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Alehashem M, Baniasadi S. Important exposure controls for protection against antineoplastic agents: Highlights for oncology health care workers. Work 2018; 59:165-172. [PMID: 29439374 DOI: 10.3233/wor-172656] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A great number of antineoplastic drugs (ANPDs) are used globally in cancer treatment. Due to their adverse health effects, occupational exposure to ANPDs is considered a potential health risk to health care workers. OBJECTIVE The current study aimed to evaluate safe-handling practices of ANPDs, exposure controls, and adverse health implications for health care providers exposed to ANDPs. METHODS Prevention measures, including engineering, administrative, and work practice controls, as well as personal protective equipment (PPE), were recorded daily through a questionnaire for six weeks. Acute adverse health effects experienced by health care workers were also documented. RESULTS The implemented exposure controls for preparation, administration, cleaning, and waste disposal were not in accordance with the safe handling guidelines. Central nervous system disorders (26.33%) were the most frequent acute adverse effects reported by health care workers. A significant correlation was found between the number of experienced adverse effects and handling characteristics, including the number of preparations (r = 0.38, p < 0.05), dose, and the number of prepared drugs (r = 0.46, p < 0.01 and 0.39, p < 0.05), and working hours in different locations of oncology setting for six weeks (preparation room: r = 0.38, P < 0.05, treatment room: r = 0.46, P < 0.01, patient room: r = 0.63, P < 0.01, and station: r = 0.68, P < 0.01). CONCLUSIONS Due to inadequate control measures, oncology health care workers were in danger of exposure to ANPDs and experienced acute adverse health effects. Implementation of appropriate exposure controls is required to prevent occupational exposure to ANPDs.
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Affiliation(s)
- Maryam Alehashem
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Baniasadi
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Wizner K, Nasarwanji M, Fisher E, Steege AL, Boiano JM. Exploring respiratory protection practices for prominent hazards in healthcare settings. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:588-597. [PMID: 29750600 PMCID: PMC6201744 DOI: 10.1080/15459624.2018.1473581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/12/2018] [Accepted: 04/30/2018] [Indexed: 06/08/2023]
Abstract
The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.
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Affiliation(s)
- Kerri Wizner
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
- Association of Schools and Programs of Public Health, Washington, D.C., USA
| | - Mahiyar Nasarwanji
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Edward Fisher
- National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Andrea L. Steege
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - James M. Boiano
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
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Izzo V, Charlier B, Bloise E, Pingeon M, Romano M, Finelli A, Vietri A, Conti V, Manzo V, Alfieri M, Filippelli A, Dal Piaz F. A UHPLC-MS/MS-based method for the simultaneous monitoring of eight antiblastic drugs in plasma and urine of exposed healthcare workers. J Pharm Biomed Anal 2018; 154:245-251. [PMID: 29558725 DOI: 10.1016/j.jpba.2018.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 02/26/2018] [Accepted: 03/12/2018] [Indexed: 01/20/2023]
Abstract
Exposure of healthcare workers to anticancer drugs requires the combined action of environmental and biological monitoring to assess the effective level of exposure to these chemicals, to improve awareness and to avoid adverse health effects on this category of workers. Cancer chemotherapeutic drugs show different mechanisms of action due to diverse chemical structures; consequently, they differ in hydrophobicity, pharmacokinetics and pharmacodynamics. Therefore, the appearance, accumulation and elimination of each of these molecules in body fluids and tissues might be extremely variable; this prompts the need for a rapid and versatile analytical protocol for the biological monitoring of possible exposure of workers involved in the manipulation, administration and disposal of cancer chemotherapeutic drugs. In this paper we describe the development, optimization and validation of a UHPLC-MS/MS method for the simultaneous quasi-quantitative analysis of eight widely used antineoplastic drugs, which can be used for the analysis of both urine and blood samples. This methodology was applied to the biological monitoring of healthcare workers exposed to different extents to antiblastic drugs at the University Hospital "San Giovanni di Dio e Ruggi d'Aragona" in Salerno (Italy), and allowed to identify two subjects exposed to irinotecan out of a total of fifteen workers analyzed.
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Affiliation(s)
- Viviana Izzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy; University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Bruno Charlier
- Postgraduate School in Hospital Pharmacy, University of Salerno, Fisciano, Salerno, Italy; University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Elena Bloise
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Marine Pingeon
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy
| | - Marianna Romano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy
| | - Antonietta Finelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy
| | - Alfonso Vietri
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy; University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Valentina Manzo
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Postgraduate School in Clinical Pharmacology and Toxicology, University of Salerno, Fisciano, Salerno, Italy
| | - Maria Alfieri
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy; University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Fabrizio Dal Piaz
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Salerno, Italy; University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
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Medical Surveillance for Hazardous Drugs: A Qualitative Assessment of Current Practices. J Occup Environ Med 2017; 60:521-527. [PMID: 29200189 DOI: 10.1097/jom.0000000000001238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The National Institute for Occupational Safety and Health recommends that institutions establish a medical surveillance program for workers who handle hazardous drugs. Our aim was to investigate current practices with occupational medicine practice (OMP) national leaders. METHODS A series of qualitative telephone interviews were conducted with 11 OMP national leaders from medical centers in 10 states. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes. RESULTS All respondents were board-certified physicians in medical center OMP. Interviews up to 45 minutes found three themes: policy interpretation, benefits and barriers to surveillance, and potential respondent-generated solutions. Three of 10 medical centers provided medical surveillance. CONCLUSIONS Medical surveillance for hazardous drugs is infrequent, and consensus is lacking regarding standard practices. Further work is needed to minimize risk to health care workers.
