“Hey, you didn’t dress up for me today. Where’s your pretty blue dress?”

At first I wasn’t sure what the patient in the chemotherapy chair was talking about. After a moment, I realized the patient was referring to the blue safety gowns we wear. I heard the infusion nurse respond as she removed the chemotherapy from the hazard bag, “Oh yeah, I’m kind of in a hurry today.”

While the patient could possibly benefit from the chemotherapy, for the nurse that same drug posed a serious hazard.

It is estimated that on any given workday, over 8 million healthcare workers could potentially be exposed to hazardous drugs. In the oncology setting, chemotherapeutics, biologics, immunotherapy, and antiviral medications carry some degree of hazard to oncology nurses and other personnel in contact with these agents. The type and degree of hazardous exposure can vary. For example, intact pills present less of a hazard than when the pill is crushed or reconstituted. The length and frequency of exposure are other considerations.

In 2004, the National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) released an alert titled, Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. The alert was updated in 2010 and again at 2 year intervals. In 2014, 27 new drugs were added to the list; the 2016 update proposes 36 new drugs be added; 17 of these drugs have black box warnings.

The NIOSH alert states personal protective equipment (PPE) including gloves, goggles, and protective gowns, be used during hazardous drug administration and disposal. In a study published in the Oncology Nursing Forum, authors surveyed 330 oncology infusion nurses on their use of PPE. Alarmingly, nurses gowned-up only 50% of the time when administering chemotherapy, 23% of the time when handling secretions, and double gloving was exceedingly rare (11-18%).

The ONS publication Safe Handling of Hazardous Drugs can guide oncology nurses in preventing unwanted exposure. Importantly, oncology nurses teaching patients and families on safe handling of oral therapies and chemotherapy agents in the home setting can lead by example by taking the extra minute to put on the pretty blue gown. What you wear matters in more ways than you may realize.

Comments

Posted by Judy Jensen (n… (not verified) 11 months 3 weeks ago

We too wear the pretty blue gowns. What I am curious about is how often to you change them in the course of a shift. Currently we change gowns 2x during a 8-9 hour shift. The other question I have is many nurses find the gowns hot and uncomfortable so they take them off and drape across chairs or counters. In theory wouldn't that mean you are transferring chemo onto clean surfaces. Curious what other facilities do.

Posted by L. Rasmussen (… (not verified) 11 months 3 weeks ago

In reply to by Judy Jensen (n… (not verified)

Judy I am also very interested in how often chemo infusion nurses change chemo gowns. ONS supports single use, however, I have found this can be interpreted very differently. We use one chemo gown per shift unless there is any obvious contamination.
Nurses will hang the gown up on the IV poles that come with the chemo chairs. (no used for the actual chemo because we have free standing pumps)

Everyone else please join in the discussion.
What is your practice at your facility?

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