Chemotherapy-Handling Practices of Outpatient and Office-Based Oncology Nurses

Susan Martin

Elaine Larson

ONF 2003, 30(4), 575-581. DOI: 10.1188/03.ONF.575-581

Purpose/Objectives: To determine the current patterns of use of personal protective equipment among oncology nurses while handling antineoplastic chemotherapeutic agents in outpatient and office-based settings.

Design: Descriptive-correlational, mailed survey.

Setting: National survey of oncology nurses.

Sample: 500 randomly selected members of the Oncology Nursing Society who identified their work settings as office, clinic, or outpatient private practice; 263 responded for an overall response rate of 53%.

Methods: Mailed, self-report survey based on the current Occupational Safety and Health Administration's (OSHA's) guidelines for the handling of hazardous drugs.

Main Research Variable: Chemotherapy-handling practices.

Findings: More than 94% of participants reported usually wearing gloves during chemotherapy handling; 55% reported using laboratory coats as protective garments. Usual use of face and respiratory protection was less than 6%. Chemotherapy was reported to be prepared in laminar air flow hoods in 99% of work settings. Only 46% of sites reportedly provided any type of medical monitoring.

Conclusion: Use and availability of personal protective equipment when handling chemotherapy have increased, but medical monitoring of exposed employees still is neither widely practiced nor consistent with OSHA guidelines.

Implications for Nursing: Safety concerns and potential adverse health effects associated with the occupational handling of chemotherapeutic agents have been reported. Historically, nurses' adherence to chemotherapy-handling guidelines has been poor. Results suggest that adherence is increasing; however, research is lacking regarding nurses' level of knowledge of and specific barriers to safe handling of chemotherapy.

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    References

    Bellinger, N., & Schutz, R. (1987). A NIOSH technical guide… NIOSH guide to industrial respiratory protection (DHHS NIOSH Publication No. 87-116). Washington, DC: U.S. Government Printing Office.

    Chabner, B., & Longo, D. (1996). Cancer chemotherapy and biotherapy: Principles and practice (2nd ed.). Philadelphia: Lippincott-Raven.

    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Academic Press.

    Connor, T.H., Laidlaw, J.L., Theiss, J.C., Anderson, R.W., & Matney, T.S. (1984). Permeability of latex and polyvinyl chloride gloves to carmustine. American Journal of Hospital Pharmacy, 41, 676-679.

    Doyle, J., & Sinha, N. (1998). Economics of ifosfamide-based chemotherapy in outpatient setting. Cancer Management, 3. Retrieved May 7, 2003, from http://www.cancernetwork.com/journals/manage/m9803b.htm

    Harris, P., Connor, T., Stevens, K., & Thesis, J. (1992). Cytogenetic assessment of occupational exposure of nurses to antineoplastic agents. Journal of Occupational Medical Toxicology, 1, 243-254.

    Hemminki, K., Kyyronen, P., & Lindbohm, M. (1985). Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. Journal of Epidemiology and Community Health, 39, 141-147.

    Laidlaw, J.L., Connor, T.H., Theiss, J.C., Anderson, R.W., & Matney, T.S. (1984). Permeability of latex and polyvinyl chloride gloves to 20 antineoplastic drugs. American Journal of Hospital Pharmacy, 41, 2618-2623.

    Mahon, S.M., Casperson, D.S., Yackzan, S., Goodner, S., Hasse, B., Hawkins, J., et al. (1994). Safe handling practices of cytotoxic drugs: The results of a chapter survey. Oncology Nursing Forum, 21, 1157-1165.

    Nieweg, R.M., de Boer, M., Dubbleman, R.C., Gall, H.E., Hesselman, G.M., Lenssen, P.C., et al. (1994). Safe handling of antineoplastic drugs. Results of a survey. Cancer Nursing, 17, 501-511

    Occupational Safety and Health Administration. (1986). Work practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs (OSHA Publication 8-1.1). Washington, DC: Office of Occupational Medicine.

    Occupational Safety and Health Administration. (1995). OSHA technical manual. Washington, DC: Author.

    Sessink, P.J., Boer, K.A., Scheefhals, A.P., Anzion, R.B., & Bos, R.P. (1992). Occupational exposure to antineoplastic agents at several departments in a hospital. Environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. International Archives of Occupational and Environmental Health, 64, 105-112.

    Stajicj, G.V., Barnett, C.W., Turner, S.V., & Henderson, C.A. (1986). Protective measures used by oncologic office nurses handling parenteral antineoplastic agents. Oncology Nursing Forum, 13(6), 47-49.

    Valams, B., Driscoll, K., & McNeil, V. (1990). Comparison of antineoplastic drug handling policies of hospitals with OSHA guidelines: A pilot study. American Journal of Public Health, 80, 480-481.

    Valams, B., McNeil, V., & Driscoll, K. (1991). Staff members' compliance with their facility's antineoplastic drug handling policy. Oncology Nursing Forum, 18, 571-576.

    Valanis, B., & Shortridge, L. (1987). Self protective practices of nurses handling antineoplastic drugs. Oncology Nursing Forum, 14(3), 23-27.

    Valanis, B., Vollmer, W., Labuhn, K., & Glass, A. (1997). Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists. Journal of Occupational and Environmental Medicine, 39, 574-580

    Valanis, B., Vollmer, W.M., Labuhn, K., Glass, A., & Corelle, C. (1992). Antineoplastic drug handling protection after OSHA guidelines. Comparison by profession, handling activity, and work site. Journal of Occupational Medicine, 34, 149-155.

    Valanis, B.G., Hertzberg, V., & Shortridge, L. (1987). Antineoplastic drugs. Handle with care. AAOHN Journal: Official Journal of the American Association of Occupational Health Nurses, 35, 487-492.

    Valanis, B.G., Vollmer, W.M., Labuhn, K.T., & Glass, A.G. (1993). Acute symptoms associated with antineoplastic drug handling among nurses. Cancer Nursing, 16, 288-295.