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Cruickshank S, Henry R. Foreword. ACTA ACUST UNITED AC 2017; 26:S3-S4. [PMID: 28981321 DOI: 10.12968/bjon.2017.26.sup16b.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a significant body of evidence describing the benefits of using systemic anti-cancer therapy (SACT) agents, such as chemotherapy, biological, hormone and antibiotics, to treat people diagnosed with cancer (Cancer Research UK, 2017). However, the potential improvements in survival outcomes must be regularly weighed against the risk of adverse health effects associated with exposure to them. For patients, the risks are balanced against the need to treat the cancer. For health professionals, the risks simply result from the occupational exposure that can occur when caring for patients receiving these drugs. Collectively referred to as cytotoxic agents, SACTs are known to be toxic; they are considered carcinogenic to humans, and are classified as hazardous (National Institute for Occupational Safety and Health (NIOSH), 2010).
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Affiliation(s)
- Susanne Cruickshank
- Associate Professor of Cancer Nursing, Faculty of Health Sciences and Sport, University of Stirling, and Chair, Royal College of Nursing (RCN) Cancer and Breast Care Forum
| | - Richard Henry
- President, UK Oncology Nursing Society (UKONS) and Lecturer in Cancer Nursing, Queen's University, Belfast
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Field A, Hughes G, Rowland S. A strategy for formulating regulation on CSTDs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S15-S22. [PMID: 28981323 DOI: 10.12968/bjon.2017.26.sup16b.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article identifies what steps need to be taken to ensure the mandatory use of closed system transfer devices by all health professionals involved in the hazardous drug journey.
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Affiliation(s)
- Allison Field
- Lead Chemotherapy Nurse, Dudley Group NHS Foundation Trust
| | - Gemma Hughes
- Clinical Nurse Educator, Heart of England NHS Foundation Trust
| | - Sarah Rowland
- Chemotherapy and IV Access Clinical Nurse Specialist, Cardiff and Vale University Health Board
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Meade E, Simons A, Toland S. The need for national mandatory guidance on CSTDs. ACTA ACUST UNITED AC 2017; 26:S5-S14. [DOI: 10.12968/bjon.2017.26.sup16b.s5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Meade
- Advanced Nurse Practitioner in Oncology, HSE Dublin Mid Leinster, Midland Regional Hospital Tullamore, Ireland
| | - Alison Simons
- Senior Lecturer, Pathway Leader Haematology and Cancer Care, Birmingham City University, UK
| | - Samantha Toland
- Lead Chemotherapy Nurse, Worcestershire Acute Hospitals NHS Trust, UK
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Roussel C, Witt KL, Shaw PB, Connor TH. Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 781:207-217. [PMID: 31416576 DOI: 10.1016/j.mrrev.2017.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/15/2022]
Abstract
Many antineoplastic drugs used to treat cancer, particularly alkylating agents and topoisomerase inhibitors, are known to induce genetic damage in patients. Elevated levels of chromosomal aberrations, micronuclei, and DNA damage have been documented in cancer patients. Elevations in these same biomarkers of genetic damage have been reported in numerous studies of healthcare workers, such as nurses and pharmacists, who routinely handle these drugs, but results vary across studies. To obtain an overall assessment of the exposure effect, we performed a meta-analysis on data obtained from peer-reviewed publications reporting chromosomal aberration levels in healthcare workers exposed to antineoplastic drugs. A literature search identified 39 studies reporting on occupational exposure to antineoplastic drugs and measurement of chromosomal aberrations in healthcare workers. After applying strict inclusion criteria for data quality and presentation, data from 17 studies included in 16 publications underwent meta-analysis using Hedges' bias-corrected g and a random-effects model. Results showed the level of chromosomal aberrations in healthcare workers exposed to antineoplastic drugs was significantly higher than in controls. The standardized mean differences (difference of means divided by within sd) from all studies were pooled, yielding a value 1.006 (unitless) with p<0.001. Thus, in addition to the documented genotoxic effects of antineoplastic drugs in cancer patients, this meta-analysis confirmed a significant association between occupational exposure to antineoplastics during the course of a normal work day and increases in chromosomal aberrations in healthcare workers. Based on the studies reviewed, we were unable to accurately assess whether appropriate use of protective measures might reduce the incidence of genetic damage in healthcare workers. However, given the potential for increased cancer risk linked to increases in chromosomal aberrations, the results of this study support the need to limit occupational exposure of healthcare workers to antineoplastic drugs as much as possible.
