COMMENTARY

Why Nurses Need Better Protection From Cytotoxic Chemotherapy Contamination

Matt Fowler

Disclosures

September 28, 2019

This transcript has been edited for clarity.

My name is Matt Fowler. I'm a nurse consultant for oncology and haematology in Birmingham in the United Kingdom. And part of my additional duties that I do, I'm a member of the Advocacy Working Group for the European Oncology Nursing Society (EONS).

What concerns did you raise in your ESMO session?

As part of our work with EONS we have a safety manifesto and one of our objectives is to look at occupational exposure to cytotoxic chemotherapy drugs for nursing staff, as we are predominately involved in the administration of chemotherapy.

And whilst there are very strong robust guidelines for our pharmacy colleagues with regards to the reconstitution of chemotherapy drugs and safe handling, from a nursing perspective, there's a lot of disparity across the world, as well as locally, and across Europe.

We feel quite strongly that we really need to be having robust guidelines that ensure nurses have access to appropriate personal protective equipment (PPE), that we have access to use closed system transfer devices, and good education.

We also feel strongly that nurses that are either trying to conceive, are pregnant, or breastfeeding have no contact with cytotoxic chemotherapy drugs at the moment - with no consequences for not having any contact.

It's very difficult in the workplace sometimes for nursing staff to actually say, 'no, I'm not going to be able to care for that group of patients'. But there's always a way. We can always find a way to find alternative duties for nurses that belong to that group that I mentioned earlier.

Why is guidance lagging in this area?

The problem is we've got a lot of guidance out there, but it is just that, it's guidance. It's not legislative. I'm aware that there are some EU directives that are legislation whereby we should be adhering to certain guidelines. However, that's not happening across the board. And the problem is we've got different guidelines in different parts of countries, and different organisations. And for me, they just all need to marry-up, but they need to be robust, evidence-based, and the protection of the nurse must be at the forefront of this.

Who would produce these guidelines?

I think we need to really look at working with our European colleagues, initially. I think ASCO and ONS did some work, but there was some slight disparity there between their guidelines.

Across Europe now we've got a very good opportunity with regards to the MASHA Project and working with ECCO, ESOP, EONS, working in collaboration, to actually formulate some robust guidelines that are evidence-based to ensure that we protect the nursing workforce.

What's the best practice when delivering these drugs?

If I think about my own practice, when I administer chemotherapy, I would from a protective point of view, I would wear a pair of standard gloves and I would wear an apron. However, that is not the case in other areas of the world or indeed other parts of the country, and across Europe as well.

We've got such disparity between what nurses have access to when it comes to PPE, because for some areas nurses will wear a full gown, they'll have a respirator on, they'll have eye protection, they'll double-glove. And obviously, the use of closed system transfer devices is key as well.

Whereas in other parts of the world that I have worked in myself, a nurse will just literally have access to a pair of gloves as PPE. And personally, I don't think that gloves and an apron is enough.

We need more, we need to do more. And we need more robust guidelines.

What are the possible consequences of accidental contact?

This is another interesting point because there are studies out there that suggest that nurses that don't have access to appropriate PPE and are inadvertently exposing themselves to carcinogens are at increased risk of miscarriage. There's some anecdotal evidence to suggest that we may be putting ourselves at increased risk of cancer. We are exposing ourselves to these carcinogens that can cause some short-term problems, such as nausea. Some nurses have reported hair loss.

There's a whole myriad of symptoms, fatigue, that nurses have reported, but we've got no robust clinical trials to back this up and we really do need it.

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