Guidelines exist for preparing and administering hazardous drugs, such as chemotherapy, to protect both the patient and the provider. However, there has been much less emphasis on exposure to these agents after they have passed through a patient’s body, as many times, they are excreted unchanged or as active metabolites in urine and feces.
Nurse researchers at the Seattle Cancer Care Alliance recently initiated a quality improvement project to analyze the degree of contamination in patient and staff bathrooms at an ambulatory comprehensive cancer center. Findings were presented at the 2020 ONS Bridge virtual conference.
“We did this project back in October and November of last year, and we had a couple of goals in mind. One was to take a look at the amount of contamination. We assumed that we were going to see some in patient bathrooms. Then as a parallel, we also wanted to see if we had any contamination in a staff bathroom that was locked behind a security door,” lead author Seth Eisenberg, RN, OCN, BMTCN, professional practice coordinator, infusion services at Seattle Cancer Care Alliance, said in his presentation.
Daily wipe testing was performed in the bathrooms – first in the morning before patients arrived, and then again between 5:00 and 6:00 pm. The researchers decided to test for the most common chemotherapy agents administered, 5FU and oxaliplatin.
Measurable contamination was found in the patient bathroom every day of testing, and there was 1 day where there was a drastic increase in contamination.
“We looked at reasons for why there might have been such a huge spike there, [since there were no patient falls and no reported spills,” Eisenberg said. “So we can assume that it was related to the fact that there was some more urine on the floor area.”
But the patient bathroom was not the only contaminated bathroom.
“We were surprised to find that we also had contamination of drugs in the staff bathroom,” Eisenberg said. “This was a bit of a surprise because it’s on a security door. The staff bathroom is shared by multiple departments, including infusion and pharmacy personnel.”
Eisenberg explained that there was also an increase of contamination in the staff bathroom on the same day where the patient bathroom had a spike, though the research team is unsure why. However, it those findings did indicate to the research team that not only are the drugs excreted via urine, but that they are also difficult to clean.
Moving forward, Eisenberg and his team hope to conduct more research of this kind and improve the cleaning of patient and staff bathrooms.
“We’ve actually got a different product that we’re going to try here soon, once things are back to normal [after the COVID-19 pandemic], and we will evaluate whether or not that product made a change in the amount of exposure we saw on the floors,” Eisenberg said.