Hazardous drug exposure

Case report analysis from a prospective, multisite study of oncology nurses’ exposure in ambulatory settings¹

Nurses, clinicians and other healthcare workers treating cancer patients are often exposed to hazardous, cytotoxic drugs. Studies have shown that adverse health events are linked to exposure to hazardous drugs,² prompting several agencies to issue guidelines on how to reduce exposure to them.³ Measures recommended include environmental surveillance through wipe sampling, the use of closed-system transfer devices (CSTDs) and bio-safety cabinets (BSCs), giving special attention to vulnerable personnel like pregnant and breastfeeding workers, the use of personal protective equipment (PPE) and by establishing a culture of safety.³

Oncology healthcare workers face exposure to cytotoxic drugs either indirectly by encountering contaminated surfaces, or directly through drug spills. To evaluate risk-reduction methods and changes in clinical practise needed to improve healthcare worker safety, it is necessary to analyse data related to toxic drug spills from multiple clinical sites. As a part of a larger randomised, controlled trial, Friese et.al collected data on spills by nurses and the PPE worn.¹ The results of the study are summarised here.

As a part of the Drug Exposure Feedback and Education for Nurses’ Safety Study launched in 2015, consented registered nurses administering chemotherapy in ambulatory settings were asked to complete a questionnaire whenever they encountered a spill. The use of the equipment and the spill events were characterised using descriptive statistics. ¹ Fifty-one nurses from 12 participating institutions reported a total of 61 spill events.

The study revealed that the most frequently spilled drugs were paclitaxel, gemcitabine, and anthracycline. Forty-one participants reported that they had used a CSTD, out of which 21 reported that the device did not work properly during the spill. It was unclear from the data whether this was because of improper usage or malfunction of the device. A variety of PPE were worn during the infusions including disposable gowns, chemotherapy-tested gloves, respirators, and eye protection.

The study highlights the role of education, practice and leadership support for the use of PPE by nurses. It proposes that novel CSTDs be designed using human-centred design principles with nurses as end-users. The study recommends the application of existing quality-improvement practices to promote the adoption of evidence-based methods to minimise exposure when spills occur.

To conclude, the study found that drug spills occurred frequently and that nurses remain vulnerable to hazardous drug spills. Therefore, ongoing training should be warranted. Routine reporting of drug spills may motivate clinical practice change and aid manufacturers in designing engineering controls that effectively reduce nurses’ exposure to hazardous drugs.

Read the article in the Clinical Journal of Oncology Nursing

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