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Risk In today’s cancer care settings, safety as it relates to antineoplastic drugs primarily addresses patient safety. Beardwood and Kainer contend that “professional risk in nursing practice is seldom discussed” and has yet to be recognized as a problem.21 The American Nurses Association Code of Ethics for Nurses Provision 5 maintains that nurses owe “the same duties to self as to others,” including the responsibility to promote health and safety.22 Minimizing risk to health care workers is nurses’ responsibility.22 Further, “nurses should model …[avoidance of] unnecessary risks to health or safety in the course of their professional and personal activities.”22 Put simply, minimizing risks associated with exposure to antineoplastic drugs is a nursing duty.

State-of-the-science protection Hazardous drug containment and worker safety must be a primary concern in cancer care settings. Although nurses have not always been involved in product evaluation, selection, and purchasing decisions, nurses must demand an official seat at the table when hazardous drug safety devices are considered. Some experts indicate that use of CSTDs in compounding and administration processes is no longer optional. Instead, organizational resources should be directed toward identifying the CSTD best suited for that setting, and developing, implementing, and monitoring of safety devices to ensure workplace safety.

Medical surveillance Health care workers exposed to infectious diseases and radiation are routinely monitored in the workplace. Although NIOSH recommends medical surveillance of health care workers who prepare, administer, transport, and dispose of hazardous drugs, these measures are not required or practiced in most health care settings. Recommended elements of a medical surveillance program include collection of workers’ medical, reproductive, and occupational history, physical examination, laboratory studies, and biological monitoring.13 Polovich and Clark advocate implementation of a registry of data connecting nurses’ exposure history and health outcomes.16 Without data on occupational exposure to hazardous drugs, its true impact remains unknown.16

Pamela Haylock is an adjunct faculty for the Online RN to BSN Program at Schreiner University in Kerrville, Texas, and chairs Equashield‘s Nurse Advisory Council, which seeks to develop strategies to increases nurses’ awareness of issues around occupational exposure to hazardous drugs. She is a past president of the Oncology Nursing Society. 


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2. Connor TH, Lawson CC, Polovich M, McDiarmid MA. Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. J Occup Environ Med. 2014;56(9):901-910.

3. Lawson CC, Rocheleau CM, Whelan EA, et al. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol. 2012;206(4):327.e1-328.

4. Oncology Nursing Society, American Society of Clinical Oncology, Hematology/Oncology Pharmacy Association. Ensuring healthcare worker safety when handling hazardous drugs. Oncology Nursing Society Web site. Accessed September 2, 2015.

5. Neuss MN, Polovich M, McNiff K, et al. 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. Oncol Nurs Forum. 2013;40(3):225-233.

6. Polovich M, ed. Safe Handling of Hazardous Drugs. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2011.

7. National Institute for Occupational Safety and Health, US Department of Health and Human Services. Preventing Occupational Ex­posures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Cincinnati, OH: Department of Health and Human Services; 2004. DHHS (NIOSH) publication 2004-165. Accessed September 2, 2015.

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10. Friese CR, McArdle C, Zhao T, et al. Antineoplastic drug exposure in an ambulatory setting: a pilot study. Cancer Nurs. 2015;38(2):111-117.

11. Davis J, McLauchlan R, Connor TH. Exposure to hazardous drugs in healthcare: an issue that will not go away. J Oncol Pharm Pract. 2011;17(1):9-13.

12. Friese CR, Himes-Ferris L, Frasier MN, et al. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf. 2012;21(9):753-759.

13. National Institute for Occupational Safety and Health, US Department of Health and Human Services. Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs. Cincinnati, OH: De­partment of Health and Human Services; 2012. DHHS (NIOSH) publication No. 2013-103 (Supersedes 2007-117).

14. Hon CY, Teschke K, Chua P, et al. Occupational exposure to antineoplastic drugs: identification of job categories potentially exposed throughout the hospital medication system. Saf Health Work. 2011;2(3):273-281.

15. Teschke K, Chu W. Healthcare Workers and Antineoplastic Drugs: Identifying the Determinants of Exposure and Current Challenges to Reducing Exposure. Richmond, BC, Canada: WorkSafe BC; 2012. Project RS2008-OG01.

16. Polovich M, Clark PC. Factors influencing oncology nurses’ use of hazardous drug safe-handling precautions. Oncol Nurs Forum. 2012;39(3):E299-E309.

17. Connor TH. Safe handling of hazardous drugs. CDC Centers for Disease Control and Prevention Web site. Posted May 21, 2014. Accessed September 2, 2015.

18. Berdi F, Powell MF, Sanz C, et al. Assessing the efficiency of CSTDs for compounding. 2015;12(7):4. Pharm Purchasing Prod. 2015;12(7):4. Accessed September 2, 2015.

19.  Clark BA, Sessink PJ. Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents. J Oncol Pharm Pract. 2013;19(2):99-104.

20. Smith ST, Slaczky MC. Syringe plunger contamination by hazardous drugs: a comparative study. J Oncol Pharm Pract. 2014;20(5):381-385. Accessed September 2, 2015.

21. Beardwood BA, Kainer JM. Exploring risk in professional nursing practice: an analysis of work refusal and professional risk. Nurs Inq. 2015;22(1):50-63.

22. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: American Nurses Association; 2015.