The Case of the Explicit Exposure
Mr. Larsen presents to the clinic for his first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) for a diagnosis of diffuse large B-cell lymphoma. Elizabeth, his oncology nurse, just started the cyclophosphamide when she is paged to the desk for a call from Mr. Larsen’s oncologist. She quickly removes her face shield and gloves as she hurriedly leaves the room to take the call. After completing the call, she returns to Mr. Larsen’s room to remove her gown.
What Would You Do?
Despite guidelines detailing the risk of exposure to hazardous drugs (HDs) and preventative measures, exposure remains a common problem in healthcare settings (https://doi.org/10.1177/0018578717722870). The National Institute for Occupational Safety and Health (NIOSH) maintains a complete list of HDs (https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf) that meet at least one of the following features:
- Is known to cause cancer (carcinogenicity)
- Can result in developmental toxicity to an embryo or fetus (teratogenicity)
- May negatively affect the reproductive system
- May cause organ toxicity at low doses
- Can damage genetic function (genotoxicity)
- Mimics existing drugs determined hazardous by the previous criteria
Although research is limited on the hazards of targeted therapies and immunotherapy, the dangers associated with exposure to chemotherapy agents, antiviral therapies, and many bioengineered drugs is well established (https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf). With the introduction of closed-system transfer devices (CTSD), some nurses may not see the need for continued observation of HD handling practices and use of personal protective equipment (PPE). Although CTSDs have reduced surface contamination in several studies, use of PPE is still considered best practice.
Elizabeth inadvertently put herself and her coworkers at risk for HD contamination by not performing proper removal of all PPE prior to leaving Mr. Larsen’s room. Every nurse is responsible to diligently maintain NIOSH’s safe handling guidelines to protect themselves, coworkers, patients, and others who may come into the healthcare setting.