High Eye, Skin Exposure to Chemotherapy Reported in Study

Almost 1 of 5 oncology nurses is unintentionally exposed to chemotherapy agents, according to an article published online August 16 in BMJ (British Medical Journal) Quality & Safety.

Christopher Friese, RN, PhD, and colleagues reported that the overall rate of exposure to the skin or eyes in the past year among nurses working in an outpatient setting was 16.9%. Such “secondhand chemo” can have immediate effects on the nervous system and acute and long-term reproductive effects (infertility, miscarriage), and may place individuals at risk for hematologic malignancies.

In the study, 1339 oncology nurses working in an ambulatory care setting were sent questionnaires; 402 (30.5%) responded. The survey examined the likelihood of self-reported exposure to chemotherapy as “a function of perceived quality of the practice environment,” nursing workload, and 7 ambulatory chemotherapy administration safety standards adapted from those issued by the Oncology Nursing Society (ONS) and the American Society of Clinical Oncology (ASCO).

Nurses reporting exposure had lower (worse) scores on several of the subscales of the Practice Environment Scale of the Nursing Work Index, reporting less participation in practice affairs and less adequate staffing and resources. In particular, chemotherapyexposed nurses claimed to have higher workloads: an average assignment of 11.1 patients per shift compared with 8.4 per shift for nurses not reporting exposures (P = .02). Because of the substantial variation in workload, however, the authors cautioned against overinterpretation. And although there was no significant difference between the percentage reporting a “favorable” practice environment, a numerical difference favored the nonexposed group.

Chemotherapy orders were verified by 2 or more nurses on a frequent or very frequent basis 94.5% of the time for the whole cohort; however, only 82.9% of the chemotherapy-exposed nurses said this held true for them, compared with 96.9% of those not exposed (P <.01). The authors called this finding “intriguing” and suggested “it may serve as a proxy for various processes to protect patients and nurses.” They noted that centers adhering to the ONS/ASCO-recommended safety practices “likely are predisposed to a positive safety culture.”

Number of years of nursing employment did not differ by exposure status, nor did race, oncology certification status, or education level.

According to the authors, this study is one of the few to evaluate chemotherapy safety among oncology nurses in an ambulatory care setting, and the first to assess the impact of organizational structures and processes on exposure risk. In addition to strengthening the safety culture within their institution, nursing leadership could help protect nurses from harm by distributing nursing workloads more evenly, assuring the availability of adequate time, space, and personnel for chemotherapy verification, and guaranteeing that requisite resources are available to administer chemotherapy in ways that minimize occupational exposure, they suggested.