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Affiliation(s)
- Christine Roussel
- Doylestown Hospital, 595 West State Street, Doylestown, PA, 18901, United States.
| | - Kristine L Witt
- Biomolecular Screening Branch, National Institute of Environmental Health Sciences/Division of the National Toxicology Program, Research Triangle Park, NC, 27709, United States.
| | - Peter B Shaw
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
| | - Thomas H Connor
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
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Bayraktar-Ekincioglu A, Korubük G, Demirkan K. An evaluation of chemotherapy drug preparation process in hospitals in Turkey - A pilot study. J Oncol Pharm Pract 2017; 24:563-573. [PMID: 28728495 DOI: 10.1177/1078155217720007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the practice differences among chemotherapy units and the opinions of pharmacists on safety precautions for handling antineoplastic drugs in hospitals. METHOD The survey was administered to hospital pharmacists in Turkey. The pharmacists who work in chemotherapeutic drug preparation units were asked to participate if they are volunteered. The participating pharmacists were asked questions about the type of chemotherapy units, order and verification process of chemotherapy protocols and potential shortcomings of chemotherapy preparation. The questions were initially assessed in a small sample of pharmacists and subsequently revised and refined. The filled and returned questionnaires were accepted as given consent. RESULTS A total of 97 questionnaires were delivered and 40 (41%) were returned by pharmacists. The median age and practicing years in hospitals of the pharmacists were 38.0 and 6.25 years, respectively. Fully automated chemotherapy units were used by 42.5% of respondents, whereas 30% prepare chemotherapeutics manually; furthermore, 87.5% provide chemotherapeutic drug preparations (admixtures) less than 120 per day. With regard to the drug preparation process, more than half of the respondents 'always' use protective equipment without foot covers (32.3%). Almost 90% of respondents 'always' use a coat, mask and biological safety cabinets; however, 20% of respondents 'often' use closed-system drug transfer sets. More than 50% of pharmacists expressed that they have sufficient knowledge on cytotoxics and the risk of exposure, protective precautions, selection and usage of personal protective equipment and correct storage of cytotoxics. CONCLUSION Pharmacists acknowledge sufficient understanding of safe preparation and handling of chemotherapeutics, but reported practices by pharmacists in hospitals are not consistent with published recommendations. Providing theoretical and practical educations for pharmacists and developing standard procedures for preparing chemotherapy may be beneficial in improving the preparation and use of antineoplastics in Turkey.
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Affiliation(s)
| | - Gamze Korubük
- 2 Hacettepe University Hospitals, Oncology Hospital Pharmacy, Sihhiye-Ankara, Turkiye
| | - Kutay Demirkan
- 1 Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Sihhiye-Ankara, Turkiye
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DeJoy DM, Smith TD, Woldu H, Dyal MA, Steege AL, Boiano JM. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:485-493. [PMID: 28326998 DOI: 10.1080/15459624.2017.1285496] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Antineoplastic drugs pose risks to the healthcare workers who handle them. This fact notwithstanding, adherence to safe handling guidelines remains inconsistent and often poor. This study examined the effects of pertinent organizational safety practices and perceived safety climate on the use of personal protective equipment, engineering controls, and adverse events (spill/leak or skin contact) involving liquid antineoplastic drugs. Data for this study came from the 2011 National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers which included a sample of approximately 1,800 nurses who had administered liquid antineoplastic drugs during the past seven days. Regression modeling was used to examine predictors of personal protective equipment use, engineering controls, and adverse events involving antineoplastic drugs. Approximately 14% of nurses reported experiencing an adverse event while administering antineoplastic drugs during the previous week. Usage of recommended engineering controls and personal protective equipment was quite variable. Usage of both was better in non-profit and government settings, when workers were more familiar with safe handling guidelines, and when perceived management commitment to safety was higher. Usage was poorer in the absence of specific safety handling procedures. The odds of adverse events increased with number of antineoplastic drugs treatments and when antineoplastic drugs were administered more days of the week. The odds of such events were significantly lower when the use of engineering controls and personal protective equipment was greater and when more precautionary measures were in place. Greater levels of management commitment to safety and perceived risk were also related to lower odds of adverse events. These results point to the value of implementing a comprehensive health and safety program that utilizes available hazard controls and effectively communicates and demonstrates the importance of safe handling practices. Such actions also contribute to creating a positive safety climate.
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Affiliation(s)
- David M DeJoy
- a Department of Health Promotion and Behavior, College of Public Health , University of Georgia , Athens , Georgia
| | - Todd D Smith
- b Department of Applied Health Science, School of Public Health , Indiana University , Bloomington , Indiana
| | - Henok Woldu
- c Department of Epidemiology and Biostatistics, College of Public Health , University of Georgia , Athens , Georgia
| | - Mari-Amanda Dyal
- d Department of Health Promotion and Physical Education , Kennesaw State University , Marietta , Georgia
| | - Andrea L Steege
- e Division of Surveillance, Hazard Evaluations and Field Studies , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Cincinnati , Ohio
| | - James M Boiano
- e Division of Surveillance, Hazard Evaluations and Field Studies , National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Cincinnati , Ohio
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Warembourg C, Cordier S, Garlantézec R. An update systematic review of fetal death, congenital anomalies, and fertility disorders among health care workers. Am J Ind Med 2017; 60:578-590. [PMID: 28514021 DOI: 10.1002/ajim.22711] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Health care workers (HCWs) are occupationally exposed to various hazards, some associated with adverse pregnancy outcomes in previous reviews. This systematic review aims at synthesizing the recent literature on occupational exposures among HCWs related to fetal death, congenital anomalies, and fertility disorders. METHODS We searched the Medline database from 2000 to 2015 for articles about all potential occupational exposures of women and men working in this sector. RESULTS We retained 32 studies, most of them (n = 30) among women HCWs. Studies based on job title reported excess risks of some congenital anomalies (especially nervous and musculoskeletal systems) among HCWs compared to non-HCWs but no evidence about fetal death. Excess risks associated with specific exposures includes reports of some congenital anomalies for women exposed to anesthetic gases. Exposure to some sterilizing agents and, with less evidence, to antineoplastic drugs and to ionizing radiation, is associated with increased risks of miscarriage but not stillbirth. Strenuous work schedules appear to be associated with fertility disorders, but the evidence is limited. Only a few studies have been published since 2000 about non-ionizing radiation, or about fertility disorders related to chemical or physical agents, or about male HCWs. CONCLUSIONS Despite the establishment of recommendations to limit exposures of HCWs, some excess risks of adverse pregnancy outcomes are still reported and need to be explained.
