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Ballard A, Thamm C, Ogle T, Phillips JL. Influences Shaping Clinicians' Monoclonal Antibody and Immune Checkpoint Inhibitor Preparation and Administration Management Practices: A Systematic Review. Semin Oncol Nurs 2024; 40:151583. [PMID: 38336551 DOI: 10.1016/j.soncn.2024.151583] [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: 08/13/2023] [Revised: 12/16/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES In 30 years, monoclonal antibodies (mAbs) and immune checkpoint inhibitors (ICPIs) have enhanced cancer survival and quality of life. Limited knowledge exists regarding the long-term risks of repeated exposure, especially for cancer nurses, who prepare and administer them. This systematic review aimed to identify influences shaping clinicians' awareness and practices in the safe preparation and administration of mAbs and ICPIs. DATA SOURCES This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases CINAHL, EMBASE, Joanna Briggs Institute, OVID, MEDLINE, and Cochrane were searched. Eligibility and risk of bias were assessed by four reviewers. RESULTS Of 7301 identified studies, 481 duplicates were removed, and 6673 were excluded after title and abstract review. A full-text review was conducted on 147 studies; six studies were included. A narrative synthesis generated two themes: (1) ambiguity contributes to variation in handling practices and (2) continuing professional development (CPD) is vital but hard to implement without evidence. CONCLUSION Lack of evidence regarding long-term risks and consensus creates uncertainty about the hazardous nature of unconjugated mAbs and ICPIs. Resulting in varied risk reduction strategies during preparation and administration, and inconsistent CPD. Protecting the long-term health of clinicians necessitates consensus on risk reduction strategies. This will be challenging without compelling evidence or international agreement on their hazardous classification. IMPLICATIONS FOR NURSING PRACTICE In nursing, policy gaps and inconsistent CPD related to unconjugated mAbs and ICPIs may expose nurses to risks. Understanding the educational needs of nurses and global standardized guidelines are urgently needed.
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Affiliation(s)
- Angela Ballard
- Ph.D Candidate, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland; Lecturer, Federation University, Institue of Health and Wellbeing, Berwick, Victoria, Australia.
| | - Carla Thamm
- Senior Research Fellow, Caring Futures Institute, School of Nursing and Health Sciences, Flinders University, Adelaide, South Australia; Senior Lecturer, School of Nursing, Queensland University of Technology (QUT), Brisbane, Australia
| | - Theodora Ogle
- Lecturer, School of Nursing, Queensland University of Technology (QUT) Brisbane, Queensland, Australia
| | - Jane L Phillips
- Professor, Head of School, School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Hu J, Zhao F, Liu L, Huang H, Huang X. The meta-analysis of sister chromatid exchange as a biomarker in healthcare workers with occupational exposure to antineoplastic drugs. Medicine (Baltimore) 2023; 102:e34781. [PMID: 37653817 PMCID: PMC10470682 DOI: 10.1097/md.0000000000034781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Sister chromatid exchange (SCE) can be used to identify early occupational health status in health care workers. Our aim is to comprehensively assess the relationship between long-term exposure to antineoplastic drugs (ADs) and SCE in health care workers via meta-analysis. METHODS Five databases were systematically searched for relevant articles published from inception to November 30, 2022. Literature data are expressed as mean difference and 95% confidence intervals (CI) or relative risk and 95% CI. For I2 > 50% trials, random effect model is used for statistical analysis, otherwise fixed effect model is used. This review was registered in the International Prospective Register of Systematic Reviews (identifier CRD42023399914). RESULTS Fourteen studies were included in this study. Results showed the level of SCE in healthcare workers exposed to ADs was significantly higher than in controls. The mean difference of the SCE trial was 0.53 (95% CI: 0.10-0.95, P = .01) under a random-effects model. CONCLUSIONS The findings suggested a significant correlation between occupational exposure to ADs in health care workers and SCE, requiring the attention of health care workers in general.
