When nurses do not wear appropriate personal protective equipment while administering chemotherapy drugs, they risk exposure, which increases their chances of developing leukemia and other cancers, adverse reproductive outcomes, and chromosomal damage. In this interview with i3 Health, Dr. Friese provides insight regarding his study of an intervention to improve nurses' handling of hazardous drugs, the implications of unsafe handling, and potential solutions to improve the safety of nurses who administer chemotherapy drugs.
What risks are involved in unsafe handling of hazardous drugs?
Christopher Friese, PhD, RN, AOCN®, FAAN: We have known for 40 years that health care workers who handle hazardous drugs like chemotherapy agents are more likely to report a host of health problems, including reproductive difficulties, miscarriages, skin or airway ailments, and rare cancers, including leukemia. The small amounts of repeated exposure through incidental contact and the occasional spill increase exposure to nurses, pharmacists, and pharmacy technicians who handle hazardous drugs as part of their routine work.
Why do nurses not always use appropriate personal protective equipment (PPE)?
Dr. Friese: Our study found a number of barriers. The key one is that nurses' peers don't wear PPE, so there is a peer effect that we need to correct. Other cited barriers included discomfort wearing gowns, gloves, and protective eyewear, as it can make a nurse feel hot. We also have reports in some settings that the equipment isn't routinely available or in a convenient place in the cancer center.
Why do you believe the intervention was not successful in improving nurses' hazardous drug handling?
Dr. Friese: Our study points to the need for a multi-pronged strategy. We had done an earlier pilot survey that targeted front-line nurses directly. In that study, we shared results of our work as we went along, and the staff made a number of changes to their practice. In this larger study (with 12 cancer centers), we didn't see that. Every cancer center is different with respect to physical layout, equipment used, personnel, and organizational structure, so the interventions may need more tailoring to each practice.
What steps need to be taken in order to improve safety concerning nurses' hazardous drug handling?
Dr. Friese: We need to engage both practice managers and clinicians in understanding the risks and co-creating an action plan that will work in their particular clinical setting. As stated above, the peer effect is important, so making sure your colleagues are keeping themselves safe may be an important strategy. We also think there needs to be more innovation in the technology used to prepare and administer drugs so it is easier to use and more reliable. We also recommend that manufacturers improve the protective equipment so the materials are lighter and more comfortable.
What advice would you offer to community oncology nurses as they try to handle hazardous drugs safely?
Dr. Friese: This is a health risk that cannot often be seen, but it is still there. My key recommendation to front-line nurses is to educate themselves on the risks of handling hazardous drugs and be sure they are up to date with the latest recommendations from the Oncology Nursing Society, the National Institute for Occupational Safety and Health, and the United States Pharmacopeia. Make sure you are in charge of your own health and safety and wear PPE each and every time you handle a hazardous drug. If you have a drug spill or other exposure, report the incident to your supervisor and consult with an occupational health provider.
Anything else you'd like to add?
Dr. Friese: Our research team is applying the findings from this study, among others, in a new training program on chemotherapy safety for nurses and pharmacists. Thanks to a grant from the National Cancer Institute, the Multiprofessional Oncology Safety and Simulation Training (MOSST) program is offered free of charge for the next three years. Go to mosst.nursing.umich.edu for more information and to apply.
About Dr. Friese
Christopher Friese, PhD, RN, AOCN®, FAAN, is the Elizabeth Tone Hosmer Professor of Nursing at the University of Michigan. His interests include quality of care, health policy, oncology nursing, and the nursing workforce.
For More Information
Friese CR, Yang J, Mendelsohn-Victor K & McCullagh MC (2019). Randomized controlled trial of an intervention to improve nurses' hazardous drug handling. Oncol Nurs Forum, 46(2):248-256. DOI:10.1188/19.ONF.248-256
Oncology Nursing Society
National Institute for Occupational Safety and Health
United States Pharmacopeia
Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily represent the views of i3 Health.
Image Courtesy of University of Michigan