In the January issue, Lawson and colleagues described the alarmingly low utilization of personal protective equipment (PPE)—gloves and gowns—by nurses preparing and administering antineoplastic drugs to patients (“Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns”). Most startling were the percentages of pregnant nurses not using PPE, even though the risk of adverse reproductive health effects from exposure to chemotherapeutic drugs is well known.
Nurses deliver the vast majority of antineoplastic agents to treat cancer and other conditions. For almost four decades, the Oncology Nursing Society (ONS) has been a leader in the development of safe handling practices for all nurses. ONS safe handling guidelines are consistent with those of national organizations and regulatory bodies including the National Institute for Occupational Safety and Health1 and the Occupational Safety and Health Administration,2 as well as the American Society of Health-System Pharmacists and the U.S. Pharmacopeia. A key guideline is that nurses should wear, at a minimum, gowns and double chemotherapy-tested gloves when handling and administering antineoplastic drugs, whether via infusion or pills. (If pills are intact, only one pair of gloves is required.3)
The ONS supports a collaborative approach to improving health care worker safety. Institutional policies and procedures need to support the use of engineering controls, safe work practices, and PPE. Nurses should participate in selecting PPE supplies that are comfortable, easy to use, and effective. Supplies must be available at the point of care with receptacles for convenient disposal. Hospital administration and nursing management must ensure adequate staffing and support and enforce the use of PPE to protect nurses from exposure to hazardous drugs and ensure safety in the patient care environment.
Lisa Kennedy Sheldon, PhD, ANP-BC, AOCNP, FAAN
Submitted on behalf of and approved by the Oncology Nursing Society, Pittsburgh, PA
1. Connor TH, et al. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings, 2016.
Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health; 2016. DHHS (NIOSH) publication no. 2016-161 (Supersedes 2014-138). https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf
2. Occupational Safety and Health Administration (OSHA). Controlling occupational exposure to hazardous drugs. In: OSHA technical manual. Washington, DC: U.S. Department of Labor; 2016. https://www.osha.gov/SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html
3. Polovich M, Olsen MM, editors. Safe handling of hazardous drugs.
3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2018.