Accidental Exposure to Chemotherapeutic Agents: An Occupational Health Hazard for Oncology Nurses
Cytotoxic drugs, also known as anti-neoplastic or cancer chemotherapy drugs are expressly designed to kill or arrest the growth of living cells. They have been the mainstay of treatment of certain cancers but are also finding a wider role as immunosuppressive agents, for use in autoimmune diseases and to forestall immune rejection of tissue transplants. Most antineoplastic agents are known to be teratogenic and mutagenic to humans. In the hospital setting, nurses are the main group that is exposed to these drugs.
Generally, the occupational activities that pose greatest risk of exposure are the preparation and administration of antineoplastic agents. There is also some risk from exposure to urine, vomit, and excreta from patients being treated with cytotoxic drugs, and spillages or accidents of various kinds. Finally, exposure may occur in handling and disposal of cytotoxic wastes and related trace contaminated material. The main routes of exposure to cytotoxic drugs are inhalation of drug dusts or aerosols, transdermal, inadvertent ingestion through contact with contaminated food or cigarettes, and needle stick injuries.
The actual risks to workers handling cytotoxic drugs are a combined result of the drugs’ inherent toxicity and the extent to which workers are directly exposed. Other factors include the susceptibility of the individual to the drugs’ toxic effects, and co-factors such as dietary habits, smoking, and man-made or natural environmental contaminants.
Some cytotoxic drugs have a direct irritant effect on the mucous membranes, eyes and skin. Spills onto cut or abraded skin surfaces, and skin punctures with contaminated needles or broken glass can lead to severe soft tissue injury and should be treated immediately and monitored for potential problems. Symptoms such as dizziness, light-headedness, and nausea have also been reported, possibly as a result of working in poorly ventilated areas.
However, the greatest cause for concern among health care workers is not the acute but the long-term effects of occupational exposure to cytotoxic drugs. Many published studies have been inconclusive, and little is known of the long-term effects of exposure to small quantities of cytotoxic drugs over an extended period of time. The likelihood that the carcinogenic threshold may be a cumulative one indicates that any exposure to cytotoxic drugs should be minimized.
There has been increasing concern among healthcare workers regarding exposure to cytotoxic drugs during reconstitution, preparation, administration, and disposal of these agents. While evidence from the administration of therapeutic doses of cytotoxic drugs to cancer patients is not directly applicable to the low level exposure of healthcare workers preparing or administering cytotoxic drugs, this evidence does imply that those involved in occupational handling of cytotoxic drugs may be at risk as a result of chronic low-level exposure to toxic drugs.
It is therefore necessary to establish techniques and protocols to prevent exposure in the workplace. The hazard can be further controlled and the risks minimized by ensuring that staff is both properly trained and using adequate protective equipment.
Matti,S.A.,Claus,H.K.,Harvey,J.C.,& Martine,E.A.(2005). Safe handling of parental cytotoxic. The American Journal of Medical Oncology,10(3),198-204.
Martin, S,(2005) The adverse Health effects of occupational exposure to hazardous drugs
Martin, S (2003). Chemotherapy handling Practices of Outpatient and Office Based Oncology Nurses
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