“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.