Nearly 17% of nurses who work in outpatient chemotherapy-infusion centers suffer from skin or eye exposure to the toxic drugs they deliver, according to a new study.

Researchers at the University of Michigan Comprehensive Cancer Center (Ann Arbor, MI, USA) conducted a Michigan (USA) state-wide sample survey of 1,339 oncology nurses (response rate 30.4%) who reported their employment outside of hospital inpatient units, between April 2010 and June 2010. The survey examined the likelihood of self-reported exposure to chemotherapy as a function of perceived quality of the practice environment, nursing workload, and seven ambulatory chemotherapy administration safety standards.

The results showed minimal demographic differences between respondents and nonrespondents, with the overall rate of exposure to the skin or eyes during the past year at 16.9%. In multivariable logistic regression models that controlled for demographic characteristics and clustering of nurses in practices, the likelihood of exposure decreased when nurses reported adequate staffing and resources, and when nurses reported that chemotherapy doses were verified by two nurses frequently or very frequently. The study was published early online on August 16, 2011, in BMJ Quality and Safety.

“We have minimized needle stick incidents so that they are rare events that elicit a robust response from administrators. Nurses go immediately for evaluation and prophylactic treatment. But we don't have that with chemotherapy exposure,” said lead author Christopher Friese, RN, PhD, an assistant professor at the University of Michigan school of nursing. “Any unintentional exposure to the skin or eyes could be just as dangerous as a needle stick.”

Unlike needle sticks, where a specific virus is involved and preventive treatments can be given, it is more difficult to link chemotherapy exposure to a direct health effect. Unintentional chemotherapy exposure can affect the nervous system, impair the reproductive system, and confer a future risk of blood cancers. Ensuring adequate staffing and resources and adherence to recognized practice standards may protect oncology nurses from harm.

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