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Cheng J, Yuan M, Zhang S, Xiao Q, Zhou Q, Huang X. Latent class analysis of healthcare workers' knowledge, attitudes, and practice levels, and risk factors regarding associated with occupational exposure to antineoplastic drugs: A multicenter cross-sectional study. Medicine (Baltimore) 2024; 103:e38400. [PMID: 38996165 PMCID: PMC11245233 DOI: 10.1097/md.0000000000038400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
The study investigated the health care workers' knowledge, attitudes, and practice levels regarding occupational protection against antineoplastic drugs (ADs) via analysis of latent classes and their influencing factors. A convenience sampling method was used to select healthcare workers from 7 hospitals in southern China between April and August 2023. A questionnaire based on literature analysis, brainstorming, and Delphi method was used to investigate the knowledge, practice, and attitudes of healthcare workers exposed to ADs for appropriate occupational protection intervention, followed by latent class analysis. The factors influencing latent classes were identified via single-factor analysis and multiple logistic regression. A total of 322 healthcare workers from departments using ADs were surveyed. The knowledge score associated with occupational protection against ADs was 31.95 ± 7.38. The attitude score was 21.08 ± 2.729, while the practice score was 36.54 ± 9.485. The overall score was 89.57 ± 15.497. The healthcare workers were divided into 4 latent classes based on their knowledge, attitude, and practice associated with occupational protection measures against ADs. Healthcare workers in the 4 categories showed significance differences based on professional title, marital status, educational background, and frequency of exposure to ADs (P < .05). The knowledge, attitude, and practice levels of healthcare workers engaged in ADs at work can be divided into 4 latent classes. Despite their increased awareness of the hazards associated with ADs and their attitudes toward protection, the healthcare workers displayed poor knowledge and implementation of occupational protection measures.
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Affiliation(s)
- Jintao Cheng
- Zunyi Medical University, Zunyi, China
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, China
| | - Meng Yuan
- Zunyi Medical University, Zunyi, China
| | | | | | - Qian Zhou
- Zunyi Medical University, Zunyi, China
| | - Xiaohong Huang
- Zunyi Medical University, Zunyi, China
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, China
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Campos D, Silva I, Rego M, Correia P, Moreira F. Characterization of education, technical practices and attitudes of Portuguese pharmacy technicians towards manipulation of cytotoxic drugs. J Oncol Pharm Pract 2024; 30:893-901. [PMID: 37489259 PMCID: PMC11179318 DOI: 10.1177/10781552231190025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
Pharmacy professionals that manipulate cytotoxic drugs need to undergo educational programs, adopt the most convenient practices, and use appropriate equipment to avoid, as far as possible, occupational exposure to cytotoxic drugs. The main goal of this work is to characterize the education, technical practices, and attitudes towards cytotoxic drugs, of Portuguese pharmacy technicians. A questionnaire comprising eleven questions deemed pertinent was elaborated and subsequently validated by a pilot test. The anonymous, web-based survey was conducted between December 2022 and January 2023, by graduated pharmacy technicians that had manipulated cytotoxic drugs between 2017 and 2022. A total of 77 pharmacy technicians responded to the survey. Although sixty-six pharmacy technicians (86%) had been trained before beginning to manipulate cytotoxic drugs, the promotion of regular post-admission training by the institutions is sparse - only assumed by 53% of the pharmacy technicians (n = 41). All participants reported using gloves and gown during manipulation and the use of double gloves was common (99%; n = 76). Compliances with the recommended limit time for uninterrupted manipulation activity (82%; n = 63) and systematic double-checking (86%; n = 66) were high, but the regular use of sterile gauze around syringe connection sites 58% (n = 45), was less frequent. None of the surveyed pharmacy technicians used closed-system transfer devices (CSTD) and 41 (53%) of those who used spikes did not thoughtfully use these devices. The implementation of regular training programs in manipulating cytotoxic drugs should be fostered, to promote the more judicious use of engineering controls and transversal adoption of the safest technical practices.
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Affiliation(s)
- Daniela Campos
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
| | - Inês Silva
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
| | - Mariana Rego
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
| | - Patrícia Correia
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
- Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
| | - Fernando Moreira
- Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
- Centro de Investigação em Saúde e Ambiente, Escola Superior de Saúde, Instituto Politécnico do Porto, Rua Dr António Bernardino de Almeida, Porto, Portugal
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Pirot C, Benoist H, Saint-Lorant G. Impact of lack of knowledge on risk perception and protective practices of home nurses handling antineoplastic drugs. J Oncol Pharm Pract 2024; 30:313-321. [PMID: 37151100 DOI: 10.1177/10781552231174181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Introduction: Health care workers handling antineoplastic drugs (ADs) are at risk of carcinogenic, mutagenic and reproductive toxic risks (CMR). The aim of this study was to assess the impact of the lack of knowledge (K) on risk perception (P) and on protective practices (PP) related to the handling of home-based chemotherapy (HC) by home nurses. Methods: This study was conducted in Normandy among home nurses. A questionnaire was developed to explore the K, P and PP related to handling ADs by home nurses working with four different providers from two hospitals. Results: Among the 28 home nurses included, 25.93% had received initial training on the specific treatment of ADs, 48.15% scored below average on risk management K, 52.00% scored below average on personal PP. Conclusion: This study reveals the importance of adapted and regular training on the handling of ADs. It will help develop a climate of safety and reinforce adherence to wearing personal protective equipment to protect health care workers from contamination.
