Oncology
Joey Sweeney, PharmD, BCPS
Chemotherapy continues to be the predominant treatment for patients with cancer. Although the benefit-to-risk ratio of chemotherapy medications is favorable for these patients, health care workers preparing, transporting, and administering these drugs are exposed to workplace health risk. The creation of USP <800>, which describes practice and quality standards for handling hazardous drugs in health care settings, addresses these risks, but exposure to hazardous drugs when there is an accidental spill or when a surface is contaminated cannot be regulated. Nursing and pharmacy staff are typically most exposed to spill risk. As such, health care workers in both disciplines have invested time and energy in keeping themselves safe.
Case report analysis
A recent study published in the Clinical Journal of Oncology Nursing details a case report analysis of nursing exposure to these drugs from a surface contamination and spill perspective. Friese and colleagues focused on the use of personal protective equipment (PPE) by nursing staff at 12 ambulatory cancer centers when responding to a hazardous drug spill event. the 2-year study A total of 393 nurses who worked at least a 40% full-time equivalent (FTE), and therefore should have had adequate expertise and training in spill management, were included in the 2-year study. Nurses who received antineoplastic therapy in the previous 12 months were excluded.
When a spill occurred, the nurses were directed to complete an online demographic survey detailing the specifics of what transpired during spill management. Workload was evaluated in the context of the drug spill by additional questions. Questions about PPE included whether nurses wore two pairs of chemotherapy gloves, disposable gown, eye protection, a respirator (or equivalent), and shoe coverings.
A total of 61 spills were reported, ranging from a few drops to 250 mL. Paclitaxel, gemcitabine, and anthracycline were the most commonly spilled medications, with a mean spill volume of 28.8 mL.
Interestingly, there was no correlation between demographic information and the likelihood of a spill event, which may indicate that experience and education are independent of spill events.
Lessons learned
Curiously, of the 41 spills that involved a closed-system transfer device (CSTD), these devices failed 21 times. More studies would be useful to determine the efficacy of worker protection when using CSTDs in a real-world setting.
The researchers found that rarely were all recommended PPE elements worn by nursing staff during a spill. This represents an opportunity for improved support of frontline staff by policymakers, other administrative stakeholders, and educators. With 94% of the study participants being female, and the most common drugs spilled being pregnancy category D or greater, using the correct PPE not only ensures worker safety, but also the well-being of babies born to these workers.
Because the study was conducted at an academic medical system in Michigan, the generalizability of the study results is unknown. If there is a defect in this health system’s training or supply chain that contributes to poor PPE use, this may not be true of other health systems.
It is also unknown how applicable these results are to pharmacy staff, although the failure of CSTDs is alarming and worthy of additional study in real-world environments. Another unknown is whether nurses who are more prone to spills are also more likely to not use adequate PPE—it is possible that nurses who would have worn appropriate PPE are at lesser risk for being involved in a spill.
Inadequate use of PPE puts healthcare workers who take care of patients with cancer at risk. In addition, devices such as CSTDs designed to limit worker exposure may be less effective than previously thought.
Although this study involved nursing staff, pharmacy staff should be aware of the risks of not wearing adequate PPE when working with oncology medications.