Healthcare workers caught between drugs that save and drugs that kill

By: July 20th, 2010 Email This Post Print This Post

That life-saving drugs for patients also pose life-threatening hazards for healthcare workers, was made painfully evident in a report by msnbc.com on chemotherapy’s deadly toll on pharmacists and nurses.

The report focuses on a number of pharmacists and nurses who are struggling from or have succumbed to the hazards of second-hand chemo exposures in healthcare workplaces, including Sue Crump who for 23 years as a hospital pharmacist in Seattle, WA, prepared chemotherapy drugs for administration.

Crump developed pancreatic cancer which she believed was from occupational exposure.

In a video profile accompanying the msnbc.com article, Crump explains that for years she prepared chemo drugs in areas that were not segregated for other preparation areas, that gloves and masks were not provided until much later in her career, and then only as an option, and  that she experienced routine splashes.

“I had no concern,” said Crump, “because there was nothing to tell that I wasn’t safe.”

Crump died last September at the age of 55.

“There is no other occupation population (that handles) so many known human carcinogens,” said Thomas Connor, a research biologist with the NIOSH. For 40 years, Connor has been studying the effect on workers of the chemical agents used in chemotherapy and is one of the lead authors of a just-completed NIOSH study confirming “that chemo continues to contaminate the workspaces where it’s used, and in some cases is still being found in the urine of those who handle it, despite knowledge of safety precautions,” according to msnbc.com.

The msnbc.com report also cites an investigation by InvestigateWest showing that OSHA does not specifically regulate exposures to chemotherapy drugs in the workplace with a standard, relying instead on the use of the general duty clause. According to InvestigateWest, OSHA has issued such a citation only once in ten years in “any health care institution, including hospitals, clinics, dental and veterinary offices, for their handling of hazardous drugs.”

The NIOSH Web site on Occupational Exposure to Antineoplastic Agents, the classification of many chemotherapy drugs, includes information on environmental sampling, decontamination, the use of personal protective equipment, and publications for assessing hazardous drug exposure and implementing policies to protect workers, including the 2004 NIOSH alert, Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings.

Two tools from that publication, “Common Hazardous Drugs in Healthcare” and “Handling Hazardous Drugs Safely Checklist” may be downloaded from the OSHA Healthcare Advisor Tools page under the hazard communication heading.

Are hazardous drugs, especially those used in chemotherapy, a concern in your workplace. What safeguards do you have or wish you did have? Is an OSHA standard specific to hazardous drugs necessary? Let us know in the comments section below.

Comments

Dave

Please don’t succumb to biased journalism. This article did nothing but add fear.

While I am not saying it is not possible that these employees developed their diseases from exposure at work, there is not proof that they did. How many patients are treated for these cancers a year that had no exposure to chemo agents? Remember, if you monitor any specific group of people, you are going to find some issues.

The employees also worked prior to current safety standards being in place. They had exposures that were most likely much more significant. If not even gloves were used, as was mentioned, I have no doubt that there were some very high exposures.

What do we need?

What we need is to get CDC to repeat the medical studies that were done in the 1960’s, 70’s and 80’s that actually look at if workers who handle chemo agents are developing medical conditions that can be linked to their work. Finding chemo agent in someone’s urine but not showing that this is causing any medical issues is poor science. In the past, reproductive issues were the primary issues raised about chemo exposure. I have not seen any evidence that these have continued now that safety protocol are in place.

We now have about 24 years since OSHA first published safety guidelines for antineoplastic agents. Let’s look at this population and see if there are common health issues.

We need better methods of evaluating if safety measures are working, not more fear stories. Did you know that it is near impossible to get a wipe sample evaluated for chemotherapy agents? You have to send it to Norway. There are no threshold levels to compare to. There are no standards for how to even do this testing.

If you work in Nuclear Medicine, you scan your work area each day to see if any traces of radioactivity leaked out. We have no way of doing this in our oncology areas. We do not know if surfaces are or are not contaminated.

I can tell you, that we have been running surveillance programs for years and have not found any issues that we could relate to exposure. But we also have a strong safety program to educate and train staff on proper techniques for handling chemo agents.

I don’t see a need for additional regulation unless there is good scientific evidence that current safety protocol are not working. So far, I see not evidence that they are not. I also would not feel regulations are going to work unless we can determine if exposures are actually happening. Since we do not have any threshold limits on these medications, how do you establish if employers are in compliance?

PS. This article did do one thing that is brought out in the comments. It has raised some guilt in chemo patients that the treatments that saved their lives may have harmed someone else. We need to help assure our employees and patients that these medications can be safely handled.

By David LaHoda on July 21st, 2010 at 4:17 pm

As always, Bruce, a well-reasoned comment. and it is good that you pointed out the time lapse since OSHA published on antineoplastics. In the last few years, however, NIOSH has been publishing a lot on this topic, which makes me think there is reason for concern. Whether it merits and reflects the concerns of the msnbc.com and The Seattle Times reports have yet to be determined.

 

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