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Affiliation(s)
- C Pirot
- Normandie University, UNICAEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
- CHU Caen, Department of Pharmacy, Avenue de la Côte de Nacre, CS, Caen, France
| | - H Benoist
- Normandie University, UNICAEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
- CHU Caen, Department of Pharmacy, Avenue de la Côte de Nacre, CS, Caen, France
| | - G Saint-Lorant
- Normandie University, UNICAEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
- CHU Caen, Department of Pharmacy, Avenue de la Côte de Nacre, CS, Caen, France
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Delafoy C, Benoist H, Vasseur M, Breuil C, Divanon F, Odou P, Simon N, Saint-Lorant G. Perception, knowledge, practices and training regarding the risk of exposure to antineoplastic drugs in three French compounding units. J Oncol Pharm Pract 2023; 29:1893-1906. [PMID: 36785934 DOI: 10.1177/10781552231156520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Healthcare workers are exposed to hazardous drugs such as antineoplastic drugs, which have potential carcinogenic, mutagenic and teratogenic effects. Protective measures must be taken after appropriate staff training to handle antineoplastic drugs in a safe way. The objective was to assess perception, knowledge, practices and training regarding the risk of exposure of healthcare workers in three French compounding units. METHODS This descriptive study was based on a questionnaire made of 33 questions divided into five sections related to the handling of antineoplastic drugs: perception of the risks, knowledge of the risks, protection practices, specific training and general questions. RESULTS Among the 39 participants, over half considered their overall risk of exposure to antineoplastic drugs not being very low. Inhalation was known to 69.2% of them as possible route of contamination. The breakroom was identified by 28.9% of them as a place of contamination. The procedure in case of accidental exposure to antineoplastic drugs was known by 69.2%, but only half could explain it. Only 38.5% said they changed their gloves every 30 min as recommended. Barely half said that they had been trained specifically for the handling of antineoplastic drugs during an initial training. Over half wished to be informed, trained and aware of the proper handling of antineoplastic drugs. CONCLUSION Although some of these results are encouraging, specifically when compared to the other settings where antineoplastic drugs are handled, there is still room for improvement. Efforts to build an adapted and impactful training program must pursue. CLINICAL TRIAL REGISTRATION Study CONTACT, ref. 19-504.
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Affiliation(s)
- Clémence Delafoy
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
| | - Hubert Benoist
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Cécile Breuil
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Fabienne Divanon
- Departement of Pharmacy, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - Pascal Odou
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Nicolas Simon
- ULR 7365-GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institute of Pharmacy, Institut de Pharmacie, CHU Lille, Lille, France
| | - Guillaume Saint-Lorant
- Department of Pharmacy, Centre Hospitalier Universitaire de Caen, Caen, France
- Aliments Bioprocédés Toxicologie Environnements, Normandie Univ, UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Caen, France
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Delafoy C, Benoist H, Patin A, Vasseur M, Guillouet S, Eveno C, Guilloit JM, Odou P, Simon N, Saint-Lorant G. Knowledge and practices about safe handling regarding the risk of exposure to antineoplastic drugs for caregivers in compounding units and in operating rooms performing HIPEC/PIPAC. J Oncol Pharm Pract 2023; 29:1628-1636. [PMID: 36514878 DOI: 10.1177/10781552221144303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Ever since the late 1970s, occupational exposure associated with the handling of antineoplastic drugs (ADs) in the healthcare environment has been highlighted and demonstrated. Contamination was detected in both operating rooms (OR) and compounding units (CU), where healthcare workers handle and are exposed to ADs in different ways. In the OR, the risk of exposure is higher and the staff receives less training in handling ADs than in the CU. This study aimed to assess and compare knowledge and practices about the safe handling of ADs by caregivers working in these two locations, namely the CU and OR. METHODS Two questionnaires (one each for the OR and CU) were created by two investigator pharmacists and were completed during a personal interview of 20 min. The questions were related to the following topics: training, knowledge about occupational exposure and questions related to protective practices. A scoring system was implemented to assess the knowledge and practices of each participant. RESULTS In total, 38 caregivers working in the OR and 39 in the CU were included in our study. Significantly more CU staff had specific initial training (p < 0.001) and ongoing training (p < 0.001) in handling ADs. Concerning the knowledge score, OR caregivers had a significantly lower median score for contamination routes (p < 0.001), contamination surfaces (p < 0.001), existing procedures (p < 0.001) and total knowledge (p < 0.001) than CU caregivers. Concerning protective handling practices of ADs, the two locations had nonsignificantly different median scores (p = 0.892). CONCLUSION This study suggests that there is still room for improvement in terms of knowledge and protection practices when handling ADs. An appropriate and tailored training program should be developed and provided to all caregivers who handle or come in contact with ADs.Clinical trial registrationStudy CONTACT, ref. 19-504.