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Affiliation(s)
- Charline Warembourg
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
| | - Sylvaine Cordier
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
| | - Ronan Garlantézec
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
- Service de santé publique et d’épidémiologie; CHU de Rennes; Rennes France
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Topçu S, Beşer A. Oncology nurses' perspectives on safe handling precautions: a qualitative study. Contemp Nurse 2017; 53:271-283. [PMID: 28387169 DOI: 10.1080/10376178.2017.1315828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Oncology nurses can be exposed to hazardous drugs during their preparation, administration, transfer and storage and elimination of their waste. AIM This study was directed towards describing attitudes, opinions and experiences of nurses administering these drugs about safe handling precautions. METHODS A qualitative study design was used. Fifteen nurses working for at least three months involved in preparation, administration and transfer of antineoplastic drugs and management of wastes. FINDINGS Experiences, viewpoints and attitudes of nurses about safe handling precautions were analyzed in accordance with basic components of Health Belief Model. CONCLUSIONS Based on experiences, viewpoints and attitudes emphasized most by nurses, the most important factors about safe handling precautions were perceived barriers and cues to action. As well as heavy work schedules and high number of patients per nurse, lack of equipment and insufficient knowledge were found to be barriers to taking safe handling precautions.
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Affiliation(s)
- Sevcan Topçu
- a Public Health Nursing , Ege University , Izmir , Turkey
| | - Ayşe Beşer
- b Public Health Nursing, School of Nursing , Koc University, Istanbul , Turkey
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Zimmer J, Hartl S, Standfuß K, Möhn T, Bertsche A, Frontini R, Neininger MP, Bertsche T. Handling of hazardous drugs - Effect of an innovative teaching session for nursing students. NURSE EDUCATION TODAY 2017; 49:72-78. [PMID: 27889581 DOI: 10.1016/j.nedt.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/22/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Imparting knowledge and practical skills in hazardous drug handling in nursing students' education is essential to prevent hazardous exposure and to preserve nurses' health. OBJECTIVES This study aimed at comparing routine nursing education with an additional innovative teaching session. DESIGN A prospective controlled study in nursing students was conducted in two study periods: (i) a status-quo period (routine education on handling hazardous drugs) followed by (ii) an intervention period (additional innovative teaching session on handling hazardous drugs). SETTINGS/PARTICIPANTS Nursing students at a vocational school were invited to participate voluntarily. METHODS In both study periods (i) and (ii), the following factors were analysed: (a) knowledge of hazardous drug handling by questionnaire, (b) practical skills in hazardous drug handling (e.g. cleaning) by a simulated handling scenario, (c) contamination with drug residuals on the work surface by fluorescent imaging. RESULTS Fifty-three nursing students were enrolled. (a) Median knowledge improved from status-quo (39% right answers) to intervention (65%, p<0.001), (b) practical skills improved from status-quo (53% of all participants cleaned the work surface) to intervention (92%, p<0.001). (c) Median number of particles/m2 decreased from status-quo to intervention (932/97, p<0.001). CONCLUSIONS Compared with routine education, knowledge and practical skills in hazardous drug handling were significantly improved after an innovative teaching session. Additionally, the amount of residuals on the work surface decreased. This indicates a lower risk for hazardous drug exposure.
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Affiliation(s)
- Janine Zimmer
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Eilenburger Str. 15a, 04317 Leipzig, Germany; Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Stefanie Hartl
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Eilenburger Str. 15a, 04317 Leipzig, Germany; Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Katrin Standfuß
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Eilenburger Str. 15a, 04317 Leipzig, Germany; Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Till Möhn
- Faculty of Physics and Earth Sciences, Institute of Experimental Physics I, Linnéstraße 5, 04103, Leipzig University, Leipzig, Germany.
| | - Astrid Bertsche
- Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research, University of Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany.
| | - Roberto Frontini
- Pharmacy Department and Drug Safety Center, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany.
| | - Martina P Neininger
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Eilenburger Str. 15a, 04317 Leipzig, Germany
| | - Thilo Bertsche
- Department of Clinical Pharmacy and Drug Safety Center, University of Leipzig, Eilenburger Str. 15a, 04317 Leipzig, Germany.