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Affiliation(s)
- Jinchen Hu
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Feifei Zhao
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lin Liu
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hong Huang
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaohong Huang
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen Guangdong & Clinical Medical College of Shenzhen, Guangzhou University of Chinese Medicine, Shenzhen, China
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The relationship between safety climate and nurses’ safe handling of chemotherapy: A partial least squares structural equation modeling analysis. Eur J Oncol Nurs 2022; 61:102222. [DOI: 10.1016/j.ejon.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022]
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Acramel A, Blondeel-Gomes S, Matta C, Narayani S, Madar O, Desmaris R, Escalup L, Fouque J. Reporting environmental contamination results to healthcare workers could play a crucial role in decreasing the risk of occupational exposure to antineoplastic drugs. Front Public Health 2022; 10:989977. [PMID: 36091516 PMCID: PMC9452744 DOI: 10.3389/fpubh.2022.989977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Alexandre Acramel
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
- Université Paris Cité, CiTCoM, UMR8038 CNRS, U1268 Inserm, Paris, France
| | - Sandy Blondeel-Gomes
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France
| | - Carla Matta
- Département d'Oncologie Médicale, Institut Curie, Saint-Cloud, France
| | | | - Olivier Madar
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France
- Département de Radiopharmacologie, Institut Curie, Saint-Cloud, France
| | - Romain Desmaris
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Laurence Escalup
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Julien Fouque
- Département de Radiopharmacologie, Institut Curie, Saint-Cloud, France
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Ogbaghebriel A, Alshamrani M, Ibrahim A, Al-Masaary W, Hakami S, Alrasheed S, Al-Sayed N. Pharmacy practitioners' adherence to safe-handling practices of chemotherapeutic drugs: A cross-sectional study in Saudi Arabia. J Oncol Pharm Pract 2022:10781552221105584. [PMID: 35642271 DOI: 10.1177/10781552221105584] [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: 11/17/2022]
Abstract
BACKGROUND Chemotherapy drug handling and occupational exposure are topics of concern for a variety of oncology health care professionals. Inappropriate handling can pose health risks to practitioners particularly, those who handle them on a daily basis. Therefore, this study aimed to assess chemotherapy handling practices among oncology pharmacists and pharmacy technicians in Saudi Arabia. METHODS A cross-sectional study was conducted using an online survey with a structured pre-validated questionnaire. Data was collected from pharmacists and pharmacy technicians who handle chemotherapeutic agents in Saudi Arabia, and analyzed using descriptive and inferential statistics. RESULTS A total of 79 oncology pharmacy practitioners responded to the survey. The majority (92.4%) had written chemotherapy guidelines at their workplaces. Almost all participants (98.7%) reported the availability of protective gloves and gowns, however, the availability of eye protection was only 57%. Most used chemotherapy-designated gloves (83.6%), and gowns (86.1%). However, 54.4% have reused disposable gowns. The extent of utilization of most protective equipment ranged from 70% (always using closed system transfer device) to 98% (always using shoe cover); while the practice of always using eye protection and face shield was only 30.4% and 38%, respectively. With regard to cleaning practice, the work area was cleaned at least once a day by 35%; monthly decontamination (77%); certification by the biomedical department every 6 months (67%) and at least yearly (95%). Accidental exposure was reported by 28%, and the most common adverse effect was skin irritation (82%). There was no workplace medical surveillance available for 50%. The majority (88.6%) received relevant training, but not periodic updates on their training (38%). The main barriers against the use of personal protective equipment were: that some personal protective equipments were not always available (38%), and personal protective equipments were too uncomfortable to use (30.4%). The demographic variables did not have a statistically significant effect (p > 0.05) on the responses except for type of institution (workplace) on some of the cleaning practices that showed significant differences namely, the monthly decontamination and certification by the biomedical department. CONCLUSIONS Most protective equipment and chemotherapy guidelines were available, and the majority of pharmacy practitioners adhered to many aspects of chemotherapy safe-handling practices. Nevertheless, some areas such as medical surveillance programs, use of eye protection and face shields, the practice of re-using disposable gowns, some of the barriers against personal protective equipment use, and the provision of periodic training need improvement for better protection of the health care professionals.
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Affiliation(s)
- Azieb Ogbaghebriel
- Department of Pharmaceutical Sciences, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Majed Alshamrani
- Pharmaceutical Care Services, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Alnada Ibrahim
- Department of Pharmacy Practice, College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Wed Al-Masaary
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Sarah Hakami
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Shahad Alrasheed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
| | - Nada Al-Sayed
- College of Pharmacy, 112893Princess Nourah bint Abulrahman University, Riyadh, Saudi Arabia
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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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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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Oratz T, Ogletree R, Gettis M, Cherven B. Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste. Clin J Oncol Nurs 2021; 25:272-281. [PMID: 34019028 DOI: 10.1188/21.cjon.272-281] [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: 11/17/2022]
Abstract
BACKGROUND Safe handling practices for patient waste have focused on patients receiving IV chemotherapy, but these practices do not address safe handling for patients receiving oral chemotherapy. OBJECTIVES The aim of this article is to evaluate evidence and formulate best practice recommendations for handling and disposing waste from patients receiving oral chemotherapy. METHODS A literature search established a framework for the project. For healthcare providers and staff, procedures were established to access biohazard supplies and to follow safe handling of patient waste post-oral chemotherapy administration. Supply cost utilization was evaluated pre- and postimplementation. Staff perceptions were assessed six months after project implementation. FINDINGS The cost of supplies per patient day increased minimally. Staff self-reported use of biohazard precautions when handling patients' waste increased. The majority of staff reported that they had access to supplies and were knowledgeable regarding safe handling procedures six months after this practice change.
