Although chemotherapy drugs can be lifesaving for patients with cancer, they can be toxic to nurses and other health care personnel who handle them. Nurses should protect themselves through the use of proper handling techniques. A regular review of safe chemotherapy drug handling practices and evaluation of the effectiveness of housekeeping can ensure the safety of patients and clinic employees. The National Institute for Occupational Safety and Health (NIOSH), a part of the Centers for Disease Control and Prevention (CDC), investigates possible workplace health hazards by conducting a health hazard evaluation (HHE). Employees, employers, or union representatives can request an HHE of their workplace to investigate health and safety concerns. 


The NIOSH team contacts the requestor and discusses the problems and possible solutions. This discussion may result in NIOSH sending the requestor information, referring the requestor to a more appropriate agency, or making a site visit (which may include environmental sampling and medical testing). If NIOSH makes a site visit, the clinic receives a report that includes recommendations specific to the issues identified in the site visit, as well as general guidance for following good occupational health practices. 


As an oncology nurse, you may be exposed to chemotherapy drugs through direct skin contact, skin absorption, a needlestick or sharps injury, unintentional ingestion from hand-to-mouth contact, or inhalation.1,2 Inhalation and skin exposure can occur during preparation, administration, or disposal of chemotherapy drugs, or by touching contaminated surfaces. Workplace exposures to chemotherapy drugs may cause acute health effects including hair loss, headache, acute irritation, and/or hypersensitivity.3,4 Studies have also found reproductive effects (eg, increased fetal loss, congenital malformations and abnormalities, low birth weight, infertility) resulting from workplace exposures to chemotherapy drugs.5,6 Finally, an increased risk of genotoxic and carcinogenic effects has been demonstrated in health care workers, and the International Agency for Research on Cancer identified some chemotherapy drugs as group 1 carcinogens.7-9 No occupational exposure limits are established for chemotherapy drugs, so reducing exposures as much as possible is extremely important (see Occupational exposure limits). Adhering to proper work practices will reduce your risk of adverse effects from workplace exposures to chemotherapy drugs.10

NIOSH was asked to evaluate an oncology clinic in Florida that employed 54 people. Clinic employees were concerned about potential exposures to chemotherapy drugs and potentially related health effects, such as upper respiratory symptoms, rash, diarrhea, and headache. In this article, the authors discuss their HHE of this clinic and their recommendations to the clinic to protect its employees and patients.



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SITE VISITS


Our evaluation included two site visits to the oncology clinic. During the first visit, we measured the face velocity at the class 2 biological safety cabinet (BSC) in which chemotherapy drugs were mixed. The face velocity indicates airflow into the BSC from the workspace. Surface and hand wipe samples were collected and analyzed for total platinum (Figure 1, Figure 2). Platinum-containing chemotherapy drugs include cisplatin, oxaliplatin (Eloxatin, generics), and carboplatin, and others. Fourteen employees (10 clinical staff members and 4 administrative staff members) were interviewed as part of our evaluation. In addition, we reviewed the Occupational Safety and Health Administration (OSHA) Form 300 Log of Work-Related Injuries and Illnesses from the previous 2 years.


At the second clinic visit, we collected surface wipe samples from locations similar to those analyzed in the first visit. Surface wipe samples were also collected to detect cyclophosphamide (Cytoxan, generics), ifosfamide (Ifex, generics), and doxorubicin (Doxil, generics) at the beginning of the workday (before the chemotherapy drugs were unpacked) and at the end of the workday (after the last chemotherapy treatment was completed and before nightly housekeeping) to evaluate the clinic’s cleaning procedures and employee work practices.