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Antineoplastic Drug Exposure in an Ambulatory Setting: A Pilot Study

Friese, Christopher R. PhD, RN, AOCN, FAAN; McArdle, Cristin MPH; Zhao, Ting PhD; Sun, Duxin PhD; Spasojevic, Ivan PhD; Polovich, Martha PhD, RN, AOCN; McCullagh, Marjorie C. PhD, RN, PHCNS-BC, COHN-S

doi: 10.1097/NCC.0000000000000143
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Background: Exposure to antineoplastic drugs confers health risks to workers, yet little is known about the exposure after a drug spill, nor has the relationship between exposure and organizational factors such as staffing and work environment been studied.

Objective: The aim of this study was to evaluate drug spills prospectively using biological measures and correlate drug spills with organizational factors.

Methods: Prospective questionnaires with 8-hour timed urine samples were collected from nursing and pharmacy personnel who reported drug spill events in 1 academic health center’s infusion center. Urine was collected similarly from workers who did not report a spill. Liquid chromatography tandem mass spectrometry techniques identified detectable drug levels. After the prospective sampling period, workers were surveyed on workloads, practice environment, and safety behaviors.

Results: From 81 eligible individuals, 40 participated in the prospective study and 19 completed retrospective questionnaires. Four spills were reported by 9 personnel, as multiple employees were exposed to drug spills. Four participants who reported a spill showed detectable levels of antineoplastic drugs. Four participants who did not report a spill had detectable levels of docetaxel. Compared with respondents who did not report a spill, collegial relations with physicians were significantly poorer for workers who reported spills.

Conclusions: The study protocol successfully captured drug spill reports and biological samples. Workers have detectable levels of antineoplastic drugs through both drug spills and environmental contamination.

Implications for Practice: Multisite research studies and practice-based quality improvement approaches are needed to improve adherence to personal protective equipment use and safe handling procedures.

Author Affiliations: School of Nursing (Drs Friese and McCullagh) and College of Pharmacy, Pharmacokinetics Core (Dr Zhao), University of Michigan, Ann Arbor; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing (Ms McArdle); Department of Medicine, Duke University Medical Center and Duke Cancer Institute Pharmacokinetics/Pharmacodynamics Bioanalytical Core Lab, Durham, North Carolina (Dr Spasojevic); and Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta (Dr Polovich).

Dr Polovich received honoraria from ICU Medical and B.D. Dr Friese was supported by a Pathway to Independence award from the National Institute of Nursing Research (R00NR010750) and by a University of Michigan Comprehensive Cancer Center Support Grant (P30CA46592). Drs Friese and McCullagh received pilot funds from the University of Michigan’s Education and Research Center for Occupational Safety and Health (T42OH008455).

The authors have no conflicts of interest to disclose.

Correspondence: Christopher R. Friese, PhD, RN, AOCN, FAAN, School of Nursing, University of Michigan, 400 North Ingalls, 4162, Ann Arbor, MI 48109-5482 (cfriese@umich.edu).

Accepted for publication February 14, 2014.

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