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He B, Mendelsohn-Victor K, McCullagh M, Friese C. Personal Protective Equipment Use and Hazardous Drug Spills Among Ambulatory Oncology Nurses. Oncol Nurs Forum 2017; 44:60-65. [PMID: 28067030 PMCID: PMC5225785 DOI: 10.1188/17.onf.60-65] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose/Objectives To examine patterns and organizational correlates of personal protective equipment (PPE) use and hazardous drug spills. Design Cross-sectional mailed survey. Setting Ambulatory practices in California, Georgia, and Michigan. Sample 252 Oncology Nursing Society members who administer hazardous drugs. Methods Bivariate and multivariable regression analyses. Main Research Variables Outcomes were PPE use and hazardous drug spills. Covariates included nursing workloads, nurses’ practice environments, and barriers to PPE use. Findings Twenty-six percent reported a recent drug spill, and 90% wore only one pair of chemotherapy-tested gloves. Increased PPE use was associated with increased nurse participation in practice affairs, nonprivate ownership, increased nursing workloads, and fewer barriers to PPE use. Spills were associated with significantly less favorable manager leadership and support and higher workloads. Conclusions Drug spills occur often in ambulatory settings. PPE use remains low, and barriers to PPE use persist. Higher workloads are associated with more drug spills. Implications for Practice Managers should monitor and correct aberrant workloads and ensure that PPE is available and that staff are trained.
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Graeve C, McGovern PM, Arnold S, Polovich M. Testing an Intervention to Decrease Healthcare Workers' Exposure to Antineoplastic Agents. Oncol Nurs Forum 2017; 44:E10-E19. [PMID: 27991608 DOI: 10.1188/17.onf.e10-e19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To develop and test a worksite intervention that protects healthcare workers who handle antineoplastic drugs from work-related exposures.
. DESIGN Intervention study.
. SETTING A university hospital in a large midwestern metropolitan area and its outpatient chemotherapy infusion clinic.
. SAMPLE 163 staff (nurses, pharmacists, and pharmacy technicians) who work with antineoplastic agents.
. METHODS A self-report survey measured workplace and individual factors to assess use of personal protective equipment (PPE). Wipe samples were tested for surface contamination. An intervention incorporating study findings and worker input was developed.
. MAIN RESEARCH VARIABLES PPE use was the dependent variable, and the independent variables included knowledge of the hazard, perceived risk, perceived barriers, interpersonal influence, self-efficacy, conflict of interest, and workplace safety climate.
. FINDINGS PPE use was lower than recommended and improved slightly postintervention. Self-efficacy and perceived risk increased on the post-test survey. Chemical residue was found in several areas. Awareness of safe-handling precautions improved postintervention. The unit where nurses worked was an important predictor of safety climate and PPE use on the pretest but less so following the intervention.
. CONCLUSIONS Involving staff in developing an intervention for safety ensures that changes made will be feasible. Units that implemented workflow changes had decreased contamination.
. IMPLICATIONS FOR NURSING Worksite analysis identifies specific targets for interventions to improve antineoplastic drug handling safety.
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Colvin CM, Karius D, Albert NM. Nurse Adherence to Safe-Handling Practices: Observation Versus Self-Assessment. Clin J Oncol Nurs 2016; 20:617-622. [PMID: 27857252 DOI: 10.1188/16.cjon.617-622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy medications place nurses at risk for occupational exposure, a primary nursing safety concern. No literature was available on adherence to following chemotherapy handling practices and nurses' perceptions of safe-handling practices. OBJECTIVES The aims of the pilot study were to examine actual and subjective ambulatory oncology nurse adherence to chemotherapy safe-handling guideline recommendations that prevent chemotherapy exposure. METHODS A prospective, comparative mixed-methods study was used to compare objective and subjective nurse behaviors of expected safe chemotherapy handling-specifically, micro-ethnography and questionnaires. Fisher's exact test was used to assess differences in the rates of observations and questionnaire responses. FINDINGS Twenty-two cases of chemotherapy handling were observed, and 12 of 33 nurses completed self-assessments. Of observed practices, nurses completed three behaviors 100% of the time (disposing of gloves in a chemotherapy-approved container after initiating chemotherapy, discarding the chemotherapy bag and tubing after disconnecting chemotherapy infusions, and washing hands after chemotherapy was administered). When objective and subjective behavior adherence were compared, three behaviors were carried out with greater frequency than what nurses perceived on questionnaires (double gloving and gowning when disconnecting chemotherapy and properly discarding chemotherapy). Two behaviors were carried out with less frequency than nurses provided on questionnaires (double gloving and protecting work surfaces during administration).
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Graeve CU, McGovern PM, Alexander B, Church T, Ryan A, Polovich M. Occupational Exposure to Antineoplastic Agents. Workplace Health Saf 2016; 65:9-20. [DOI: 10.1177/2165079916662660] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Approximately 8 million health care workers are unnecessarily exposed to highly toxic drugs used to treat cancer; antineoplastic drugs can contribute to negative health effects for these workers. The drugs have been detected in the urine of workers and on the floors and counters of worksites. Safety precautions that could reduce the risk of exposure are underutilized. This cross-sectional study of 163 oncology health care workers used a survey to measure workplace and individual factors, and environmental sampling to measure surface contamination. The study objective was to identify potential exposures to antineoplastic drugs and factors influencing safety behavior. Personal protective equipment (PPE) use was lower than recommended; unit of employment was significantly associated with PPE use. Chemical residue from antineoplastic drugs was found, revealing potential exposures. Workplace safety must be a higher organizational priority. The contamination of common work areas where PPE use is not expected was of utmost concern.
