The way it was.
cyclophosphamide IV
When I was in graduate school in the mid-1970s, I had a part-time job working for a physician group that treated patients with blood cancers, mostly leukemia and lymphomas. I started the IVs and administered chemotherapy, which typically included drugs such as vincristine, nitrogen mustard, doxorubicin, and cyclophosphamide.
I drew up the medications in a utility room—there was no special fume hood to clean the air. Initially, I did not use either a protective gown or gloves; after a bout of contact dermatitis on my hands, I used gloves, but I never used a gown. At that time, there were no guidelines for those of us who administered the drugs. Given what is known today about the reproductive toxicity of many of these drugs, I was fortunate that my exposure was short-term and before I became pregnant.
Do nurses follow today’s guidelines?
Today, there are clear recommendations for using personal protective equipment (PPE) like gloves and gowns when administering these hazardous agents. Yet, surprisingly, many nurses—even pregnant nurses—don’t follow them, according to a study published in AJN’s January issue.
In “Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns,” the researchers used data from the Nurses Health Study 3 to assess the use of PPE by nurses who administered chemotherapy. They found that, despite recommendations that have existed since the 1980s, many nurses are putting themselves at risk:
“Although pregnant nurses in our study were more likely than nonpregnant nurses to report using gloves and gowns when administering antineoplastic drugs, about one in 10 did not always wear gloves and one in two did not always wear a gown when doing so during the first 20 weeks of pregnancy—a time during which the fetus is highly susceptible to exposure.”
Reasons why nurses don’t wear gowns or gloves.
The study did not assess why nurses didn’t use gowns or gloves as recommended, but does cite reasons found by other researchers, which include
- the time it takes to don and doff gowns.
- a sense that skin exposure is minimal.
- the lack of a clear policy about usage.
- the simple fact that other colleagues didn’t wear gowns.
Employers share responsibility.
The authors call for employers to provide equipment and greater education and training in the use of PPE among those handling neoplastic drugs. “First, do no harm” needs to include those who are providing care.
In the early 70s I worked on a Pediatric cancer ward. One of my patients was a beautiful six year old boy named Dean who had a brain tumour which eventually killed him. His mother worked as a chemo nurse while she was pregnant with him, mixing and administering without benefit of PPE. I’ll never forget that sweet little boy, so heartbreaking.