Unintentional chemotherapy exposure is substantial among oncology nurses

A survey completed by approximately 400 oncology nurses practicing in ambulatory settings indicated that 16.9% had had their skin or eyes exposed to the toxic drugs they deliver.

In a University of Michigan Health System statement describing the survey findings, lead study author Christopher R. Friese, RN, PhD, noted that although any unintentional chemotherapy exposure to the skin or eyes could be just as dangerous as a needlestick, protocols for such incidents fall far short of the response seen with needlesticks.

“We have minimized needlestick incidents so that they are rare events that elicit a robust response from administrators; nurses go immediately for evaluation and prophylactic treatment,” observed Friese, an assistant professor at the University of Michigan (Ann Arbor) School of Nursing. “But we don't do that with chemotherapy exposure.”

One obstacle may be that whereas a needlestick puts the health care worker at risk for a specific virus that can be fought with specific treatments, chemotherapy exposure isn't as easily linked to a direct health effect. (Such exposure can affect the nervous system, impair the reproductive system, and increase the risk for blood cancers.) Thus, health care systems have a more difficult time responding to such episodes.

The survey was sent to 1,339 outpatient oncology nurses in one state, garnering a response rate of 30.4%. The results—reported online by BMJ Quality & Safety—showed the likelihood of exposure decreased in settings with adequate staffing and resources and when chemotherapy doses were verified by two nurses on a frequent or very frequent basis.

According to the statement, about 84% of chemotherapy is delivered in outpatient settings, largely by nurses. The National Institute for Occupational Safety and Health and other organizations have issued safety guidelines for chemotherapy drug administration, but the recommendations set forth for using gowns, gloves, and other protective gear while handling chemotherapy agents are not mandatory.

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