Protecting the Frontline: The Evolution of Hazardous Drug Safety in Oncology Nursing

The landscape of oncology nursing has undergone a seismic shift in safety protocols over the last two decades. In the latest episode of the Onc Nurse on Call podcast, nursing leaders MiKaela M. Olsen, DNP, APRN-CNS, AOCNS®, FAAN; and AnnMarie Walton, PhD, MPH, RN, OCN, CHES, FAAN; joined hosts Patricia Jakel, MN, RN, AOCN; and Stephanie Desrosiers, DNP, MSN, RN, AOCNS, BMTCN; to reflect on the transition from a 'wild west' era of
chemotherapy administration to the rigorous, evidence-based standards of today.

The 'Wild West' of Early Oncology Nursing

The conversation began with a look back at the early days of the profession—a time when personal protective equipment (PPE) was often ignored. Olsen recalled the jarring reality of early practice: "My preceptors were not wearing gloves... I wasn’t involved in actually pulling up these drugs in my career, but
nurses that practiced before me said they used to pull up Adriamycin and squirt the air out of the syringe, and they’d see red on the wall."

Walton echoed these sentiments, sharing a vivid memory of the lack of perceived risk. "I will remember vividly my preceptor was not wearing gloves, and she unspiked the cap... with her teeth," she said. "I
thought, 'Wow, this is definitely not someone who’s worried about potential exposure to this drug.'"

The Impact of USP <800> and Engineering Controls

A central theme of the episode was the enforcement of USP <800>, which became mandatory for many institutions in late 2023. The standard mandates the use of Closed System Transfer Devices (CSTDs) for drug administration—a move Olsen calls a “big win” for the nursing profession. Unlike pharmacists who have worked within biological safety cabinets for years, nurses are often the final link in the chain without a physical barrier between them and the hazardous agent. CSTDs act as that essential engineering control.

The shift isn't just about hardware; it's about data. Dr. Walton emphasized the growing importance of surfac ewipe sampling. "USP <800> is really thoughtful about environmental contamination... It recommends routine surface wipe sampling, which is a measure of environmental contamination that’s recommended at baseline and every six months." This allows teams to identify 'hot spots' in the clinic and remediate them immediately.

The Hidden Risks in Home Care

As oncology care shifts toward the community and the home, new challenges arise. The experts expressed concern over the lack of standardized education for home care nurses and family caregivers.

"There are some beautiful studies out of Japan and Germany that have demonstrated not only is there hazardous drug contamination in the home, but it’s in the urine of family members," Walton noted. This secondary exposure highlights the need for better education on handling patient excreta and waste outside the hospital
setting.

Looking Ahead: 5 to 10 Years

The episode concluded with a hopeful look at the future. Olsen highlighted emerging technologies, such as CSTDs designed specifically for crushing oral hazardous medications and newer syringe technologies for subcutaneous injections that prevent leakage. For these experts, the goal remains clear: ensuring that as treatments evolve, the safety of the healthcare workforce evolves alongside them.

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