The airline attendant instructs passengers in the event of an emergency to always put their safety equipment on first then help those who need assistance. This same message is resonating across healthcare systems from regulatory bodies to nurses and other healthcare providers administering and handling hazardous drugs (HDs). In order to safely treat and care for our patients, healthcare providers must first protect themselves.
In the effort to provide patients the best care possible, many nurses have sacrificed their own safety from skipping out on lunch, having minimum to no bathroom breaks, and not properly wearing their personal protective equipment (PPE). However, this effort from nurses can be detrimental to their own health. If nurses are not healthy how can they care for their patients?
As I sat in a small group session with other oncology nurses from different communities and infusions centers to discuss PPE, I heard many reasons why it is difficult for nurses to comply with PPE guidelines. Some of the reasons I heard were, “It takes too much time to put it on,” “I’ve been a nurse for many years and I’m OK,” I’m too busy to have to stop and put all that on,” and “the PPE makes me hot.” I was amazed to hear some of these reasons from oncology infusion nurses, although I understand them the potential risks associated with administering these hazardous drugs
outweigh why PPE cannot be worn.
The use of PPE provides healthcare workers protection to reduce exposure to HD aerosols and residues.1
Unintentional exposure to HDs can affect nervous system, impair reproductive system and increase risks of developing blood cancers.2
PPE have always been strongly recommended, but never mandated. As I round through the infusion centers, I have observed PPEs half worn or not worn at all. I have witnessed nurses being exposed to chemotherapy during spills because PPE was not worn properly. As an educator, I encourage nurses to wear PPE and continue to educate them on the importance of this protection. However, we now have support to regulate and enforce the use of PPE.
The latest United States Pharmacopeia chapter 800 (USP800) has expanded upon recommendations from the National Institute for Occupational Safety and Health (NIOSH), Oncology Nursing Society (ONS), Occupational Safety and Health Administration (OSHA) and American Society for Health-Care Pharmacists (ASHP) to provide a complete set of standards for all healthcare workers to ensure the safe handling of HDs across the healthcare system. As of December 2019 this latest chapter will be enforceable by each state’s board of pharmacy or delegated agency.3
USP 800 requirements include responsibilities of personnel handling HDs; facilities and engineering controls; procedures for deactivating, decontaminating and cleaning; spill control; and documentation.4
These standards apply to all healthcare personnel who receive, prepare, administer, transport or otherwise come in contact with HDs and all the environments in which they are handled.
I believe this is a step in the right direction with increasing new HDs arising for the treatment of various cancers. This protection will allow those who work with HDs to continue their work with decreased risk of exposure from these drugs and decrease potentially long term complications.
Healthcare workers must take care of themselves first so that we can continue to care for their patients. It is easier to stop and take a few minutes to protect yourself than to find yourself in a position of dealing with a compromised health that could have been prevented.
- USP. USP general chapter 800 hazardous drugs-handling in healthcare settings. USP website. www.usp.org. Published 2017. Accessed May 17, 2019.
- Live Science. Nurses exposed to toxic cancer drugs, study finds. Live Science website. https://www.livescience.com/15721-nurses-exposed-toxic-cancer-drugs.html. Published August 24, 2011. Accessed May 17, 2019.
- Eisenberg S; Hazardous drugs and USP 800. Clinical Journal of Oncology Nursing. 2017,21(2): 179-187. doi: 10.1188/17CJON.179-187
- Beans B.E; USP 800 adds significant safety standards. PMC-NCBI. 2017,42(5):336-339