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New Study Finds Lack of Adherence to Safe Handling Guidelines for Administration of Antineoplastic Drugs

Most common reason for not wearing gloves or gowns in a web-based survey was “skin exposure was minimal”; however, 4% of respondents reported skin contact during handling and administration
09 Oct 2014
Anticancer agents & Biologic therapy

A new USA National Institute for Occupational Safety and Health (NIOSH) study, published in the Journal of Occupational and Environmental Hygiene, found that recommended safe handling practices for workers who administer antineoplastic drugs in healthcare settings are not always followed. The toxicity of antineoplastic drugs is well documented. Many are known or suspected human carcinogens where no safe exposure level exists.

Results are derived from the 2011 Health and Safety Practices Survey of Healthcare Workers, the largest federally-sponsored web survey of healthcare workers in the USA, which addresses safety and health practices relative to use of hazardous chemicals. This paper presents findings on current administrative and engineering control practices, personal protective equipment, and barriers to using recommended personal protective equipment during administration of antineoplastic drugs by oncology nurses and other healthcare personnel who completed a module addressing antineoplastic drug administration.

All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers, and physician offices, respondents reported that they had collectively administered over 90 specific antineoplastic drugs in the past week.

“Chemotherapy drugs save lives of cancer patients but also can result in adverse health outcomes in workers who are exposed to these drugs, including cancer, reproductive problems, and organ damage when recommended safe handling guidelines are not followed,” said NIOSH Director, Dr John Howard in an accompanied press release. “Safeguarding healthcare workers from potential occupational hazards is an essential part of providing good jobs for these dedicated women and men, and furthering high-quality patient care.”

Findings suggest that best practices are not always used. Below are examples of practices that may increase exposure risk, expressed as percentage of respondents:

  • Not always wearing two pairs of chemotherapy gloves (80%) or not even a single pair (15%).
  • Failure to always wear non-absorbent gown with closed front and tight-fitting cuffs (42%).
  • Intravenous tubing primed with antineoplastic drug instead of a non-drug containing liquid by the respondent (6%) or by the pharmacy department (12%).
  • Potentially contaminated clothing taken home (12%).
  • Spill or leak of antineoplastic drug during administration (12%).
  • Lack of hazard awareness training (4%).
  • Skin contact with antineoplastic drug (4%).

Authoritative guidelines developed by professional practice organisations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. However, recommended exposure controls were not always used, underscoring the importance of training and education for employers and workers. According to NIOSH, this is highly noteworthy considering that there is no safe level of exposure to cancer-causing agents. Reported barriers to using personal protective equipment suggest that there is a perception that exposures are inconsequential or so rare that employers or workers feel personal protective equipment use is not justified.

The researchers conclude that better risk communication is needed to ensure that employers and employees are fully aware of the hazards and the availability of precautionary measures to minimise exposures. Commitment from all levels in the healthcare organisation is essential to adequately protect workers from one of the most toxic classes of chemical agents used in healthcare.


Boiano JM, Steege AL, Sweeney MH.  Adherence to Safe Handling Guidelines by Health Care Workers Who Administer Antineoplastic Drugs. Journal of Occupational and Environmental Hygiene 2014; 11(11):728-740. 

Last update: 09 Oct 2014

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