Pharmacists who compound antineoplastic and other hazardous drugs, and the nurses who then administer them, are at high risk of occupational exposure. These exposures can cause acute health effects, from sore throats to hair loss; allergic reactions; cancer; and reproductive toxicity—including an increased risk of miscarriage. Despite this, multiple studies have shown that healthcare workers can be remarkably cavalier about the precautions that could prevent exposure, like wearing gloves. A National Institute for Occupational Safety and Health (NIOSH) survey reported that the most common reason given for failing to wear gloves was that “skin exposure was minimal”—an opinion at odds with various biological measures of worker exposures.
ronstik / iStock / Getty Images Plus / Getty Images
Yesterday we looked at the ways that healthcare workers can be exposed to hazardous drugs. Today we’ll look at some of the reasons they give for failing to comply with safe work practices that could help to prevent occupational exposures.
Risky Behavior
In 2011, NIOSH surveyed 2,069 healthcare workers—most of them nurses—who had administered one of more than 90 specific antineoplastic drugs in the previous week about their adherence to safe work practices. According to the survey, which was published in the Journal of Occupational and Environmental Hygiene in 2014, workers reported that they had engaged in risky activities or been exposed to hazardous drugs by incidents that included:
- Failing to wear a nonabsorbent gown with closed front and tight cuffs (42%);
- Priming intravenous (IV) tubing with the antineoplastic drug (6% had done this themselves; another 12% reported that this was done by the pharmacy);
- Taking potentially contaminated clothing home (12%);
- Spills or leaks of antineoplastic drugs during administration (12%);
- Failing to wear chemotherapy gloves (12%); and
- Lack of hazard awareness training (4%).
In another NIOSH survey of compounding practices published in 2015, nurses and pharmacy practitioners who had compounded antineoplastic drugs in the preceding 7 days reported that they did not always:
- Wear two pairs of chemotherapy gloves (85% and 47%, respectively) or even a single pair (8% and 10%, respectively).
- Use closed-system drug-transfer devices (75% and 53%, respectively).
- Wear a protective gown (38% and 20%, respectively).
- Use either a biological safety cabinet or isolator (9% and 15%, respectively).
Why do healthcare workers—who see and treat very sick people as part of their jobs—fail to protect their own health?
Barriers to Compliance
When NIOSH asked healthcare workers why they did not wear their personal protective equipment (PPE), including double gloves and gowns, while compounding or administering hazardous drugs, it found that workers were essentially shrugging off the risk. “Skin exposure is minimal” was the most common answer to the question, followed by “not part of our protocol” and “not provided by employer.” The researchers concluded that “there is a perception among respondents that chemotherapy drugs pose a minimal exposure risk.” In addition, employers’ reported failure to implement safe work practices and provide PPE suggest that employers may not think of hazardous drugs as all that dangerous, either.
To increase worker compliance, NIOSH recommended that employers:
- Provide regular hazard awareness training.
- Implement safe handling procedures that reflect national guidelines.
- Ensure that engineering controls and PPE are available and that workers know how to use them.
- Provide medical surveillance and exposure monitoring.
Tomorrow we’ll look at the most recently developed national guideline, which is scheduled to go into effect in 2019.