The following is an oral presentation I made to the Occupational Health and Safety Committee at my worksite in June 1999.

Chemotherapy, a.k.a. antineoplastic, agents are cytotoxic drugs. This means they are toxic to the cells they are targeted for. The cells will no longer be able to divide and grow. In principle, then arresting any further cancer growth. Since they act on cells, they also affect normal cells, resulting in the undesirable side effects, for example aleopcia, and low blood counts (Barton et al, 1991)

Since these agents are harmful to normal cells, they have the potential to affect workers who are exposed to them (Dunne, 1989). <Description of Sally's case from my memory given at this time>.

To further substantiate the need for precautions I would like to compare two articles, Self Protective Practices Of Nurses Handling Antineoplastic Drugs, and Occupational Exposure of Nursing Personnel to Antineoplastic Agents. Both of these articles were quantitative studies. I will compare them in relation to their purpose, sample size method, and conclusions.

The first study, Occupational Exposure of Nursing Personnel to Antineoplastic Agents was published in the Sept/Oct 1985 issue of Oncology Nursing Forum. The purpose of the study was to assess the degree of exposure while mixing and/or administering chemotherapy agents.

The sample of this study consisted of 28 nurses from one facility or work site. Their demographics consisted of a mean age of 31.4, twenty-seven women and one man, the length of time in their current position, where or not they were current smokers.

The method used was a longitudinal study in which daily urine samples were collected in the morning. These urine samples were tested for mutagenicity using bacteria.

Findings from this study were inconclusive. The study showed the method of testing was not reliable to support or refute data. The urine samples were affected by byproducts of cigarette smoking, and the collection time also may have been wrong for the excretion time of any antineoplastic agent absorbed, missing any systemic exposure. This study then referred to several other studies about chromosome-type breaks in their samples. The study concluded that while this technique was not appropriate there was still a demonstrable need for precautions when mixing and/or administering chemotherapy agents.

The authors of this study also recommended a need for further studies using a different technique. They also recommended education of nursing personnel regarding hazards, handling and disposal of agents and the excreta of patients receiving chemotherapy drugs.

The second study I looked at was Self Protective Practices of Nurses Handling Antineoplastic Drugs, and was published in the May/June 1987 issue of Oncology Nursing Forum. The purpose of this study was to examine the use of precautions used by nurses, as well as explore the reasons for use, and non-compliance.

This study was a cross-sectional study done using a questionnaire filled out by 632 nurses from various facilities and work sites. The inclusion criteria was having mixed and/or administered chemotherapy agents previously. Demographic data of the sample included a mean age of 35.2, extent of experience handling antineoplastics, area of employment and type of shifts worked.

I found the conclusions of this article very interesting. The study showed use of adequate protection was widely variable. The most consistent protection used was gloves, but gowns, lab coats, masks and goggles were used inconsistently and less frequently. The study also referred to a new technique allowing Adriamycin spills to be visible. This technique was applied to nurses reporting no skin contact, only to show Adriamycin on their skin. Thus indicating many nurses are not aware of skin exposure, further supporting the need to use gowns when administering or mixing chemotherapy agents. The study also examined why nurses do not use precautions. The reasons cited included lack of available equipment and lack of perceived hazard.

While the first study supports the need for protection, the second study indicates we, as nurses, have a need for education regarding administering chemotherapy agents. An interesting study we could do in the Capital Health Region, is to examine the correlation between use of precautions and education. I believe we need to have more education about antineoplastics to reduce our Occupational Health and Safety risks.

In the Capital Health Region Home Nursing Care program there is an extensive care plan. <hand out care plan to members present> As you glance through it with me you can see it is all related to patient symptoms and emotional disposition. There is no nursing diagnosis or invention section for precautions for nursing personnel and/or family of the patient receiving chemotherapy. If there was a section, there may be an increased awareness of precautions as well as a patient education component.

I believe both the patient and family need to be protected from the hazards of chemotherapy as well. For instance, the patient I gave chemotherapy to recently had carpet in their house. Without proper education this client may not have cleaned up a spill adequately. The drug would then sit in the carpet and get walked on and transported throughout the house. Everyone entering the house would then be exposed to the chemotherapy agent unwittingly.

There is current literature available to us for providing care, and enhancing our care plans. <hand out BC Cancer Agency Nursing Practice Reference Guide and Safe Handling Standards, 1997> These guidelines were developed by the BC Cancer Agency and cover infusion policies, nursing considerations, documentation, and procedures for dealing with spills and necessary precautions. While these are guidelines there is no background information provided.

In the Capital Health Region (CHR) in the late 1980's a two-module course, referred to as Module one and two, on Chemotherapy was developed. It has since been revised into an eight lesson self-directed learning module (G.V.H.S., 1998). The original two-module course had the same information, but in a different format. Modules consisted of some background information and a few opinion articles. <show Module 3> This new course, referred to as module three, has many interactive portions to it and is research based. I would have gotten you all a copy, but as you can see it is a 220-page booklet. I will leave this one for you to share. All the staff administering chemotherapy in the C.H.R. Acute Care has to be certified through this module. As you can see from the comprehensive content, it would also benefit the overall quality of care of these clients. I am not sure how long it takes to complete, but I would be willing to find out.

In closing, research literature supports the need for precautions when administering chemotherapy. It also indicates an inconsistency in use of precautions. I also understand you have all examined the Workers' Compensation Board regulations governing chemotherapy in the workplace. It identifies a need for education, and has approved this course already for the Capital Health Region. For these reasons I would like you to consider making Module Three available to Home Care Nurses having to administer chemotherapy to clients.

Any questions?

Thank you for your time, please feel free to contact me at work by pager 413-5996 for further discussion.