Health Hazards among Oncology Nurses Exposed to Chemotherapy Drugs

Karima Elshamy, Mona El-Hadidi, Mohamed El-Roby, Mona Fouda

Abstract


AIM To determine the health hazards among nurses exposed to chemotherapy drugs; identify potential risk factors that may predispose nurses to chemotherapy hazards; and evaluate available protective measures used in clinical practice.

METHODS This was an analytical cross sectional study carried out during six months from February 2006 to July 2006 at Mansoura University hospitals. A study group of 35 oncology nurses and a control group of 29 non-oncology nurses were compared for safe behavior, use of protective measures while dealing with drugs, complaints due to drug exposure and mutagens in urine. Three tools were used in the study: a self administered questionnaire, a performance checklist to assess the practice of nurses, and Ames test for the detection of mutagens in urine.

RESULTS Health hazards among the study group and controls were: abortions (31.4% vs 10.3%), infertility & sub-fertility (14.3% vs 3.4% ), premature labour (14.3% vs 17.2%), soft tissue injuries due to spills & splashes (14.3% vs 0.0%), and developmental and behavioral abnormalities among the children of the nurses (8.6% vs 3.4%). Urine samples from study nurses were more mutagenic than controls (40% vs 10.3%). Risky behaviour among study nurses included: eating food in drug handling areas (45.7%),  use of improper place for preparing and handling cytotoxic drugs, expelling air from syringes filled with drugs, needle stick injuries, unsafe handling of contaminated material and unsafe cleaning of spills. Only 22.9% of the study nurses attended a training program about occupational health and safety and 8.6% of them mentioned that there are nursing care guidelines for procedures for dealing with patients receiving cytotoxic drugs as well as presence of in-service training programs. There was poor use of protective equipment in the study group.

CONCLUSION This study revealed poor safety and significant adverse events among nurses handling cytotoxic drugs. There is, therefore, a need to improve the safety of the work environment; make available protective equipment; develop standard practice guidelines for oncology nurses;  implement good planning and design of the workplace; provide adequate specialized equipment (such as cytotoxic drug safety cabinets) and personal protective equipment; establish clinical pharmacy practice; and integrate health monitoring programs that include the assessment and counseling of prospective nurses before they commence any work involving cytotoxic drugs  and related waste.


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