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Affiliation(s)
- Clémence Delafoy
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
| | - Hubert Benoist
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
| | - Alex Patin
- Department of Pharmacy, CHU Caen, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Sonia Guillouet
- UNICAEN, CHU de Caen Normandie, Néphrologie, Direction des Soins, Normandie University, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, CHU Lille, Lille, France
| | - Jean-Marc Guilloit
- Department of Surgery, Comprehensive Cancer Center F. Baclesse, Caen, France
| | - Pascal Odou
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Nicolas Simon
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Guillaume Saint-Lorant
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
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Saint-Lorant G, Vasseur M, Allorge D, Beauval N, Simon N, Odou P. Four-year follow-up of surface contamination by antineoplastic drugs in a compounding unit. Occup Environ Med 2023; 80:146-153. [PMID: 36717254 DOI: 10.1136/oemed-2022-108623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/21/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study aimed to monitor the contamination by antineoplastic drugs on work surfaces in a compounding unit 4 years after its implementation. METHODS This descriptive study was done in a unit performing on average 45 000 preparations per year. Surface sampling points (N=23) were monitored monthly in the frame of routine activity from the opening of an anticancer drug compounding unit. Contamination with nine antineoplastic drugs (cyclophosphamide, ifosfamide, dacarbazine, 5-fluorouracil, methotrexate, gemcitabine, cytarabine, irinotecan and doxorubicin) was assessed on wipes with a local liquid chromatography coupled with a tandem mass spectrometer analysis. The contamination rate (CR, %) was prospectively monitored every month during the entire study period. The occurrence of critical incidents was also registered. The effect of each safety measure implemented during this period was also analysed. RESULTS Based on the 1104 samples collected between March 2016 and March 2020, the CR was 18.5%. If three different critical incidents among a vial breakage that occurred were individually considered, this CR was slightly lower than that in the literature. Eight months after opening and taking different corrective actions, the overall CR dropped from 42.39% to 11.52% (p<0.001). Contamination was limited to the area that includes the compounding room and, more precisely, the welder and the QC-Prep+ sampling points. CONCLUSIONS From the beginning of the study and from month to month, surface contamination was limited to the nearest sampling points to the compounding unit. This 4-year monitoring study allowed us to determine the intravenous conventional antineoplastic drugs and sampling points to be focused on.
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Affiliation(s)
- Guillaume Saint-Lorant
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France .,Pharmacy, CHU Caen, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
| | - Delphine Allorge
- ULR-4483-IMPECS-IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, Lille, France.,CHRU, Lille, France
| | | | - Nicolas Simon
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
| | - Pascal Odou
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, University of Lille, Lille, France.,Pharmacy, CHU Lille, Lille, France
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Gudhoor M, Ganachari MS, K J, Salimath GS. Onco-pharmacist led evaluation of knowledge, attitude & practice (KAP) of safe handling cytotoxic drugs among health care professional's (HCP's) in tertiary care hospital: A hospital based interventional Study. J Oncol Pharm Pract 2023; 29:263-269. [PMID: 34927479 DOI: 10.1177/10781552211066957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cytotoxic drugs (CDs) are hazardous in nature. But it is necessary for the treatment in cancer patients. The healthcare professionals (HCPs) act as a facilitator through which the manufactured CDs reach the patient. However, safe handling of CDs becomes a primary concern not only for the recipients but also for the HCPs. METHODS On Ethics committee approval, a prospective- interventional study was conducted among HCPs who are involved in handling of CDs in Oncology department of tertiary care hospital. The participants were screened for their eligibility criteria & 73 HCPs were recruited. The initial data was collected from the HCPs through interview & questionnaires. Later the participants were trained by oncology-pharmacist (7-8 months) for safe handling of CDs. After the training the participants were tested again through interview & questionnaires. RESULTS 73 participants, (75%) nurses & (25%) physicians were included in the study. Among these participants, only 32.87% underwent training on reconstitution whereas 67.12% of the participants didn't undergo any training. The increase in mean score of KAP after the training was observed to be 3.44 ± 4.32, 1.23 ± 1.51 and 1.3 ± 1.01 respectively. CONCLUSION The study concludes that mandatory requirement of training for HCPs using SOP's by qualified oncology-pharmacist to minimize the hazardous effects of CDs. It also highlights the improvisation techniques for handling of CDs will enhance the safety profile of HCPs & the patients, which helps in refining the quality of pharmaceutical and health care services provided in the cancer care settings.
