chris friese
Christopher Friese, PhD, RN, AOCN®, FAAN, is the Elizabeth Tone Hosmer Professor of Nursing, Health Management, and Policy at the University of Michigan in Ann Arbor.

The evidence is clear: for more than 40 years, reports have confirmed that hazardous drug exposure poses significant safety risks to providers who handle many agents related to cancer treatments. Healthcare professionals experience several substantial health threats, including reproductive problems, airway and skin irritation, and cancers. Despite the potential health risks, the data are also clear: nurses routinely do not wear personal protective equipment (PPE) as recommended when handling hazardous drugs.

Barriers to proper PPE adherence vary, including facilities not making appropriate PPE readily available or not providing adequate, ongoing training. Peer factors such as other colleagues not wearing PPE or physical discomfort also contribute to low PPE adherence. Our team led several investigations to understand the patterns, correlations, and consequences of hazardous drug exposure for healthcare professionals. We’ve conducted survey research, analyzed biologic samples from nurses, and recently completed a large randomized trial that tested an intervention to improve hazardous drug handling.

Our study findings suggested that a multilayered approach is required to protect nurses. The Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health (NIOSH) have a concept called hierarchy of controls, which uses a cohesive strategy—one that includes engineering controls like devices and equipment; administrative controls including policies, procedures, and monitoring; and proper PPE enforcement—to curbing hazardous drug exposure among nurses and other healthcare providers.

Manager and leadership involvement in the safe handling issue are critical. If management reinforces the message that safety is important and backs it up with policies, procedures, equipment, and resources, then adoption of best preventive practices is more successful. Our work also noted that although closed-system transfer devices—an engineering control to reduce exposure—are useful, they could be redesigned to be more user-friendly and reliable during routine clinical care. 

Implementation of the U.S. Pharmacopeia (USP) chapter <800> is an important advancement to protect nurses and other healthcare workers from hazardous drug exposure. USP <800> codifies existing recommendations from NIOSH, American Society of Clinical Oncology, ONS, Hematology/Oncology Pharmacy Association, and others. It covers all drug handling activities and requires facilities and individual clinicians to share responsibility for adhering to proper safe handling recommendations.  

Nurses and healthcare professionals can stay updated with NIOSH’s hazardous drugs information at their website. The University of Michigan, through funding from the National Cancer Institute, provides free courses through its Multiprofessional Oncology Safety and Simulation Training.