Health and Safety Practices Survey of Healthcare Workers

Antineoplastic Drug Administration – Predictors of Adherence to Safe Handling Practices among Hospital Nurses

Here you will learn what we found regarding factors that may affect adherence to safe handling guidelines for antineoplastic drugs among hospital nurses. We also provide links to other studies that have examined factors for safe handling of antineoplastic drugs.

Overview

Antineoplastic drugs, also known as chemotherapy, cytotoxic and oncology drugs, are used to treat cancer, as well as arthritis, multiple sclerosis, and other non-cancer medical conditions. Most antineoplastic drugs are classified by NIOSH as hazardous drugs.¹ About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs.²

Healthcare workers exposed to chemotherapy drugs have increased risk³ of

• Leukemia
• Other cancers
• Adverse reproductive outcomes  
• Chromosomal damage

Guidelines on the safe handling of antineoplastic drugs have been available for many years.^3-6 This study provided an opportunity to examine factors associated with adherence to these guidelines among hospital nurses who administered antineoplastic drugs.

Because we found that safe handling guidelines were not always being followed during administration of antineoplastic drugs, we examined factors associated with adherence. Specifically, we examined associations between the following factors and outcomes:

 

Factors	Outcomes
Administrative and engineering controls Work practices Nurse perceptions Nurse and hospital characteristics	Use of personal protective equipment (PPE) Activities performed while wearing gloves previously used to administer antineoplastic drugs Spills of antineoplastic drugs

Among the hospital nurses who administered antineoplastic drugs, we found

• Familiarity with safe handling guidelines and training in safe handling practices were associated with consistent use of more PPE items.
• Availability of PPE was associated with more PPE use and fewer reported spills of antineoplastic drugs.
• Use of closed system drug-transfer devices and luer-lock fittings was associated with fewer spills.
• Nurses who administered antineoplastic drugs more frequently reported more spills and reported performing more activities with potential for environmental contamination (e.g. touching bed controls, touching door knobs, using phones while wearing gloves previously used to administer antineoplastic drugs).
• Respondents who felt they had adequate time to take safety precautions reported fewer spills.

What can be done to reduce exposure to antineoplastic drugs

• Commitment from all levels of healthcare organizations is essential to protect workers from exposure to antineoplastic drugs, many of which are recognized carcinogens with no safe level of exposure.
• Adherence to best practices for safe administration of antineoplastic drugs requires the efforts of employers (providing engineering controls, PPE, training in safe administration, and adequate time for workers to adhere to safe practices) and healthcare workers (seeking out training, consistently following facility procedures, and reporting safety concerns).

References

¹ NIOSH. NIOSH list of antineoplastic and other hazardous drugs in health care settings 2016

² NIOSH Workplace solutions: Personal protective equipment for health care workers who work with hazardous drugs

³ NIOSH Alert on preventing occupational exposures to antineoplastic and other hazardous drugs

⁴ ASHP (American Society of Health-System Pharmacists) guidelines on handling hazardous drugs

⁵ OSHA Controlling occupational exposure to hazardous drugs

⁶ Oncology Nursing Society (ONS) Chemotherapy and biotherapy guidelines and recommendations for practice

Learn more about factors that may affect adherence to safe handling guidelines for antineoplastic drugs

Ben-Ami S, Shaham J, Rabin S, Melzer A, Ribak J: The influence of nurses’ knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel. Cancer Nurs 24:192-200 (2001).

Friese CR, McArdle C, Zhao T, Sun D, Spasojevic I, Polovich M and McCullagh MC. Antineoplastic drug exposure in an ambulatory setting. Cancer Nurs  2014 (epub ahead of print) DOI: 1097/NCC.0000000000000143.

Friese CR, Himes-Ferris L, Frasier MN, McCullagh MC, Griggs JJ: Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf 21:753-9 (2012).

Hon CY, Teschke K, Shen H: Healthcare workers’ knowledge, perceptions and behaviors regarding antineoplastic drugs: Survey from British Columbia, Canada. J Occup Environ Hyg (2015). DOI: 10.1080/15459624.2015.1029618.

Kopp B, Schierl R, Nowak D: Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health 86:47-55 (2013).

Polovich M, Martin S: Nurses’ use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum 38:718-26 (2011).

Polovich M, Martin S: Nurses’ use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum 38:718-26 (2011).

Survey and report

To request a copy of this survey, please email jmb4@cdc.gov.

Journal article

(The free full text article will be available in Pub Med Central one year after the article has published)