk communication is needed to ensure that employers and employees are fully aware of the hazards and the availability of precautionary measures to minimize exposures. Commitment from all levels in the health care organization is essential to adequately protect workers from one of the most toxic classes of chemical agents used in health care.

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