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Affiliation(s)
- Manjula Gudhoor
- Department of Pharmacy Practice, 58890KLE University's College of Pharmacy, KLE College of Pharmacy, Belgaum, India
| | | | - Jyoti K
- Department of Pharmacy Practice, 58890KLE University's College of Pharmacy, KLE College of Pharmacy, Belgaum, India
| | - Geetanjali S Salimath
- Department of Pharmacy Practice, 58890KLE University's College of Pharmacy, KLE College of Pharmacy, Belgaum, India
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Nurses’ knowledge, perceptions, and behaviors regarding antineoplastic drugs: the mediating role of protective knowledge †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To explore the relationships between Chinese nurses’ knowledge, perceptions, and attitudes and their behavior and actual implementation of safety measures when handling antineoplastic drugs (ADs) in their daily work.
Methods
This was a multisite study conducted in 8 public hospitals in China. A self-administered questionnaire was sent to participants querying the degree of contact with ADs. The hypothesized relations were explored using structural equation modelling via the bootstrap method. Mediation analysis was applied to explore the mediating role of protective knowledge regarding AD exposure on the associations among protective training, using warning labels, and using protective masks.
Results
A total of 305 nurses were enrolled. The average age of all participants was 30.2 (standard deviation [SD]: 6.2) years. Nurses who had received protective training for AD exposure were more likely to use labels for ADs after age, body mass index (BMI), length of service, marital status, education, and department were controlled as covariates. The bias-corrected bootstrap of 95% confidence interval (CI) indicated that protective knowledge significantly mediated (23.4%) the association between protective training and using labels (indirect effect = 0.202, 95% CI: 0.009, 0.495); the proportion of mediation was 23.4%. Protective knowledge significantly mediated the association between protective training and using protective masks (indirect effect = 0.157, 95% CI: 0.048, 0.325); the proportion of mediation was 27.2%.
Conclusions
The findings of this study have provided baseline information on the current state of Chinese nurses’ perceptions, knowledge, and preventive behaviors toward ADs as the crisis is happening. Training is also recommended to improve nurses’ perceptions of the risks associated with ADs.
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Benoist H, Busson A, Faveyrial A, Bouhier-Leporrier K, Divanon F, Breuil C, Roger-Leenaert S, Palix A, Odou P, Simon N, Saint-Lorant G. Perception, knowledge, and handling practice regarding the risk of exposure to antineoplastic drugs in oncology day hospitalization units and compounding unit staff. J Oncol Pharm Pract 2022:10781552221103803. [PMID: 35635230 DOI: 10.1177/10781552221103803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Antineoplastic drug exposure is a major problem in regard to caregivers' health. The aim of the present study was to assess the perception, knowledge, and handling practices of all occupation level categories of two oncology day hospitalization units and two compounding units regarding the risk of exposure to antineoplastic drugs. METHODS This descriptive study, performed through face-to-face interviews, concurrently assessed the perception, knowledge, and handling practices of antineoplastic drugs in five different job categories in four different settings. This work was part of a larger comprehensive project examining surface and blood contamination. Different scores were assigned to evaluate responses to a questionnaire about the perception, knowledge, and handling practices of healthcare workers, a risk global score including a risk perception score, and education/knowledge and handling practices scores. RESULTS In the survey, continuous training was associated with the global risk score (p = 0.03), particularly with the handling practices risk score (p = 0.01). Job category was also significantly associated with the global risk score (p < 0.001), particularly with the handling practices risk score (p < 0.001) and the education/knowledge score (p < 0.001). Pharmacy technicians had the highest score regarding risk perception (71.4%), indicating a higher perception of risk, and had a lower score regarding handling practices (25.0%) as well as a lower score (15.7%) regarding risk knowledge. Nurses and physicians had a high score (50%) regarding the risk of handling practices and a score of 57.1% regarding risk perception, indicating an increased perception of safety. Auxiliary caregivers had the highest global score (43.5%) and a score of 30.0% regarding handling practices. CONCLUSIONS This study identified significant differences among healthcare workers depending on job categories in the antineoplastic drug handling practices and in the knowledge of the risks associated with occupational exposure to antineoplastic drugs. These differences were particularly important between trained and untrained participants, revealing the importance of implementing a continuous training program.