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Nassan FL, Chavarro JE, Johnson CY, Boiano JM, Rocheleau CM, Rich-Edwards JW, Lawson CC. Prepregnancy handling of antineoplastic drugs and risk of miscarriage in female nurses. Ann Epidemiol 2021; 53:95-102.e2. [PMID: 32920100 PMCID: PMC7736108 DOI: 10.1016/j.annepidem.2020.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/22/2020] [Accepted: 09/02/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the association betweenantineoplastic drug (AD) handling and risk of miscarriage. METHODS Nurses' Health Study-3 participants self-reported AD administration and engineering controls (ECs) and personal protective equipment (PPE) use at baseline. We estimated the hazard ratio (HR) of miscarriage in relation to baseline AD handling using multivariable Cox proportional regression. RESULTS Overall, 2440 nurses reported 3327 pregnancies, with 550 (17%) ended in miscarriages. Twelve percent of nurses self-reported currently handling AD and 28% previously handling AD. Compared with nurses who never handled AD, nurses who handled AD at baseline had an adjusted HR of miscarriage of 1.26 (95% confidence interval [CI], 0.97-1.64). This association was stronger after 12-weeks gestation (HR=2.39 [95% CI, 1.13-5.07]). Nurses who did not always use gloves had HR of 1.51 (95% CI, 0.91-2.51) compared with 1.19 (95% CI, 0.89-1.60) for those always using gloves; nurses who did not always use gowns had HR of 1.32 (95% CI, 0.95-1.83) compared with 1.19 (95% CI, 0.81-1.75) for nurses always using gowns. CONCLUSIONS We observed a suggestive association between AD handling and miscarriage, particularly among nurses who did not consistently use PPE and EC with stronger associations for second trimester losses.
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Affiliation(s)
- Feiby L Nassan
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA.
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA
| | - Candice Y Johnson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - James M Boiano
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Carissa M Rocheleau
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
| | - Janet W Rich-Edwards
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA; Connors Center for Women's Health and Gender Biology and Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Christina C Lawson
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH
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Challinor JM, Alqudimat MR, Teixeira TOA, Oldenmenger WH. Oncology nursing workforce: challenges, solutions, and future strategies. Lancet Oncol 2020; 21:e564-e574. [DOI: 10.1016/s1470-2045(20)30605-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022]
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Polovich M. USP General Chapter <800>: Considerations for Oncology Nursing Practice. Semin Oncol Nurs 2020; 36:151022. [PMID: 32404243 DOI: 10.1016/j.soncn.2020.151022] [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: 11/26/2022]
Abstract
OBJECTIVES To describe the nurse leader's role in implementing the hazardous drug safe-handling standards from USP General Chapter <800> that are most relevant to oncology nursing practice, and to provide strategies for reducing nurses' exposure to hazardous drugs. DATA SOURCES Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION Nurse leaders are essential to promoting a safe environment for nurses handling hazardous cancer drugs. IMPLICATIONS FOR NURSING PRACTICE Several barriers and challenges to handling hazardous drugs exist and must be overcome before oncology nurses' exposure can be reduced.
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Affiliation(s)
- Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA.
