Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2009-0148-3158, 2012 Jun; :1-27
On May 1, 2009, NIOSH received a confidential employee request for an HHE at an oncology clinic in Florida. The request concerned potential exposures to chemotherapy drugs and adverse health effects such as upper respiratory symptoms, rash, diarrhea, migraine, and headache. During our first site visit in September 2009, we measured the face velocity of the Class 2 BSC where chemotherapy drugs were mixed and collected surface and hand wipe samples for platinum-containing chemotherapy drugs. We also conducted health interviews with 14 of 54 employees and reviewed the OSHA Form 300 Log of Work-Related Injuries and Illnesses for 2006 through 2008. In November 2010, during our second evaluation, we collected surface wipe samples (but no hand wipe samples) for platinum-containing chemotherapy drugs in similar locations as in the 2009 evaluation. We also collected surface wipe samples for cyclophosphamide, ifosfamide, and doxorubicin at the beginning of the work day before the chemotherapy drugs were unpacked and at the end of the work day after the last chemotherapy treatment was completed. We did this to evaluate the clinic's cleaning procedures and employee work practices. Platinum-containing chemotherapy drugs were detected in most surface wipe samples during both evaluations but not on the two hand wipes collected in 2009 from nurses who had recently handled platinum-containing chemotherapy drugs. Cyclophosphamide and ifosfamide were detected on surface wipe samples collected throughout the clinic, suggesting inadequate work practices and housekeeping. Doxorubicin was not detected on any surface wipe samples but its recovery may have been poor because these wipe samples had been frozen for approximately 7 months awaiting development of an analytical method [Burr 2011a]. The Class 2 BSC was certified biannually. The sash alarm that was malfunctioning during our first visit had been repaired by our second visit. The average BSC face velocity we measured was 275 feet per minute, which met the CDC recommendation of at least 100 feet per minute [CDC 2007]. Of the 14 employees we interviewed, 4 reported health symptoms consisting of runny nose, sneezing, eye irritation, and headache that improved on their days off work. One of these four reported a recurring "burning" rash on his nose after handling chemotherapy drug waste. All interviewed employees reported adequate training about the safe preparation, administration, and disposal of chemotherapy drugs. However, three employees reported inadequate training on the potential short- and long-term health effects of chemotherapy drug exposure. When preparing chemotherapy drugs, all employees reported using double gloves, goggles, and chemotherapy protective gowns. Some employees stated they voluntarily wore disposable filtering facepiece respirators and/or surgical masks to avoid contaminating the chemotherapy drugs and/or to protect the patients. Four employees reported not consistently double gloving or using chemotherapy protective gowns when administering chemotherapy drugs to patients. Some employees also reported reusing disposable surgical masks. Considering the inconsistent use of PPE and presence of chemotherapy drug residue in the clinic work area, employees are at risk of both acute and chronic health effects from exposure to chemotherapy drugs. We recommend the clinic improve employee work practices and housekeeping, start a medical surveillance program for employees, provide annual training, and require the use of appropriate PPE when handling chemotherapy drugs.
Chemotherapy; Pharmaceuticals; Health-care-facilities; Health-care-personnel; Nurses; Therapeutic-agents; Platinum-compounds; Work-practices; Surveillance-programs; Personal-protective-equipment; Personal-protection; Protective-equipment; Protective-clothing; Gloves; Housekeeping-personnel; Eye-protective-equipment; Eye-protection; Respiratory-protective-equipment;
Author Keywords: Office of Physicians (Except Mental Health Specialists); anti-neoplastic drugs; cisplatin; cyclophosphamide; ifosfamide; doxorubicin; healthcare personnel; chemotherapy drugs; housekeeping