More chemo protection is needed: Gown, goggle use low

Nurses who prepare and administer chemotherapy agents in outpatient settings often don’t use the proper gloves or other recommended personal protective equipment (PPE), according to a survey of oncology nurses.1 Furthermore, few nurses who handle chemotherapeutic drugs received health evaluations that included reproductive and cancer evaluation, the survey found.

Although the study found an increase in the use of PPE among nurses compared to earlier research, the PPE use did not reflect widespread adherence to recommendations of the National Institute for Occu-pational Safety and Health (NIOSH).

In fact, the study found less use of PPE among nurses with more years of oncology experience.

"I hear nurses all the time say, This isn’t hazardous,’" says Sue Martin, DNSc, RN, AOCN, a Long Island, NY-based consultant specializing in health care issues related to oncology. "I’ve had seasoned nurses who have worked with drugs for many years say, I don’t have to wear gloves. I know how to make sure I’m not exposed.’"

The study underscores the importance of educating oncology nurses, as outlined in a recent NIOSH hazard alert.

NIOSH recommends the use of chemotherapy gloves, low-permeability disposable gowns and sleeve covers, and eye and face protection. Respiratory protection should be available when biological safety cabinets are not adequate to protect against inhalation exposure, the agency says.

But a survey of 263 members of the Oncology Nursing Society (ONS), based in Pittsburgh, found that lab coats were used most often during administration of chemotherapy. The study also found a significant use of PVC (or vinyl) gloves, which are not protective against these agents.

Goggle and mask use was rare, the study found. The nurses worked in outpatient centers, both hospital-based and community-based.

"Nurses don’t necessarily consider gowns a necessity for administering chemotherapy up to this point," says Martha Polovich, MN, RN, AOCN, an oncology clinical nurse specialist at Southern Regional Medical Center in Riverdale, GA, and an author of the ONS chemotherapy and biotherapy guidelines and recommendations for practice. "Even people who wear gloves think, If I use good technique, I won’t contaminate my clothing.’ But we know now that’s not the case."

The risk is particularly great in office or clinic settings, where a nurse may prepare as well as administer the drugs, she says. The study found nurses were responsible for preparing chemotherapy in 74% of community-based practices.

Medical surveillance also remains an area of concern, the authors concluded. Most of the respondents said they received no medical evaluation at all. Just 46% received health evaluations from their employer, and half of those occurred only as a pre-employment medical exam. Only 6% said their health evaluation included a reproductive and cancer evaluation.

Essentially, no one is monitoring the effects of long-term handling of these hazardous drugs, Martin says. In Europe, more research has been conducted on exposure and health effects related to chemotherapeutic agents, she says.

"We don’t have a really good handle on the true effects of handling these agents in the United States," she says.

Reference

1. Martin S, Larson E. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Oncology Nursing Forum 2003; 30:575-581.