April 4, 2008
Hazardous Drug Safety Project: Evaluating chemotherapy drug safety at the MGH

To understand the environmental impact involved with the preparation, administration and removal of nine chemotherapy drugs commonly used at the hospital, the MGH launched the first-of-its-kind Hazardous Drug Safety Project (HDSP) in December 2007. The project, led by Harry Demonaco, MS, and Jackie Somerville, RN, PhDc, associate chief nurse, examines a number of areas where chemotherapy drugs are handled to determine if there is contamination in these environments. Results from the study will be used to enhance and improve personal protective equipment, assess the value of new protective devices designed to reduce the risks of chemotherapy drug exposure and ultimately ensure that all employees who come into contact with chemotherapy drugs work in the safest possible environment.

The first phase of the HDSP involved swabbing surfaces in the Yawkey 8 Infusion Unit and the Central Pharmacy. Under the direction of Jeffrey Supko, PhD, director of the Clinical Pharmacology Lab, researchers used specialized and sensitive equipment and found residual amounts of chemotherapy drugs in quantities that were nearly undetectable in some areas of both locations. These findings are consistent with those obtained at other centers in previously published work. The risk posed to employees by these very low levels is unclear at the moment. A major goal of the project, however, is to minimize the amount of these chemotherapy drugs in the environment and reduce any risks to employees.

"While it is known that there is a potential risk working in areas where chemotherapy drugs are present, strict adherence to policies and procedures will reduce these risks," says Demonaco. "Results from the first phase showed that the trace contamination found in various areas could be the result of handling techniques. Therefore, the use of personal protective equipment — such as gowns, masks and gloves — should be viewed as 'community protective equipment,' because the use of such protective gear reduces the likelihood of exposing oneself and others to these drugs."

Somerville adds, "As we move into the next phase of the project, we already have gained valuable insight. Efforts currently are underway to coordinate all policies and procedures for chemotherapy drug handling within the departments of Nursing, Pharmacy and Environmental Services. Examining these policies is a major step toward improving our ability to reduce contamination."

Demonaco credits the Clinical Pharmacology Lab for its role in the leadership and success of the project. "Without the team's expertise and collaboration, we could not conduct this project," he says. The next phase of the HDSP will include taking samples from additional locations where chemotherapy is prepared, administered and discarded. For more information about the project, contact Demonaco at
hdemonaco@partners.org. Employees with concerns or questions about their own work environment and chemotherapy drug safety should speak directly to their managers or supervisors.

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