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Affiliation(s)
- Hubert Benoist
- 357634Normandie Univ., ABTE, centre de lutte contre le cancer François Baclesse, Caen, France
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
| | - Amandine Busson
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité Mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Université de Caen Normandie, Caen, France
- Centre de lutte contre le cancer François Baclesse, Caen, France
| | - Audrey Faveyrial
- Service d'hospitalisation de jour de cancérologie, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Karine Bouhier-Leporrier
- Service d'hospitalisation de jour de gastro-entérologie, centre hospitalier universitaire de Caen, Caen, France
| | - Fabienne Divanon
- Service de pharmacie, 55072centre de lutte contre le cancer François Baclesse, Caen, France
| | - Cécile Breuil
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
| | - Sophie Roger-Leenaert
- Service de médecine du travail, centre hospitalier universitaire de Caen, Caen, France
| | - Agnès Palix
- Service de médecine du travail, centre de lutte contre le cancer François Baclesse, Caen, France
| | - Pascal Odou
- 27023Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Nicolas Simon
- 27023Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Guillaume Saint-Lorant
- 357634Normandie Univ., ABTE, centre de lutte contre le cancer François Baclesse, Caen, France
- Service de pharmacie, 26962centre hospitalier universitaire de Caen, Caen, France
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Benoist H, Eveno C, Wilson S, Vigneron N, Guilloit JM, Morello R, Simon N, Odou P, Saint-Lorant G. Perception, knowledge and protective practices for surgical staff handling antineoplastic drugs during HIPEC and PIPAC. Pleura Peritoneum 2022; 7:77-86. [PMID: 35812009 PMCID: PMC9166181 DOI: 10.1515/pp-2021-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/13/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Two surgical techniques used for peritoneal metastasis involve a risk of exposure to antineoplastic drugs (ADs): hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). The objective of this study was to assess the differences in perception, training, and knowledge of the risks as well as in the protection practices and occupational exposures of all worker categories. Methods This descriptive study, led in two hospitals from two distant French regions, was performed through a face-to-face interview and assessed the perception, knowledge and handling practices of ADs by a questionnaire consisting of 52 questions. Results Fifty-one professionals participated in this survey. A total of 29.4% (n=15) professionals were afraid to handle ADs. Very few workers have been trained on handling ADs during initial training dedicated to all caregiver (5.9%; n=3). HIPEC is considered to involve a higher risk of exposure to ADs than PIPAC (81.6% (n=31) vs. 57.9% (n=22), respectively, p=0.022, agreement 65.8%). Protective equipment is considered to be less suitable for HIPEC than for PIPAC (29% (n=11) vs. 10.5% (n=4), respectively, p=0.016, agreement 81.6%). Concerning the potential AD contamination location, the participants identified a significant difference between these two practices. During HIPEC, 15.7% (n=6) of caregivers indicated that they had negative symptoms perceived in their practice vs. 2.6% (n=1) during PIPAC. Conclusions This study shows that perception, knowledge and protection practices are different between HIPEC and PIPAC. It also shows a difference between the worker categories. In view of the difficulties in making operating room staff available, the related training programmes must have an adapted format.
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Affiliation(s)
- Hubert Benoist
- Normandie Université, UNICAEN, UNIROUEN, ABTE, Centre de Lutte contre le Cancer F. Baclesse , Caen , France
| | | | - Sarah Wilson
- CHU de Caen Normandie, Normandie Université, UNICAEN, Biostatistic and Clinical Research , Caen , France
| | - Nicolas Vigneron
- CHU de Caen Normandie, Normandie Université, UNICAEN, Biostatistic and Clinical Research , Caen , France
| | - Jean-Marc Guilloit
- Department of Surgery , Comprehensive Cancer Center F. Baclesse , Caen , France
| | - Rémy Morello
- CHU de Caen Normandie, Normandie Université, UNICAEN, Biostatistic and Clinical Research , Caen , France
| | - Nicolas Simon
- Univ. Lille, CHU Lille, ULR 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées , Lille , France
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées , Lille , France
| | - Guillaume Saint-Lorant
- Normandie Université, UNICAEN, UNIROUEN, ABTE, Centre de Lutte contre le Cancer F. Baclesse , Caen , France
- Univ. Lille, CHU Lille, ULR 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées , Lille , France
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11
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Pirot C, Benoist H, Lagadu S, Delépée R, Saint-Lorant G. Impact of low- and high-risk operators handling irinotecan on the blood contamination of health care workers in oncology day care units. J Oncol Pharm Pract 2022:10781552221090965. [PMID: 35382645 DOI: 10.1177/10781552221090965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Health care workers handling antineoplastic drugs (ADs) are at risk of mutagenicity and adverse reproductive effects. Despite protective equipment and AD handling guidelines, AD levels are still detected in caregivers in oncology units. This study attempted to assess blood contamination by irinotecan and its metabolites in all health care workers in oncology day hospital units according to activities specific to each employment category. METHODS The study was performed at two different hospitals: a university hospital and a comprehensive cancer centre. Forty-four participants were categorized according to their daily activity as a high-risk operator (29 nurses/ward aides and 5 cleaning staff) and a low-risk operator (7 doctors and 3 secretaries). The collected blood samples were subjected to UHPLC-MS/MS. The plasma and red blood cell (RBC) levels of irinotecan and its metabolites (SN-38; APC) were determined using a validated analytical method detection test. RESULTS Two hundred sixty-four assay results were collected (132 plasma results and 132 RBC results). The comparison between low- and high-risk operator-contaminated workers was not significant (18.33% positive results in low-risk operators vs. 25.98% positive results in high-risk operators; P = 0.22). This homogeneity showed overall contamination within the unit. Positive results were obtained in 21.43% of physicians, 11.11% of secretaries, 25.86% of nurses/ward aides and 26.67% of cleaning staff. These results could be explained by the lack or failure of personal and collective protective equipment. A lack of protection and inadequate decontamination procedures can result in surface contamination. CONCLUSIONS This study evaluated blood contamination with irinotecan and its metabolites in health care workers from day hospital care units. Among the 24.24% of contaminations observed in care units, the difference between low- and high-risk operator contamination was not significant (P = 0.22). The impact on blood contamination found is the same between low- and high-risk caregivers. This implies that the protective precautions associated with the handling of anticancer drugs must therefore be followed by all staff, including those believed to be at low risk of exposure.