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Zhang J, Bao J, Wang R, Geng Z, Chen Y, Liu X, Xie Y, Jiang L, Deng Y, Liu G, Xu R, Miao L. A multicenter study of biological effects assessment of pharmacy workers occupationally exposed to antineoplastic drugs in Pharmacy Intravenous Admixture Services. JOURNAL OF HAZARDOUS MATERIALS 2016; 315:86-92. [PMID: 27179702 DOI: 10.1016/j.jhazmat.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 05/11/2023]
Abstract
This multi-centered study was designed to evaluate the biological effects of exposure to antineoplastic drugs (ADs) at PIVAS (Pharmacy Intravenous Admixture Service) across ten Chinese hospitals. 8-hydroxy-2-deoxyguanosine (8-OHdG) was used as a biomarker of DNA oxidative damage and lymphocyte apoptosis assays using peripheral lymphocyte cells were used to detect primary DNA damage. The mutagenicity activity was estimated with the Ames fluctuation test. 158 exposed and 143 unexposed workers participated in this study. The urinary 8-OHdG/Cr concentrations of the exposed group was 22.05±17.89ng/mg Cr, which was significantly higher than controls of 17.36±13.50ng/mg Cr (P<0.05). The rate of early lymphocyte apoptosis was slightly increased in exposed group than that of the control group (P=0.087). The mutagenic activity was significantly higher in the exposed group relative to the control group (P<0.05). Moreover, while no statistically significant difference was observed, higher concentrations of 8-OHdG/Cr in urine and an early lymphocyte apoptosis rate were found in exposed group II as compared to exposed group I. In addition, a significant correlation between early lymphocyte apoptosis and exposure time to ADs was also observed (P<0.05). In conclusion, our study identified elevated biomarkers in PIVAS workers exposed to ADs. However whether these findings could lead to increased incidence of genotoxic responses remains to be further investigated.
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Affiliation(s)
- Jingjing Zhang
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China
| | - Jianan Bao
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China
| | - Renying Wang
- Sun Yan-Sen University Cancer Center, Guangzhou 510060, PR China
| | - Zhou Geng
- The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, PR China
| | - Yao Chen
- First People's Hospital of Yunnan Province, Kunming 650034, Yunnan, PR China
| | - Xinchun Liu
- Qilu Hospital of Shandong University, Jinan 250002, Shandong, PR China
| | - Yongzhong Xie
- Huangshan City People's Hospital, Huangshan 245000, Anhui, PR China
| | - Ling Jiang
- Anhui Provincial Hospital, Hefei 230001, Anhui, PR China
| | - Yufei Deng
- Wuxi No.2 People's Hospital, Wuxi 214002, Jiangsu, PR China
| | - Gaolin Liu
- Shanghai General Hospital, Shanghai 200080, PR China
| | - Rong Xu
- Shanghai Sixth People's Hospital, Shanghai 200233, PR China
| | - Liyan Miao
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China.
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Eisenberg S. A Call to Action for Hazardous Drug Safety: Where We Have Been and Where We Are Now. Clin J Oncol Nurs 2016; 20:20-4AP. [DOI: 10.1188/16.cjon.20-04ap] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hon CY, Abusitta D. Causes of Health Care Workers' Exposure to Antineoplastic Drugs: An Exploratory Study. Can J Hosp Pharm 2016; 69:216-23. [PMID: 27403001 DOI: 10.4212/cjhp.v69i3.1558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The exposure of health care workers to antineoplastic drugs is associated with several adverse health effects, including reproductive toxicities and mutagenic effects. Recent studies have confirmed that Canadian health care workers are at risk of exposure to these agents. However, the causes leading to occupational exposure to antineoplastic drugs are unknown. OBJECTIVE To perform an exploratory study to ascertain the immediate and contributing causes of health care workers' exposure to antineoplastic drugs. METHODS Participants were recruited from 6 acute care facilities in Vancouver, British Columbia. Those agreeing to participate were asked to complete a questionnaire about previous exposure to antineoplastic drugs while at work and to describe the circumstances of each exposure incident. Responses were qualitatively analyzed, and the causes of each incident were classified as immediate (unsafe work acts and/or unsafe working conditions) or contributing (related to the management of the organization, the environment, and/or the physical and mental status of the worker). RESULTS Completed questionnaires were received from 120 participants, 18 (15.0%) of whom reported having had previous occupational exposure to antineoplastic drugs. Qualitative analysis of the responses showed 4 categories of immediate causes (needlestick injury, spill, direct contact, and other unintended exposure) and 3 categories of contributing causes (poor communication, inadequate controls, and lack of training). Some incidents had multiple immediate and/or contributing causes. CONCLUSIONS According to a review of the immediate and contributing causes identified in this study, many of the exposure incidents were deemed preventable. A "hierarchy of controls" should be implemented, including (in the following order) engineering controls, administrative controls, and personal protective equipment. The findings of this study can be used to develop job safety analyses, which can in turn be adopted in guidelines for safe handling of hazardous drugs. Future similar studies are suggested to ensure the generalizability of results.
