MASSACHUSETTS NURSE NEWSLETTER :: April 2007

Hazardous drug awareness and control survey results

By Thomas P. Fuller, Sc D, CIH

The results of a survey on hazardous drugs sent to over 3,000 MNA nurses have been analyzed, resulting in some very interesting findings.

In 2004 the National Institute of Occupational Safety and Health (NIOSH) issued an ALERT to increase awareness of health care workers and their employers about the risks of working with hazardous drugs. However, since that time there is little indication that hospitals have expanded their hazardous drug safety programs.

A study was undertaken in 2006 to evaluate to what extent a sample of 3,000 MNA nurses was aware of their hospitals’ hazardous safety programs and controls. Close to 400 surveys were returned and the results are as follows:

• Despite a major NIOSH recommendation for hospitals to develop written hazardous drug programs and procedures, only 54 percent of MNA nurses were aware of such programs at their hospitals (as shown on Figure 1). Beyond that, only 30 percent of the nurses who responded to the survey had read their programs.
• Although 87 percent of nurses stated that they handled or administered hazardous drugs, only 12 percent had ever had classroom training and only 6 percent had hands-on training on safe handling techniques. 56 percent of the nurses indicated that no special engineering controls were ever taken when they worked with hazardous drugs (as shown by Figure 2).
• None of the nurses surveyed indicated that they were aware of any NIOSH recommended exposure assessment strategies such as evaluation of equipment; workplace monitoring; analysis of volumes and frequency of drug use; decontamination techniques; waste handling; and equipment used to minimize exposures.

Other findings showed that proper engineering controls such as ventilation and special drug handling equipment had not been implemented in most locations. Nurses who had attended hazardous drug safety training were significantly more likely to wear personal protective equipment (PPE) but it was still alarming that 36 percent of all nurses responding used no special controls or PPE when working with patients receiving hazardous drugs. In addition, fewer than 35 percent indicated that hazardous drug spill kits were available to them, and fewer than 22 percent considered warning patients’ families or other workers in the treatment areas about the presence of hazardous drugs.

Due to weaknesses in this study, such as low survey response rates and lack of detailed data about the study population set, it was not possible to make correlations about exposures and health effects here. However, the health effects from exposure to hazardous drugs are well documented in other studies. There are hundreds of hazardous drugs used throughout the hospital and new ones being developed continuously. Millions of health care workers are exposed every day. Based on this information the subsequent health effects can be expected to continue despite government warnings.

While formal institutional hazardous drug programs are being developed, nurses and other workers are encouraged to learn as much as possible about the hazards and the appropriate controls for the drugs they adminster to patients. Material Safety Data Sheets (MSDS), which are supposed to be provided by the employer, should be consulted. However, since pharmaceutical company MSDS are often lacking information and direction, additional sources of information should be sought and precautionary practices utilized to minimize exposures wherever possible. These practices would include the use of appropriate protective gloves, face shields and gowns, the availability of spill kits, and contamination control techniques particularly where drugs are mixed or prepared.

To learn more about hazardous drugs that you may be exposed to at work, go to the NIOSH ALERT, available at www.cdc.gov/ NIOSH .

The MNA Congress on Health and Safety is working to prevent nurses’ exposures to hazardous drugs in several ways. Periodically articles appear in the Massachusetts Nurse to increase the recognition of hazardous drugs and the methods that nurses should utilize in order to prevent exposures. In addition, at an upcoming conference in June (Workplace Hazards to Nurses and other Healthcare Workers: Promising Practices for Prevention) a breakout session entitled, “Preventing Exposure to Hazardous Drugs” will be presented by Kathleen Sperrazza, RN, MS on June 8. (See Page 20 for details.)

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Selected references: Connor, T., Sessink, P., Harrison, B., Pretty, J., Peters, B.,
Alfaro, R., Bilos, A., Beckmann, G., Ring, M., Anderson, L.,
DeChristoforo, R., Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: Results of three studies, Am. J. Health-Syst. Pharm., Vol. 62 (March 1, 2005).
Connor, T., External contamination of antineoplastic drug vials, Hosp. Pharm. Eur. (2005) Nov:52,54. McDiarmid, M., Chemical hazards in health care high hazard, high risk, but low protection, Ann. N.Y. Acad.Sci. 1076:601- 606 (2006).
Polovich, M., Safe handling of hazardous drugs, Online Journal of Issues in Nursing, Vol. 9, No. 3, (September 30, 2004), accessed 9//4/2006. NIOSH, Department of Health and Human Services, Centers for Disease Control, National Institute of Occupational Health and Safety, NIOSH Alert: Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings (September 2004) DHHS (NIOSH) publication number 2004-165.
Harrison, B., Risks of handling cytotoxic drugs. In: Perry MV ed., The chemotherapy source book, 3rd ed. Philadelphia, Lippencott, Williams and Wilkins, pp. 566-582.