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12
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Walton A, Bush M, Douglas C, Allen D, Polovich M, Spasojevic I. Surface Contamination With Antineoplastic Drugs on Two Inpatient Oncology Units. Oncol Nurs Forum 2020; 47:263-272. [DOI: 10.1188/20.onf.263-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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CE: Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns. Am J Nurs 2019; 119:28-35. [PMID: 30550459 DOI: 10.1097/01.naj.0000552583.69729.51] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Background: Many antineoplastic (chemotherapeutic) drugs are known or probable human carcinogens, and many have been shown to be reproductive toxicants in cancer patients. Evidence from occupational exposure studies suggests that health care workers who have long-term, low-level occupational exposure to antineoplastic drugs have an increased risk of adverse reproductive outcomes. It's recommended that, at minimum, nurses who handle or administer such drugs should wear double gloves and a nonabsorbent gown to protect themselves. But it's unclear to what extent nurses do. PURPOSE This study assessed glove and gown use by female pregnant and nonpregnant nurses who administer antineoplastic drugs in the United States and Canada. METHODS We used data collected from more than 40,000 nurses participating in the Nurses' Health Study 3. The use of gloves and gowns and administration of antineoplastic drugs within the past month (among nonpregnant nurses) or within the first 20 weeks of pregnancy (among pregnant nurses) were self-reported via questionnaire. RESULTS Administration of antineoplastic drugs at any time during their career was reported by 36% of nonpregnant nurses, including 27% who reported administering these drugs within the past month. Seven percent of pregnant nurses reported administering antineoplastic drugs during the first 20 weeks of pregnancy. Twelve percent of nonpregnant nurses and 9% of pregnant nurses indicated that they never wore gloves when administering antineoplastic drugs, and 42% of nonpregnant nurses and 38% of pregnant nurses reported never using a gown. The percentage of nonpregnant nurses who reported not wearing gloves varied by type of administration: 32% of those who administered antineoplastic drugs only as crushed pills never wore gloves, compared with 5% of those who administered such drugs only via infusion. CONCLUSION Despite longstanding recommendations for the safe handling of antineoplastic and other hazardous drugs, many nurses-including those who are pregnant-reported not wearing protective gloves and gowns, which are considered the minimum protective equipment when administering such drugs. These findings underscore the need for further education and training to ensure that both employers and nurses understand the risks involved and know which precautionary measures will minimize such exposures.
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Kim O, Lee H, Jung H, Jang HJ, Pang Y, Cheong H. Korean nurses' adherence to safety guidelines for chemotherapy administration. Eur J Oncol Nurs 2019; 40:98-103. [PMID: 31229212 DOI: 10.1016/j.ejon.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE Nurses are at risk from handling chemotherapeutic agents. This study aimed to determine adherence to safety guidelines for chemotherapy administration by Korean nurses and to examine the relationship between the hospital safety climate and nurses' adherence to safety guidelines. METHOD A descriptive, correlational design with a cross-sectional survey using data from the Korea Nurses' Health Study. For this study, participants included 872 female nurses who had administered chemotherapeutic agents to patients in the last 30 days. RESULTS Only a quarter of the participants had high adherence to the safety guidelines, while the majority had moderate to low adherence. The absence of job hindrances and feedback/training - two sub-factors of the hospital safety climate - enhanced the likeliness for nurses to comply with the safety guidelines by almost 1.3 and 1.7 times, respectively. CONCLUSION The results imply that the hospital safety climate, particularly feedback/training, and the absence of job hindrances are significantly correlated with adherence to the safety guidelines for chemotherapy administration. Therefore, organisational and policy support is needed to improve the hospital safety climate.
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Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, Ewha Research Institute of Nursing Science, Seoul, 03760, Republic of Korea; College of Nursing, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - Haeok Lee
- College of Nursing and Health Science, University of Massachusetts Boston, Boston, MA, 02125-3393, United States
| | - Heeja Jung
- College of Nursing, Konyang University, Daejeon, 35365, Republic of Korea.
| | - Hee Jung Jang
- Division of Nursing and Research Institute of Nursing Science, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Yanghee Pang
- College of Nursing, Ewha Womans University, Seoul, 03760, Republic of Korea
| | - HyeonKyoung Cheong
- Office of Policy Development for Healthy Society, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
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15
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Nwudu V, Fletcher AM, Bauer M. Patterns and predictors of personal protection compliance and workplace hygiene behaviors among workers with elevated blood lead levels in New York State. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:654-663. [PMID: 30081768 DOI: 10.1080/15459624.2018.1487066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
Despite increasing awareness and significant progress in reducing lead exposure among workers, elevated blood lead levels (BLLs) continue to be an occupational health problem. Little is currently known about the extent of personal protective equipment (PPE) use among lead-exposed workers. We examined the patterns and predictors of consistent PPE use and workplace hygiene behaviors among workers with elevated BLLs using a survey of 1,459 workers with an occupational lead exposure in New York State (NYS). Routine availability of respirators was commonplace, however only approximately half of workers consistently wore PPE while working with lead. Regular access to showers was reported by 41% of workers, but less than a quarter took showers and subsequently changed into clean clothing before leaving work site. Significant predictors of consistent PPE use and good hygiene behaviors were identified. The findings highlight the need for further educational and policy interventions for lead-exposed employees. Increased employer efforts are also required to provide workplace structures and a culture that supports compliance. These include the provision of routine training and hazard communication, provision of appropriate PPE and hygiene facilities, and enforcing its use where necessary.
