IN FOCUS
Preventing hazardous exposure to chemo drugs in the OR
Through research and education, experts are working to keep perioperative professionals safe when exposed to chemo drugs in the operating room
By Carina Stanton
Senior News Editor
Patient care techniques, technologies and treatments continue to emerge and evolve with new evidence and innovation. But with new developments in perioperative care come the need for education and awareness to make surgery safe for healthcare professionals, as well as for patients. One hazard in surgical and other healthcare settings that is being addressed for increased safety awareness is exposure to antineoplastic agents used in chemotherapy drugs.
Antineoplastic agents are used to inhibit the growth and spread of cancerous cells, but many of these drugs are carcinogenic, so they are also harmful to healthy cells. For cancer patients with a life-threatening disease, treatment with these drugs is beneficial. However, healthcare workers who are exposed to antineoplastic agents as part of their work practice should take precautions to eliminate or reduce exposure as much as possible, according to Tom Connor, PhD, research biologist for the National Institute for Occupational Safety and Health (NIOSH).
Connor explained there are a number of long-term or chronic effects linked to exposure of antineoplastic drugs, including liver and kidney damage, damage to the bone marrow, damage to the lungs and heart, infertility (temporary and permanent), effects on reproduction and the developing fetus in pregnant women, hearing impairment and cancer.
Surgical procedures that use antineoplastic agents are not new, but some of these procedures are becoming more common, Connor noted. One of these procedures is intraperitoneal chemotherapy, which involves pre-heating a chemotherapy drug solution and then introducing the antineoplastic agent drug solution into the peritoneal cavity of the patient.
“The use of this procedure has been increasing, and is used for a few different cancers now, yet we really don’t know how OR personnel are being affected by exposure to these agents,” he said.
Connor is the lead author of the 2004 NIOSH alert on preventing occupational exposure to antineoplastic drugs in the healthcare setting. He is also leading a new study on these exposures, which he hopes will result in evidence-based recommendations for safe handling. Healthcare facilities interested in participating in the study should contact Thomas Connor by e-mail at tmc6@cdc.gov.
Safety through knowledge
“All perioperative professionals working with antineoplastic agents need to be aware of the proper personal protective equipment needed to safely handle these drugs,” said Gail Davidson, RN, BSN, OCN, surgical lead patient care resource manager at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, at The Ohio State University Medical Center in Columbus.
Davidson is collaborating with colleagues who specialize in chemotherapy administration and cancer surgery to develop an educational program to ensure healthcare professionals understand the safety practices required for certain surgical oncology procedures. Procedures using antineoplastic agents are becoming more common in a broad range of surgical settings, including outpatient surgery centers and interventional radiology sites.
The program will include explanation of surgical procedures that use antineoplastic agents and will emphasize the proper use of personal protective equipment in these procedures. Her program follows NIOSH recommendations for personal protective equipment.
Seeking safety resources
Davidson encouraged any healthcare professional working with antineoplastic agents and other hazardous drugs to make sure they are following recommendations to safely work with hazardous drugs. These resources can be found online from NIOSH and from the Occupational Safety and Health Administration.
AORN has an alliance with OSHA to share information and resources relevant to workplace safety in the perioperative setting. Learn more about the alliance. AORN also has a memorandum of understanding with NIOSH to encourage communication and collaboration surrounding workplace safety for perioperative professionals.
“Workplace safety is critical to patient safety,” said Mary Ogg, RN, MSN, CNOR, a perioperative nursing specialist in AORN’s Center for Nursing Practice who serves as staff liaison to AORN’s Perioperative Environment of Care Committee. “That’s why AORN works closely with workplace safety experts through organizations like OSHA and NIOSH to ensure perioperative safety awareness is addressed and practiced.”
Learn more
Read "Safe Handling of Cytotoxic Agents: A Team Approach" in the November 2009 issue of AORN Journal.
Read more news in AORN Connections.