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Affiliation(s)
- C Pirot
- Normandie Université UNICAEN, 27003CHU de Caen Normandie, Pharmacie Centrale, 14000 Caen, France.,Normandie Université UNICAEN, UNIROUEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - H Benoist
- Normandie Université UNICAEN, 27003CHU de Caen Normandie, Pharmacie Centrale, 14000 Caen, France.,Normandie Université UNICAEN, UNIROUEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - S Lagadu
- Normandie Université UNICAEN, UNIROUEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - R Delépée
- Normandie Université UNICAEN, UNIROUEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - G Saint-Lorant
- Normandie Université UNICAEN, 27003CHU de Caen Normandie, Pharmacie Centrale, 14000 Caen, France.,Normandie Université UNICAEN, UNIROUEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
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12
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Fazel SS, Keefe A, Shareef A, Palmer AL, Brenner DR, Nakashima L, Koehoorn MW, McLeod CB, Hall AL, Peters CE. Barriers and facilitators for the safe handling of antineoplastic drugs. J Oncol Pharm Pract 2021; 28:1709-1721. [PMID: 34612752 DOI: 10.1177/10781552211040176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Antineoplastic drugs are widely used in the treatment of cancer. However, some are known carcinogens and reproductive toxins, and incidental low-level exposure to workers is a health concern. CAREX Canada estimated that approximately 75,000 Canadians are exposed to antineoplastic drugs in workplace settings. While policies and guidelines on safe handling of antineoplastic drugs are available, evidence suggests that compliance is low. In this paper, we identify barriers and facilitators for safe handling of antineoplastic drugs in workplace settings. METHODS We utilized a unique method to study public policy which involved compiling policy levers, developing a logic model, conducting a literature review, and contextualizing data through a deliberative process with stakeholders to explore in-depth contextual factors and experiences for the safe handling of antineoplastic drugs. RESULTS The most common barriers identified in the literature were: poor training (46%), poor safety culture (41%), and inconsistent policies (36%). The most common facilitators were: adequate safety training (41%), leadership support (23%), and consistent policies (21%). Several of these factors are intertwined and while this means one barrier can cause other barriers, it also allows healthcare employers to mitigate these barriers by implementing small but meaningful changes in the workplace. CONCLUSION The combination of barriers and facilitators identified in our review highlight the importance of creating work environments where safety is a priority for the safe handling of antineoplastic drugs. The results of this study will assist policy makers and managers in identifying gaps and enhancing strategies that reduce occupational exposure to antineoplastic drugs.
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Affiliation(s)
- Sajjad S Fazel
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Arshiya Shareef
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada
| | - Alison L Palmer
- CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Darren R Brenner
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Mieke W Koehoorn
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Chris B McLeod
- School of Population and Public Health, 120479University of British Columbia, Vancouver, British Columbia, Canada.,Partnership for Work, Health and Safety, Ottawa, Ontario, Canada
| | - Amy L Hall
- 142123Government of Canada, Charlottetown Prince Edward Island, Canada
| | - Cheryl E Peters
- Cancer Epidemiology and Prevention Research, 3146Alberta Health Services, Calgary, Alberta, Canada.,CAREX Canada, Simon Fraser University, Vancouver, British Columbia, Canada.,70401Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Abu Sharour L, Subih M, Bani Salameh A, Malak M. Predictors of Chemotherapy Safe-Handling Precautions and Knowledge Among a Sample of Jordanian Oncology Nurses: A Model-Building Approach. Workplace Health Saf 2021; 69:115-123. [PMID: 33446086 DOI: 10.1177/2165079920959991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are adverse side effects associated with handling chemotherapy; however, using safe-handling precautions can minimize or prevent these potential effects. Despite availability of international guidelines for chemotherapy handling, adherence to precautions is below expectations. This study examined knowledge of safe-handling precautions among a sample of oncology nurses in Jordon. METHODS A cross-sectional study was employed that included a convenience sample of 153 oncology nurses. Oncology nurses from two hospitals completed the Chemotherapy Handling Questionnaire. Descriptive analysis, Spearman rank correlation coefficients, and regression analyses were performed to determine the predictors of precaution use when handling hazardous drugs among participants. FINDINGS We observed that age, number of patients for whom the worker administered chemotherapy per day, the number of patients receiving chemotherapy per day in the participant's work unit, nurses' knowledge about safe-handling precautions, perceived risk, perceived barriers, self-efficacy, organization influence/workplace safety climate, conflict of interest, and interpersonal influences were predictors of use of safe-handling precautions (adjusted R2 = .66, p < .001). CONCLUSION/APPLICATION FOR PRACTICE Several predictors for using safe-handling precautions were identified. Clinically, chemotherapy handling procedures should be evaluated frequently to identify barriers to safe practices and to improve worker safety.
