WHY CLOSED SYSTEMS?

potential health risks for chemotherapy nurses

WHY CLOSED SYSTEMS?

There is an increasing awareness amongst healthcare professionals about the potential health risks from an exposure to cytotoxic drugs.  As well as clinical evidence and studies highlighting a range of issues, there is a recent survey of chemotherapy nurses, which revealed nearly 50% said they had experienced adverse effects on their health.

SACT and closed systems

Cytotoxic Systemic Anti-Cancer Therapy (SACT), or cytotoxic chemotherapy, is a group of medicines containing chemicals that are directly toxic to cells. In preventing the replication or growth of cells they are active against cancer.

By their very nature, the cytotoxic drugs also pose a threat to the clinicians and support staff who deliver the chemotherapy to patients. Many SACT agents are known to be carcinogenic, teratogenic and mutagenic by virtue of their mechanism of action within cells. There are now many clinical papers and reports outlining the risks to the health of staff and anecdotal accounts of possible exposure to chemotherapy ranging from itchy skin and hair loss to miscarriage and infertility.  The risk of exposure comes from of the inhalation of contaminated air, or by skin contact with contaminated surfaces, material and medical equipment (Sessink, 2016)

As nurses very familiar with the oncology environment and the potential risks to our colleagues from exposure to cytotoxic drugs, we are adamant that CSDTDs must be made mandatory to protect healthcare workers. Through our work at Birmingham City University in researching the issue, the training we do in hospitals and the reaction to the clinical papers we’ve written, we know there’s a lot of work to do to make sure all healthcare workers are aware of the risks and are properly supported in keeping themselves as safe as possible.

We believe this can only truly be achieved when all cytotoxic drugs are administered through CSDTDs and that’s the aim of the SACT Safety campaign.

Why not join us? Register your contact details here and we’ll keep you informed of all the latest news.

Growing evidence

There is a growing body of evidence detailing the potential risks to healthcare workers of exposure to cytotoxic chemotherapy during administration. There is specific guidance from the Health and Safety Executive (HSE, 2014) about the Safe Handling of cytotoxic drugs in the workplace.

But anecdotal accounts and the experience of healthcare practitioners shows that current practices may not be keeping clinicians safe enough and the only way to achieve effective protection is by the mandatory use of closed system drug transfer devices.

Below is a list of clinical evidence as well as useful links to official guidance and legislation.

  • Simons A and Toland S (2016) Closed systems for drug delivery; a necessity, not an option. British Journal of Nursing (IV therapy supplement) vol 24 no 14
  • Simons A and Toland S (2017) Perceived effects from handling systemic anti-cancer therapy agents. British Journal of Nursing (Oncology supplement) vol 26 no 16
  • BD Supplement in British Journal of Nursing: Be compliant, protect each other and stay safe: avoiding accidental exposure to cytotoxic drugs. British Journal of Nursing. 24(16):S1-56
  • Control of substances hazardous to health (COSHH) (2002) available online at: http://www.legislation.gov.uk/uksi/2002/2677/regulation/11/made
  • National Institute for Occupational Safety and Health. (2004) NIOSH Alert: Preventing occupational exposure to antineoplastic and other hazardous drugs in healthcare settings. DHHS publication no 2004-165 Cincinnati OH:US Department of Health and Human Services. Centers for Disease Control and Prevention
  • Management of health and safety at work regulation (1999) available online at http://www.legislation.gov.uk/uksi/1999/3242/pdfs/uksi_19993242_en.pdf
  • Health and Safety at Work Act (1974, 2002) Available online at http://www.legislation.gov.uk/ukpga/1974/37/contents
  • Health and Safety Executive (HSE, 2014) Safe Handling of cytotoxic drugs in the workplace. Available online http://www.hse.gov.uk/healthservices/safe-use-cytotoxic-drugs.htm
  • European Policy Recommendations. (2016) Preventing occupational exposure to cytotoxic and other hazardous drugs. Available online http://www.europeanbiosafetynetwork.eu/wp-content/uploads/2016/05/Exposure-to-Cytotoxic-Drugs_Recommendation_DINA4_10-03-16.pdf
  • American Society of Health-System Pharmacists (ASHP, 2006) AHSP Guidelines on Handling Hazardous drugs. Am J Health-Syst Pharm. 63:1172-93
  • International Agency for Research on Cancer (IARC)(2016) IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Lyon, France: World Health Organisation, International Agency for Research on Cancer, iarc.fr
  • ISOPP (2007) Standards of Practice. Safe Handling of Cytotoxics. Journal of Oncology Pharmacy Practice 13(1) 1-81
  • Beaney AM (2016) Quality Assurance of Aseptic Preparation Services: Standards, 5th Edition, Royal Pharmaceutical Society
  • Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT, 2016) Dangerous drugs: preventative measures for preparation and administration, [in Spanish] Ministerio de employeo y segridad social. http://tinyurl.com/mjh6f5r
  • MA, Oliver. M, Roth. T, Rogers. B and Escalante. C (2010) Chromosome 5 and 7 Abnormalities in Oncology Personnel Handling Anticancer Drugs, American College of Occupational and Environmental Medicine, 52 (10) p1028-1034
  • Occupational Safety and Health Administration (OSHA, 2016) Controlling Occupational Exposure to Hazardous drugs, https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html#mgmt
  • Pan American Health Organisation (2013) Safe Handling of Hazardous Chemotherapy Drugs in Limited-Resource settings Washington D.C PAHO
  • Wiley, K (2017) What Are ONS’s Recommendations for Safe Handling of Hazardous Drugs? ONS Voice https://voice.ons.org/news-and-views/safe-handling-of-hazardous-cancer-drugs accessed on 28/6/17.