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Affiliation(s)
- Vivian Nwudu
- a New York State Department of Health , Bureau of Occupational Health and Injury Prevention , Albany , New York
| | - Alicia M Fletcher
- a New York State Department of Health , Bureau of Occupational Health and Injury Prevention , Albany , New York
| | - Michael Bauer
- a New York State Department of Health , Bureau of Occupational Health and Injury Prevention , Albany , New York
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16
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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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17
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Chauchat L, Tanguay C, Caron NJ, Gagné S, Labrèche F, Bussières JF. Surface contamination with ten antineoplastic drugs in 83 Canadian centers. J Oncol Pharm Pract 2018; 25:1089-1098. [PMID: 29726786 DOI: 10.1177/1078155218773862] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to monitor environmental contamination by 10 antineoplastic drugs in Canadian oncology pharmacy and patient care areas. The secondary objective was to explore the impact of factors that may explain contamination. METHODS Twelve standardized sites were sampled in each center (six in the pharmacy and six in patient care areas). Each sample was prepared to allow quantification of seven antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, cytarabine, gemcitabine, 5-fluorouracil, irinotecan) by UPLC-MS-MS. Docetaxel, paclitaxel and vinorelbine were also detected, but not quantified due to sensibility limitations. The impact of some factors was evaluated compared with a Kolmogorov-Smirnov test for independent samples. RESULTS Eighty-three Canadian centers were recruited in 2017. A total of 953 surfaces were sampled, 495 in pharmacy and 458 in patient care areas. Cyclophosphamide was most often found on surfaces (36% of samples positive, 75th percentile 0.0040 ng/cm2). The arm rest (81.7% of samples positive for at least one antineoplastic drug), the front grille inside the hood (78.3%) and the floor in front of the hood (61.4%) were more frequently contaminated. Centers who prepared more antineoplastic drugs per year had higher concentration on different surfaces ( p < 0.0001). CONCLUSION Despite growing awareness and implementation of new safe handling guidelines, healthcare centers' surfaces remain contaminated with traces of many antineoplastic drugs. The use of personal protective equipment remains indisputable. Performing an annual monitoring remains a good indicator to monitor trends over time and to compare with similar centers.
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Affiliation(s)
- L Chauchat
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada
| | - C Tanguay
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada
| | - N J Caron
- 2 Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
| | - S Gagné
- 2 Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
| | - F Labrèche
- 3 Institut de recherche Robert-Sauvé en santé et sécurité du travail, Montréal, Canada.,4 Département de santé environnementale et au travail, École de santé publique, Université de Montréal, Montréal, Canada
| | - J F Bussières
- 1 Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Canada.,5 Faculté de pharmacie, Université de Montréal, Montréal, Canada
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18
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Karakoç MD. A Cost Saving and Waste Minimization Study About Handling of the Antineoplastic Agents. Turk J Pharm Sci 2017; 14:304-310. [PMID: 32454629 DOI: 10.4274/tjps.25238] [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: 08/11/2016] [Accepted: 02/09/2017] [Indexed: 12/01/2022]
Abstract
Objectives As a cancer treatment option, chemotherapy costs make up a large part of the budgets of social insurance foundations and related expenditures are increasing continuously annually. Cost saving and waste minimizing strategies are required to reduce the expenditures in the field of oncology. The study aimed to reduce the amount of wasted antineoplastic drugs and medical supply consumption. Materials and Methods The study explains why vials with a larger size and drugs in liquid form should be preferred over various smaller sizes and powder forms of antineoplastic preparations. Results Amounts of drug wastage, vial adaptor, and transfer set consumption data were recorded regularly for a period of seven months. The average vial adaptor consumption per patient in the last three months decreased from 5 to 3.3. The preference of liquid forms as much as possible instead of powder forms, which has a shorter stability time after dilution, and the choice of larger package sizes of frequently used drugs decreased vial adaptor consumption. Potential savings were calculated as around 31.660 USD annually. Costs of total wasted doses were 8.699.87 USD, and the whole antineoplastic drug consumption was 515.500 USD during the study. A decrease of 0.58 USD was observed per capita when the first and last three-month periods were compared in terms of waste costs. Conclusion These values indicate that the reduction of wasted drugs have potential annual savings of 3.375 USD. It is shown that total potential savings of 35.000 USD could be made per year. By implementing the same principles in all hospitals in Turkey, approximately 2.8 million USD could be made annually. The pharmaceutical industry and hospital pharmacists have important responsibilities in this issue.
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19
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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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20
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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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21
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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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