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Affiliation(s)
| | - Maha Subih
- Faculty of Nursing, AL-Zaytoonah University of Jordan
| | | | - Malakah Malak
- Faculty of Nursing, AL-Zaytoonah University of Jordan
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14
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Papadopoli R, Nobile CGA, Trovato A, Pileggi C, Pavia M. Chemical risk and safety awareness, perception, and practices among research laboratories workers in Italy. J Occup Med Toxicol 2020; 15:17. [PMID: 32550858 PMCID: PMC7298783 DOI: 10.1186/s12995-020-00268-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Exposure to chemical compounds occurs in numerous occupational settings, among which the research and healthcare laboratories have not been adequately investigated. These settings are characterized by an extreme variability of the used compounds and by the frequent turnover of young researchers. The main objectives of the study were to explore the occupational exposure to hazardous chemical substances among research laboratory workers; to assess their awareness and perceptions regarding chemical hazards; to investigate adherence to guidelines on safe handling of chemical compounds; and to analyze the effects of several factors on these outcomes of interest. Methods The survey was conducted among research laboratories workers who were exposed to chemical substances during their activity. Subjects completed a questionnaire exploring knowledge, attitudes and behaviors related to chemical hazards involved in research activities. Results Enrolled subjects were 237, for an 81.7% response rate. More than 90 hazardous chemical substances were used in the surveyed laboratories. A correct knowledge on hazardous chemicals was significantly more likely in younger researchers, in those manipulating a higher number of hazardous chemicals, and in those with a higher number of years of training in the attended laboratory; 54.4% of the workers said they felt very exposed to chemical risk. Correct practices in the laboratories were significantly more likely in researchers who perceived to have a low exposure to chemicals, but a high exposure to biological risk, who agreed with the statement that colleagues handle chemicals following safety procedures and who perceived to have received an adequate training in the management of accidents and first aid. Conclusions Our results showed significant gaps in knowledge and scarce preparedness in the adherence to safety processes to prevent and contain risks related to use of chemical compounds in research laboratories.
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Affiliation(s)
- Rosa Papadopoli
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Carmelo Giuseppe Angelo Nobile
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Arcavacata di Rende, 87036 Cosenza, Italy
| | - Alessandro Trovato
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, Medical School, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
| | - Maria Pavia
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Via L. Armanni, 5, 80138 Naples, Italy.,Department of Health Sciences, University of Catanzaro "Magna Græcia", Via T. Campanella, 115, 88100 Catanzaro, Italy
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15
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Simegn W, Dagnew B, Dagne H. Knowledge and associated factors towards cytotoxic drug handling among University of Gondar Comprehensive Specialized Hospital health professionals, institutional-based cross-sectional study. Environ Health Prev Med 2020; 25:11. [PMID: 32284041 PMCID: PMC7155262 DOI: 10.1186/s12199-020-00850-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Currently, cancer is among the leading causes of morbidity and mortality in the world. Exposure to CDs may occur during drug preparation and mixing, during drug administration, during transport, and cleaning spills and waste disposal. Healthcare workers who prepare or administer antineoplastic drugs, or who work in areas where these drugs are used, can be exposed to these agents. This also affects the public around the exposed area if appropriate disposal system is not known. Several studies reported increased risks of leukemia and breast cancer among nurses handling CDs and not following safety guidelines. Because of the absence of studies in Ethiopia, the current study was conducted to determine the knowledge level of cytotoxic drug handling and associated factors among health professionals in the University of Gondar Comprehensive Specialized Hospital. METHODS The institutional-based cross-sectional study was conducted from June to August 2019. Epi info 7.1 was used for data entry and then exported into SPSS version 20 for computing, recording, and statistical analysis. Logistic regression was used to explain the relationship with independent variables. RESULTS Four hundred and twelve health professionals participated in the study with 53.4% males. The participants' mean age was 29.9 (± 5.43) years ranging from 20-60. Two hundred and twenty-three (54.1%) health professionals heard about cytotoxic drugs, and 52.7% (95% UI 47.8-57.8%) had good knowledge of cytotoxic drug handling. Being male sex (AOR = 1.84, 95% CI (1.13-3.00)), age of 29-31 (AOR = 1.99, 95% CI (1.03-3.84)), hearing information about cytotoxic drug handling (AOR = 2.53, 95% CI (1.43-4.47)), ever attended training on cytotoxic drug handling (AOR = 3.15, 95% CI (1.13-8.79)), ever taking courses related to cytotoxic drugs (AOR = 2.03, 95% CI (1.15-3.59)), and good practice (AOR = 3.24, 95% CI (1.95-5.37)) were significantly associated with knowledge towards cytotoxic drug handling. It is therefore imperative to train health professionals and to incorporate CDs handling related course contents while revising curricula to raise the knowledge of health professionals about proper cytotoxic drug handling. CONCLUSION Above half of the study participants scored higher than the median of the cytotoxic drug handling knowledge questions. Sex, age, information about cytotoxic drug handling, training, taking courses related to cytotoxic drugs, and good practice were significantly associated with knowledge towards cytotoxic drugs handling.