Our survey results

A survey to measure whether nurses experience any harm when administering chemotherapy drugs to patients reveals that 46% had experienced one or more adverse effects on their health.

The anonymous survey carried out by Alison Simons and Samantha Toland at Birmingham City University was completed by 200 nurses across 55 different healthcare organisations from all over the UK.

The most common complaints were headache, dizziness or nausea, or combination of two or more symptoms.  One in every 10 respondents said they had suffered miscarriage or fertility problems, which they attributed to the drugs they had worked with and a further 9% said they’d experienced hair loss.

Concluding their research published in the Oncology Supplement of the British Journal of Nursing, Alison and Sam said: “There is an increase in the use of new therapies such as targeted therapies, immunotherapies and monoclonal antibodies (MABs) where the hazard of exposure of these agents to healthcare workers has not yet been identified.

“Therefore closed systems should be used to prevent exposure until there is documented evidence that these agents do not pose a health risk to people who work with them.”

Simons A and Toland S (2017) Perceived effects from handling systemic anti-cancer therapy agents. British Journal of Nursing (Oncology supplement) vol 26 no 16.

A Nurse’s Story

Alison Jones

Alison is an Acute Oncology Nurse Practitioner at Birmingham City University. She first came into contact with systemic anti cancer therapy (SACT) as an oncology nurse at the Queen Elizabeth Hospital in Birmingham in the 1990s.

Exposed to chemotherapy on a daily basis, Alison had a miscarriage and then experienced fertility problems, which resulted in IVF treatment. Two of her colleagues, who developed cancer, associated their health issues with the chemotherapy treatment they had administered.

Whilst standards of training and protection are much better for nurses today, Alison believes that any possible contact with chemotherapy needs to be eliminated to ensure carers are safe.

“There is no doubt that nurses are better protected now than when I started but there is still a way to go.

“When I first started as a chemotherapy nurse in 1993 we didn’t even have spillage kits. You spiked a bag and you taped it. There was no real knowledge of the risks and that the chemo could do us any harm. I made chemo up. If it had crystallised you would re-make it up. No-one showed me how to do it we just got on and drew it up in the clinical room, there was no face masks back then and definitely no isolator.

“You could definitely smell the chemo when you breathed it in. You’d open certain drugs, which smelled strongly of metal and some were definitely worse than others. When we made the drugs up we were often in a small, pokey room with no ventilation and you would cough with the fumes. There were times when I felt sick and once I spilled a bit of chemo on my leg and it left a burn. Rashes and dry skin were commonplace in the department and we liked to blame the gloves but it could have been the chemo.

“One of the scariest things looking back was when we spiked the bags and the chemo was being administered there was sometimes a pool of liquid on the floor. We assumed it was from the water jugs and we cleaned it up as if it was water, without gloves, but it was most likely chemo. There was no designated wash up area for the chemo equipment, we just washed everything up together. Because nothing was monitored or measured officially we will never know if the health problems we experienced were as a result of the exposure we had to the chemo but a tutor I had on an oncology course had made up hundreds and hundreds of drugs, without gloves or face mask and she got cancer. She was convinced it was the exposure to the chemo.

“Now there is much more awareness of the dangers when handing the drugs but there are still gaps that need plugging. Everyone should be choosing closed system drug transfer devices to offer the maximum protection but that will take time. In the meantime there is plenty that can be done. Better training that is consistent across the country is vital and agency staff need to be properly and consistently briefed to know what’s on a ward and what to look out for.

“The chemo passport* is an excellent initiative in to ensure SACT training is consistent across London and this needs to take place nationally.”

Do you have a story to tell?

If you have been affected by any of the issues outlined in Alison’s story, or you’ve experienced adverse effects on our health whilst administering chemotherapy and you would like to share your experiences or be part of the SACT Safety campaign, do please contact us on hello@sactsafety.com

What is SACT?

Cytotoxic Systemic Anti-Cancer Therapy (SACT), or cytotoxic chemotherapy, is a group of medicines containing chemicals that are directly toxic to cells. In preventing the replication or growth of cells they are active against cancer.

By their very nature, the cytotoxic drugs also pose a threat to the clinicians and support staff who deliver the chemotherapy to patients. Many SACT agents are known to be carcinogenic, teratogenic and mutagenic by virtue of their mechanism of action within cells. There are now many clinical papers and reports outlining the risks to the health of staff and anecdotal accounts of possible exposure to chemotherapy ranging from itchy skin and hair loss to miscarriage and infertility.  The risk of exposure comes from of the inhalation of contaminated air, or by skin contact with contaminated surfaces, material and medical equipment (Sessink, 2016)

 

*The Systemic Anti-Cancer Therapy (SACT) competency passport has been developed by cancer nurses across London and the UK Oncology Nursing Society (UKONS), with support from Capital Nurse. It will ensure that training for nurses giving patients cancer therapies, such as chemotherapy, is consistent, up-to-date and standardised in NHS trusts and private hospitals across London. Previously nurses who administer SACT have needed to undertake re-training in any new place of work. This has led to inconsistencies in the quality of training and duplication.

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