Is Your Nursing Area More Contaminated Than You Think?
As Nurses, we take pride ensuring patient safety and improving patient outcomes. We maintain clean work surfaces and practice aseptic technique to prevent microbial contamination that can spread harmful bacteria if not dealt with effectively. Ultimately, we want to provide safe, evidence based practices with improved patient outcomes while providing the same evidence based practices to protect ourselves.
Oncology nurses find themselves fighting contamination on multiple fronts. Not only must we fight contamination of bacteria, but we must also be vigilant about reducing contamination from antineoplastic drugs, used in the treatment of cancer patients. While chemotherapy drugs can save lives of patients, exposure to these same drugs can be harmful to nurses administering them. These risks are well documented and include a higher risk of miscarriages, birth defects and even some forms of cancer. (See Are you and your team aware of the risks involved in hazardous drug handling?)
Contamination Awareness is the First Step
As Oncology Nurses, we are often aware of traditional routes of occupational exposure to hazardous drugs: absorption, inhalation, ingestion, and injection. Personal protective equipment (PPE) worn by nurses is designed to help combat the risk of occupational exposure, mainly from aerosols and dermal absorption. While oncology nurses have been using PPE (double gloves, gowns, goggles, etc.) and are mindful of the risks and dangers involved with antineoplastic drugs, results of a recent study showed 15% of nurses did not know that hazardous drugs left behind on surfaces are also a source of exposure[1].
The hazardous residue has been found in administration areas, countertops, sinks, computer terminals, telephones, elevator buttons, and also on the floors of drug preparation rooms. This ‘leftover’ residue is highly transferable and can also lead to contamination amongst those who are not involved in hazardous drug handling. A recent study found that individuals that are not in direct contact with the act of preparing or administering chemotherapy but work in the same vicinity of a chemotherapy administration unit had exposure equal to that of the oncology nurses handling the cytogenic drugs[2].
Solutions to Hazardous Drug Exposure
There have been recommendations to help prevent hazardous drug exposure from The National Institute of Occupational Safety (NIOSH), The United States Pharmacopeial Convention (USP), General Chapter 800, and Oncology Nursing Society (ONS). Up until now, these remain mere recommendations and are considered best practices. However, with the implementation of USP 800, to which healthcare facilities must comply by December 1, 2019, the recommendation now mandates the use of Closed System Transfer Devices (CSTDs) for those administering hazardous drugs, namely, oncology nurses.
CSTDs are highly specialized engineering controls that are specifically designed to protect healthcare professionals from exposure to hazardous drugs. The key component of a well-designed CSTDs is the ability to adhere to a simple definition of ‘leak-proof’ and ‘air-tight.’ Using a truly closed system that adheres to this definition of preventing environmental contaminants from entering the system and preventing aerosols, vapors or leaks/drops from escaping the system, makes CSTDs a crucial tool for containing exposure for oncology nurses.[3]
Oncology nurses risk hazardous exposure on a daily basis in their life-saving work. Implementation of best safety practices is the responsibility of the nurse, and healthcare systems to ensure environments are as safe as possible. Using PPE and CSTDs will ensure optimal care for the patient without sacrificing safety in the work place for nurses and those that enter the environment.
[1] Polovich M, Clark PC. Factors influencing oncology nurses’ use of hazardous drug safe-handling precautions. Oncol Nurs Forum. 2012;39(3):E299-E309.
[2] Hon CY, Teschke K, Demers PA, Venners S. Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system. Ann Occup Hyg. 2014;58(6) 761–770.
[3] Sessink PJ, Connor TH, Jorgenson JA, Tyler TG. Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device. J Oncol Pharm Practice. 2011;17(1):39–48. doi: 10.1177/1078155210361431.
