Health and Safety Practices Survey of Healthcare Workers

Antineoplastic Drugs – Compounding

Here you will learn what we found regarding antineoplastic drug compounding and best practices for minimizing exposure.

Overview

Antineoplastic drugs, also known as chemotherapy, cytotoxic and oncology drugs, are used to treat cancer, as well as arthritis, multiple sclerosis, and other non-cancer medical conditions. Most antineoplastic drugs are classified by NIOSH as hazardous drugs.¹ About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs.²

Healthcare workers exposed to chemotherapy drugs have increased risk³ of

• Leukemia
• Other cancers
• Adverse reproductive outcomes
• Chromosomal damage

Guidelines on the safe handling of antineoplastic drugs have been available for many years.^3-6 This study was conducted to assess adherence to exposure controls and best practices in these guidelines.

The antineoplastic drug compounding survey module was mostly completed by nurses, and pharmacists and pharmacy technicians (i.e., pharmacy practitioners). We found that safe handling guidelines were not always followed. Both employers and healthcare workers share responsibility for adhering to best practices to minimize exposure to antineoplastic drugs.

Best practices and study findings

Overall, findings from this survey show that best practices to minimize exposure to antineoplastic drugs have not been universally implemented. Healthcare employers and employees share responsibility to ensure adherence to safe handling guidelines (see below). There is no safe level of exposure to cancer-causing agents; even incidental exposure to antineoplastic drugs is unacceptable.  

What we found	What employers/employees should do
85% of nurses and 47% of pharmacy practitioners said two pairs of chemotherapy gloves were not always worn; 8% and 10% respectively said they did not always wear even a single pair.  38% of nurses and 20% of pharmacy practitioners said they did not always wear a nonabsorbent gown with a closed front and tight fitting cuffs. 11% of nurses and 4% of pharmacy practitioners said that they had direct skin contact when compounding antineoplastic drugs.	Avoid skin contact with antineoplastic drugs, by always wearing two pairs of chemotherapy gloves and a nonabsorbent gown with a closed front and tight fitting cuffs during compounding activities.2-6
75% of nurses and 53% of pharmacy practitioners said that they did not always use a closed-system drug transfer device (CSTD) when transferring liquid antineoplastic drugs from primary packaging (i.e., vials) to dosing equipment (i.e., infusion bags).	Use a closed-system drug transfer device (CSTD) to reduce likelihood of exposure to liquid and aerosolized antineoplastic drugs.3-6
9% of nurses and 15% of pharmacy practitioners said that they did not always use a biological safety cabinet (BSC) or isolator. These engineering controls are designed to contain liquid and solid (i.e., particulate generated from crushed tablets) antineoplastic drug formulations.	Use a biological safety cabinet (BSC) or isolator when compounding antineoplastic drugs.3-6
19% of nurses and 30% of pharmacy practitioners said they did not always prime I.V. tubing with a non-drug containing fluid such as saline.	Prime I.V. tubing with a non-hazardous drug containing liquid.3-6
24% of nurses and 4% of pharmacy practitioners said they had done so, placing themselves and even family members at risk of exposure.	Avoid taking home any clothing that may have been contaminated with antineoplastic drugs.3-6
9% of nurses and 13% of pharmacy practitioners said they lacked safe handling training. 48% and 51%, respectively, said that it was more than 12 months ago.	Provide training to employees on the hazards of antineoplastic drugs and safe handling precautions to minimize exposure. Information and training should be provided at the time of initial job assignment and annually thereafter.3-6
80% of nurses and 70% of pharmacy practitioners said that their employer did not provide medical surveillance or were unaware whether such a program was available.	Provide medical surveillance for employees exposed to hazardous drugs and encourage them to participate. Information can be used to identify and correct prevention failures and also provide early identification of health problems in exposed workers.3-7

References

¹ NIOSH list of antineoplastic and other hazardous drugs in health care settings 2016

² NIOSH Workplace solutions: Personal protective equipment for health care workers who work with hazardous drugs

³ NIOSH Alert on preventing occupational exposures to antineoplastic and other hazardous drugs

⁴ ASHP (American Society of Health-System Pharmacists) guidelines on handling hazardous drugs

⁵ OSHA. Controlling occupational exposure to hazardous drugs

⁶ Oncology Nursing Society (ONS) Chemotherapy and biotherapy guidelines and recommendations for practice

⁷ NIOSH Workplace Solutions: Medical surveillance for healthcare workers exposed to hazardous drugs

Survey and report

To request a copy of this survey, please email jmb4@cdc.gov.

Journal article

 (The free full text article will be available in Pub Med Central one year after the article has published)