Antineoplastic, or cytotoxic drugs are used to treat patients with cancer as well as (increasingly) other medical conditions.
As the population ages and cytotoxic drugs are increasingly used the number of nurses that will come into contact with them will become even more significant.
Risks to nurses.
Effects reported following occupational exposure include:
- Sore throat and cough.
- Dizziness and headache.
- Eye irritation.
- Hair loss.
- Allergic reactions.
There is evidence that oncology nurses exposed to chemotherapy drugs have increased risk of experiencing leukaemia and other cancers.
Despite this, many studies have reported poor understanding amongst nurses of their responsibilities and the serious risk inherent in handling these materials.
Antineoplastic drugs represent one of the most toxic classes of chemical agents used in health care. Yet, despite this distinction, and the fact that sufficient evidence exists concerning their harmful effects on exposed health care workers, the data from this survey show that nurses and other health care workers are not universally adhering to longstanding safe handling guidelines, placing themselves and even family members at risk of exposure.
– Boiano (2014)
There is significant risk to nurses who do not use cytotoxic drugs correctly.
Full and correct PPE should ALWAYS be worn.
Needless systems should be used.
Absorbent pad should be used under the injection site
Chemotherapy tablets should not be broken or crushed at the bedside.
Pregnant nurses should probably not handle cytotoxic drugs.
All spillages should be treated seriously.
Personal Protective Equipment:
It has been shown that many nurses tend to be lackadaisical in their approach to wearing PPE when handling cytotoxic drugs.
Here is the correct approach:
Disposable long-sleeved gown of impermeable material (usually identified as purple), with closed front and elasticised cuffs.
Protective goggles glasses with side shields
Polyvinyl chloride (PVC), surgical latex gloves, or purpose-manufactured gloves (usually identified as purple). Gloves must cover over wrist cuffs of the gown.
Gloves should be changed after each procedure, or if overt contamination or perforation occurs.
Giving oral cytotoxic drugs:
- Use disposable medicine cups and non touch technique to give tablets.
- Avoid crushing or breaking tablets.
- Dispose of all gloves and rubbish in cytotoxic waste bins.
- Wash hands following procedures.
Giving IV cytotoxic drugs.
- Don full PPE.
- Do not touch pumps or other equipment/surfaces with gloves that have been in contact with cytotoxic agents.
- Whenever possible use a central venous access device to give cytotoxic drugs.
- Place impermeable sheet under workspace to contain minor spills.
- Test patency of access to circulation by pre-flushing with saline.
- Use specific cytotoxic labels to identify all equipment (bags, lines, syringes etc).
- Following administration dispose of all PPE and rubbish in cytotoxic waste container.
- Gloves should be immediately replace cloves if they become damaged or contaminated.
- Perform thorough hand wash after removing gloves.
What to do if you are contaminated with cytotoxic agents:
- Immediately remove gloves, gown and dispose in cytotoxic waste container.
- If any personal clothing is contaminated it should also be removed and safely packaged for laundering. Do not continue to wear contaminated clothing.
- Skin exposure: thoroughly wash with running water.
- Eye exposure: immediately irrigate with water or 9%Saline for a period of 15minutes.
- Needlestick injuries: thoroughly wash the area and follow local needlestick injury or occupational exposure guidelines.
Management of a cytotoxic spill.
Immediately obtain a ‘spill kit’ and strong alkaline detergent.
Isolate immediate area.
Person attending to spill must don full PPE.
Dry the area with absorbent material provided (it may have an absorbent side and a plastic side, so make sure absorbent side is down) in the spill kit.
Wash area with alkaline detergent and then with water.
Discard all waste and rubbish into cytotoxic waste containers and/or bags.
Should pregnant nurses giving cytotoxic drugs?
Most cytotoxic drugs are teratogenic (cause grown abnormalities in the foetus) and handling them may not be safe during pregnancy.
A recent study, published in the American Journal of Obstetrics and Gynecology , has looked at 7500 pregnant nurses involved in the handling of hazardous materials. It has shown a relative increase in rates of spontaneous abortion among mothers who handle chemotherapy. They did use PPE and were not involved in obvious exposure. This means that they were unknowingly exposed to constant low levels of exposure during their pregnancy. This study has brought the working conditions of oncology nurses into the limelight.
– Gilani (2014)
Pregnant staff should be given the choice to avoid working in contact with chemotherapy agents and should definitely not work in these areas during the first 84 days of their pregnancy.
Boiano, James M., Andrea L. Steege, and Marie H. Sweeney. 2016. “Adherence To Safe Handling Guidelines By Health Care Workers Who Administer Antineoplastic Drugs”.
Melbourne, The. 2016. “Clinical Guidelines (Nursing) : Cytotoxic Drugs – The Management Of”. Rch.Org.Au. http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Cytotoxic_Drugs_The_Management_Of/.
S Gilani, S Giridharan. 2016. “Is It Safe For Pregnant Health-Care Professionals To Handle Cytotoxic Drugs? A Review Of The Literature And Recommendations”. Pubmed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990661/.
“Safety Precautions For Doctors, Nurses And Carers | Cancer Australia”. 2016. Canceraustralia.Gov.Au. https://canceraustralia.gov.au/affected-cancer/cancer-types/gynaecological-cancers/vulval-cancer/treatment/chemotherapy/safety-precautions-doctors-nurses-and-carers.