July 18, 2008
Safe handling of chemotherapy drugs examined

As part of a continuing effort to ensure employee and patient safety in the handling of chemotherapy drugs, the MGH Hazardous Drug Safety Task Force (HDSTF) has closely examined a number of areas where staff members prepare, administer and dispose of the drugs in a first-of-its-kind study. Recently, Harry Demonaco, MS, senior clinical associate for the Clinical Care Management Unit, and Jackie Somerville, RN, PhDc, associate chief nurse, shared results from the first phase of the study with the Council for Technology Adoption and Innovative Process Promotion (CTAIPP) in an interim report June 6.

Demonaco and Somerville explained that based upon the sample collections and assays, results indicated residual levels of chemotherapy drugs in the workplace with patterns suggesting contamination due to handling techniques. They also noted that there was consistent residual contamination on and around biohazard containers, and using high-speed photography, they found that aerosolization of the drugs does not appear to be an issue.

"Based on these findings, we conclude that intermittent environmental contamination appears to be a direct result of employee 'hand-to-environment contamination,'" says Demonaco. "Therefore, closed IV systems or devices would not ensure safety, but rather strict adherence to existing policies and procedures will greatly reduce employee risk." 

To address the low levels of workplace contamination, HDSTF members and representatives from Nursing, Environmental Services and Pharmacy convened May 31 to examine the policies and procedures for handling chemotherapy drugs. Viewing a series of simulations of chemotherapy drug preparation, administration and disposal, the team began work on identifying steps to revise policies and procedures. The group also developed a set of guiding principles for the revision project. These include the understanding that it is not possible to completely eliminate hazardous drugs in the environment or exposure; hands are the primary vector for spreading contamination; and all persons having contact with hazardous drugs should view personal protective equipment as community protective equipment, accept responsibility for the safe containment of hazardous waste and follow safe handling and disposal practices. A set of revised policies and procedures is scheduled to be available this summer.

"Our goal is to continue to increase our understanding of the problem and, based on sound information, make changes that continually increase the level of protection for employees," says Somerville. 

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