Additional PPE Training Needed for Nurses Administering Chemotherapy

Nurse Leader Insider, February 21, 2019

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By Michelle Clarke

Female nurses who administer antineoplastic drugs to cancer patients do not always wear personal protective equipment (PPE) according to a recent study conducted by the National Institute for Occupational Safety and Health (NIOSH) and published in the January issue of The American Journal of Nursing.

Nurses are exposed to antineoplastic drugs, or chemotherapeutic drugs, when they administer these drugs in pill or liquid form to patients who are battling all forms of cancer. The drugs, while working to kill rapidly dividing cancerous cells of a patient can also be harmful to the healthy dividing cells of the nurse, including the cells of a developing baby.

The study, one of the first to delve into the use of PPE by pregnant and non-pregnant female nurses while administering chemotherapy medications, gathered the results of nearly 40,000 respondents over an eight-year period.

In spite of long-standing recommendations to use safe handling precautions when dealing with antineoplastic medications, many of the respondents reported not wearing gloves and gowns – the minimum PPE requirements.

NIOSH reports the following results for pregnant and non-pregnant female nurses:

  • Twelve percent of non-pregnant female nurses and nine percent of pregnant nurses reported never using a gown when administering antineoplastic drugs
  • Forty-two percent of non-pregnant nurses and thirty-eight percent of pregnant nurses reported never using a gown
  • One in 10 pregnant nurses did not always wear gloves while administering these medications during the first 20 weeks of pregnancy

“NIOSH has worked extensively to protect workers who handle antineoplastic drugs, many of which are known or probable human carcinogens,” said Christina Lawson, Ph.D., epidemiologist and lead author of the study. “Many of these drugs can also damage a person’s fertility or harm a pregnancy, for example by causing a miscarriage or birth defects, so we wanted to look at the health of pregnant nurses for this study.”

Survey respondents did not offer insight as to why they did not use the recommended minimal PPE (which is just gloves and gowns). However, other studies cite the following explanations as to why PPE was not used: skin exposure was minimal, PPE not provided by employer, and simply not part of the protocol.  Another study found that 15% of respondents did not believe chemotherapy could be absorbed from contaminated surfaces.

Based on the results of the survey, the study authors recommend expanded and updated training in the use of PPE for nurses administering these medications.

The study was the result of a collaboration between NIOSH researchers, and investigators from Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital in Boston, Massachusetts.

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