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Affiliation(s)
- Chun-Yip Hon
- PhD, CPHI(C), CRSP, CIH, is an Assistant Professor in the School of Occupational and Public Health, Ryerson University, Toronto, Ontario
| | - Dina Abusitta
- BSc, was, at the time of this study, an Occupational Health and Safety student in the School of Occupational and Public Health, Ryerson University, Toronto, Ontario
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73
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Comments Regarding Masroor et al: Perceptions and Barriers to Universal Gloving for Infection Prevention. Infect Control Hosp Epidemiol 2016; 37:488. [PMID: 26818822 DOI: 10.1017/ice.2016.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Böhlandt A, Schierl R. Benefits of Wipe Sampling: Evaluation of Long-Term 5-Fluorouracil and Platinum Monitoring Data. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2016. [DOI: 10.1515/pthp-2016-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractObjectives:The aim of this study was to evaluate environmental contamination levels from a large dataset of long-term monitoring data of 5-fluorouracil and platinum-containing drugs in pharmacies, and to investigate the contaminations over 15 years.Methods:Wipe sampling for 5-fluorouracil and platinum (marker for cis-, carbo- and oxaliplatin) was performed on-site from various surfaces in hospital and retail pharmacies with a validated sampling procedure over a period of 15 years. The 5-fluorouracil concentrations were quantified by GCMSMS and platinum concentrations by voltammetry. Statistical evaluation was performed with respect to sampling locations and years, and over the course of time.Results:Overall, 3,584 wipe samples for 5-fluorouracil and 2,955 wipe samples for platinum were analysed and contamination was detected at all surface types in all 151 examined pharmacies with ranges from ND (not detectable) to 1,725,000 pg/cm² and ND to 23,068 pg/cm², respectively. Median concentrations from the different locations ranged between ND and 4.3 pg/cm² (5-fluorouracil) and 0.2 and 1.8 pg/cm² (platinum) with highest loads inside the biological safety cabinets/isolators and storage areas. Evaluation of contamination over the course of 15 years showed a substantial decrease, especially in the years after introduction of guidance values.Conclusions:Long-term evaluation of surface wipe samples for antineoplastic drug contamination with repeated monitoring seems to be a beneficial tool to characterize the actual exposure situation and to assess surface contamination over time. Wipe sampling is a suitable control means to evaluate the work practices and the effectiveness of applied safety and hygiene measures and to identify the potential exposure risk for health care workers.
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Silver SR, Steege AL, Boiano JM. Predictors of adherence to safe handling practices for antineoplastic drugs: A survey of hospital nurses. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2016; 13:203-212. [PMID: 26556549 DOI: 10.1080/15459624.2015.1091963] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite growing awareness of the hazards of exposure to antineoplastic drugs (ADs), surveys continue to find incomplete adherence to recommended safe handling guidelines. A 2011 survey of healthcare workers presents an opportunity to examine factors associated with adherence among 1094 hospital nurses who administered ADs. Data for these hypothesis-generating analyses were taken from an anonymous, web-based survey of healthcare workers. Regression modeling was used to examine associations between a number of predictors (engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE); activities performed with gloves previously worn to administer ADs; and spills of ADs. Adherence to safe handling guidelines was not universal, and AD spills were reported by 9.5% of nurses during the week prior to the survey. Familiarity with safe handling guidelines and training in safe handling were associated with more reported PPE use. Nurse-perceived availability of PPE was associated with more reported PPE use and lower odds of reported spills. Use of closed system drug-transfer devices and luer-lock fittings also decreased the odds of self-reported AD spills, while more frequent AD administration increased the risk. AD administration frequency was also associated with performing more activities with gloves previously worn to administer ADs, and nurse perception of having adequate time for taking safety precautions with fewer such activities. The results suggest that training and familiarity with guidelines for safe handling of ADs, adequate time to adhere to guidelines, and availability of PPE and certain engineering controls are key to ensuring adherence to safe handling practices. Further assessment of training components and engineering controls would be useful for tailoring interventions targeting these areas.
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Affiliation(s)
- Sharon R Silver
- a Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health , Cincinnati , Ohio
| | - Andrea L Steege
- a Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health , Cincinnati , Ohio
| | - James M Boiano
- a Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health , Cincinnati , Ohio
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Casalino E, Astocondor E, Sanchez JC, Díaz-Santana DE, del Aguila C, Carrillo JP. Personal protective equipment for the Ebola virus disease: A comparison of 2 training programs. Am J Infect Control 2015; 43:1281-7. [PMID: 26277572 DOI: 10.1016/j.ajic.2015.07.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/29/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Personal protective equipment (PPE) for preventing Ebola virus disease (EVD) includes basic PPE (B-PPE) and enhanced PPE (E-PPE). Our aim was to compare conventional training programs (CTPs) and reinforced training programs (RTPs) on the use of B-PPE and E-PPE. METHODS Four groups were created, designated CTP-B, CTP-E, RTP-B, and RTP-E. All groups received the same theoretical training, followed by 3 practical training sessions. RESULTS A total of 120 students were included (30 per group). In all 4 groups, the frequency and number of total errors and critical errors decreased significantly over the course of the training sessions (P < .01). The RTP was associated with a greater reduction in the number of total errors and critical errors (P < .0001). During the third training session, we noted an error frequency of 7%-43%, a critical error frequency of 3%-40%, 0.3-1.5 total errors, and 0.1-0.8 critical errors per student. The B-PPE groups had the fewest errors and critical errors (P < .0001). CONCLUSION Our results indicate that both training methods improved the student's proficiency, that B-PPE appears to be easier to use than E-PPE, that the RTP achieved better proficiency for both PPE types, and that a number of students are still potentially at risk for EVD contamination despite the improvements observed during the training.