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Affiliation(s)
- Wudneh Simegn
- Department of Pharmaceutics, School of Pharmacy, University of Gondar, P.O.Box 196, Gondar, Ethiopia.
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, P.O.Box 196, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, P.O.Box 196, Gondar, Ethiopia
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16
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Villa A, Molimard M, Bignon E, Martinez B, Rouyer M, Mathoulin-Pelissier S, Baldi I, Verdun-Esquer C, Canal-Raffin M. Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study. BMJ Open 2019; 9:e033040. [PMID: 31712349 PMCID: PMC6858204 DOI: 10.1136/bmjopen-2019-033040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Antineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination. METHODS AND ANALYSIS This trial will be conducted in two French hospital centres: University Hospital of Bordeaux and IUCT-Oncopole of Toulouse. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The trial will be conducted with the following steps: (1) development of analytical methods to quantify AD urine biomarkers, (2) study of the workplace and organization around AD in each care department (transport and handling, professional practices, personal and collective protection equipments available) (3) development of a self-questionnaire detailing professional activities during the day of inclusion, (4) nurses inclusion (urine samples and self-questionnaire collection), (5) urine assays, (6) data analysis. ETHICS AND DISSEMINATION The study protocol has been approved by the French Advisory Committee on the Treatment of Information in Health Research (CCTIRS) and by the French Data Protection Authority (CNIL). Following the opinion of the Regional Committee for the Protection of Persons, this study is outside the scope of the provisions governing biomedical research and routine care (n°2014/87). The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03137641.
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Affiliation(s)
- Antoine Villa
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Consultation de Pathologie Professionnelle et de I'environnement, CHU Timone, AP-HM, Marseille, France
- Univ. of Bordeaux, Bordeaux, France
| | - Mathieu Molimard
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
| | - Emmanuelle Bignon
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Béatrice Martinez
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Simone Mathoulin-Pelissier
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Isabelle Baldi
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Catherine Verdun-Esquer
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Mireille Canal-Raffin
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
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17
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Walton AL, Kneipp S, Linnan L, Asafu-Adjei J, Douglas C, Leff M, Rogers B. Nursing Assistants' Use of Personal Protective Equipment Regarding Contact With Excreta Contaminated With Antineoplastic Drugs. Oncol Nurs Forum 2019; 46:689-700. [PMID: 31626622 DOI: 10.1188/19.onf.689-700] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the feasibility of observing and interviewing nursing assistants about handling of antineoplastic drugs contaminated with excreta, acceptability of a measure of personal protective equipment (PPE) use with nursing assistants, and predictors of PPE use. PARTICIPANTS & SETTING 27 nursing assistants in an inpatient hematology-oncology unit at an academic medical center in the southeastern United States. METHODOLOGIC APPROACH This was an exploratory, multimethod study using observation, verbally administered questionnaires, and interviews. Research variables included recruitment rates, acceptability of observation, and understandability of a safe-handling instrument. FINDINGS Observed use of double gloves, chemotherapy gowns, and face shields was low; use of plastic-backed pads when flushing excreta was high. IMPLICATIONS FOR NURSING Nursing assistants are willing to participate in research. Standardized training and education about PPE use are needed.
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18
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Power LA, Coyne JW. ASHP Guidelines on Handling Hazardous Drugs. Am J Health Syst Pharm 2018; 75:1996-2031. [DOI: 10.2146/ajhp180564] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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19
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Koller M, Böhlandt A, Haberl C, Nowak D, Schierl R. Environmental and biological monitoring on an oncology ward during a complete working week. Toxicol Lett 2018; 298:158-163. [DOI: 10.1016/j.toxlet.2018.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
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20
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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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21
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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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A review of high performance liquid chromatographic-mass spectrometric urinary methods for anticancer drug exposure of health care workers. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1060:316-324. [PMID: 28654869 DOI: 10.1016/j.jchromb.2017.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/14/2017] [Accepted: 06/17/2017] [Indexed: 12/15/2022]
Abstract
This review describes published high performance liquid chromatography/mass spectrometry (HPLC-MS) methods for the determination of anticancer drugs in human urine as non-invasive tool for monitoring of health care worker exposure to antineoplastic and cytotoxic drugs. HPLC-MS is a sensitive and specific method for analysis of anticancer drugs and their metabolites in biological fluids. In this review, a tabular summary and overview of published HPLC-MS methods are presented, as well as future trends and limitations in this area of research.
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23
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Walton AL. Doing the Dirty Work: Who Handles Antineoplastic Drug Contaminated Excreta and do They Do It Safely? Asia Pac J Oncol Nurs 2017; 4:120-121. [PMID: 28503643 PMCID: PMC5412148 DOI: 10.4103/apjon.apjon_8_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- AnnMarie Lee Walton
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing. Int Arch Occup Environ Health 2017; 90:275-284. [DOI: 10.1007/s00420-017-1196-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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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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