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Meade E. Use of closed-system drug transfer devices in the handling and administration of MABs. ACTA ACUST UNITED AC 2015; 24:S21-7. [DOI: 10.12968/bjon.2015.24.sup16a.s21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Meade
- Registered Advanced Nurse Practitioner in Oncology, HSE Dublin Mid Leinster, Midland Regional Hospital Tullamore, County Offaly, Republic of Ireland
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78
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Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F, Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey. Eur J Surg Oncol 2015; 41:1361-7. [PMID: 26263848 DOI: 10.1016/j.ejso.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.
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Affiliation(s)
- G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France.
| | - L Simon
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France; INSERM, U 965, Paris, France
| | - L Gladieff
- Department of Medical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - J M Bereder
- Department of General Surgery, Archet 2 University Hospital, Nice, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - F Bibeau
- Department of Pathology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - N Goasguen
- Department of General Surgery, Diaconesses Croix Saint Simon Group Hospital, Paris, France
| | - L Gouthi
- Department of Digestive Surgery, Purpan University Hospital, Toulouse, France
| | - B Heyd
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - R Kianmanesh
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - E Leblanc
- Department of Gynaecological Surgery, Oscar Lambret Cancer Center, Lille, France
| | - V Loi
- Department of Digestive Surgery, Tenon University Hospital, Paris, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Cancer Center, Angers, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - S Msika
- Department of Surgery, Louis Mourier University Hospital, Colombes, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J Paineau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - N Pirro
- Department of Digestive Surgery, Timône University Hospital, Marseille, France
| | - C Pomel
- Department of Surgical Oncology, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France
| | - J Porcheron
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - G Pourcher
- Department of General Surgery, Antoine-Béclère University Hospital, Clamart, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J M Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - E Thibaudeau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J J Torrent
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Tougeron
- Department of Hepato-Gastroenterology, University Hospital, Poitiers, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - F Zinzindohoue
- Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France
| | - P Lundberg
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - F Herin
- Department of Occupational Medicine, University Hospital, Toulouse, France
| | - L Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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Hon CY, Teschke K, Shen H. Health Care Workers' Knowledge, Perceptions, and Behaviors Regarding Antineoplastic Drugs: Survey From British Columbia, Canada. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:669-677. [PMID: 25897641 DOI: 10.1080/15459624.2015.1029618] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although nurses are knowledgeable regarding the risk of exposure to antineoplastic drugs, they often do not adhere with safe work practices. However, the knowledge, perceptions, and behavior of other health care job categories at risk of exposure has yet to be determined. This study aimed to survey a range of health care workers from British Columbia, Canada about their knowledge, perceptions, and behaviors regarding antineoplastic drugs. A self-administered questionnaire was sent to participants querying the degree of contact with antineoplastics, knowledge of risks associated with antineoplastics, perceptions of personal risk, previous training with respect to antineoplastics, and safe work practices. Subjects were recruited from health care facilities in and around Vancouver. Fisher's exact tests were performed to ascertain whether there were differences in responses between job categories. We received responses from 120 participants representing seven different job categories. Pharmacists, pharmacy technicians, and nurses were more knowledgeable regarding risks than other job categories examined (statistically significant difference). Although 80% of respondents were not afraid of working with or near antineoplastics, there were concerns about the suitability of current control measures and practices employed by co-workers. Only half of respondents felt confident that they could handle all situations where there was a potential for exposure. Only one of the perception questions, self-perceived risk of exposure to antineoplastic drugs, differed significantly between job categories. Not all respondents always wore gloves when directly handling antineoplastic drugs. Further, hand hygiene was not regularly practiced after glove usage or after being in an area where antineoplastic drugs are handled. The majority of responses to questions related to safe work practices differed significantly between job categories. Our results suggest that knowledge regarding risks associated with antineoplastic drugs can be improved, especially among job categories that are not tasked with drug preparation or drug administration. There is also a gap between knowledge and compliance with glove usage and hand hygiene.Training is also recommended to improve health care workers' perceptions of the risks associated with antineoplastic drugs.
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Affiliation(s)
- Chun-Yip Hon
- a School of Occupational and Public Health, Ryerson University , Toronto , Ontario , Canada
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Boiano JM, Steege AL, Sweeney MH. Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:588-602. [PMID: 25897702 DOI: 10.1080/15459624.2015.1029610] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine self-reported use of engineering, administrative, and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procedures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring, and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions, and report any safety concerns.
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Affiliation(s)
- James M Boiano
- a Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health Centers for Disease Control and Prevention , Cincinnati , Ohio
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