Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Over 100 types of cancers affect humans. It can develop almost anywhere in the body. According to National Institute of Cancer Prevention and Research (NICPR), estimated number of people living with the disease in India is around 2.25 million. According to the Indian council of medical research over 11, 57,294 lakh new cancer patients registered every year and cancer-related deaths are 7,84,821. There are many types of cancer treatments. The commonly used cancer treatments in India include surgery, chemotherapy, radiation therapy, immuno therapy, hormone therapy, stemcell transplant, targeted therapy and precision medicine.
As the number of cancer cases increases, so does the demand for professionals involved in the care and treatment of these patients. This, in turn, increases the occupational risks to which these professionals are exposed. The handling of drugs is considered the major occupational exposure to chemical agents in hospitals, and involves a high risk of accidents and work diseases, affecting mostly pharmacists, nurses, and nurse technicians, who are constantly involved in preparing and administrating these drugs. This is because the inhalation of aerosol and percutaneous absorption of residues and particles are the main routes of exposure. Such agents may go unnoticed, leading to an immediate or delayed health-disease process to the worker. Studies have found that there are two major risks involved in anticancer drugs. One is the health of the person receiving them and the other is the health of the person administering them. Though doctors are the one who prescribing these drugs, it is the nurses who have to manually handle and administer them to their patients. So nurses handling chemotherapeutic agents are in risk to develop health hazards as they are exposed to chemotherapy drugs. Like the effects of passive smoking, nurses can also be exposed to second-hand chemotherapy. Research studies has shown that these drugs can harm workers’ health due to their toxicity, and may cause undesirable and irreversible side effects when exposed and manipulated without safety measures. Some nurses will even find that they themselves have developed cancer because of the time that they spend handling and administering these drugs.
National Institute for Occupational Health and Safety (NIOSH) included chemotherapy drugs in the hazardous drug list .The reason why these drugs are so toxic is because they target normal human cells in addition to cancer cells. These drugs are extremely difficult to clean up and can stay in a certain spot for months on end. The serious consequences will arise for nurses who don’t handle these drugs properly. Some of the chronic effects that have been identified in patients given these drugs include cytogenetic effects like chromosomal aberrations, sister chromatid exchange/ translocation, point mutations, structural chromosomal damage, reproductive effects like congenital malformations and spontaneous abortions, damage to the liver and kidney, bone marrow, the lungs and heart, hearing impairment. Acute effects may include headache, hair loss, nausea, irritation of eyes, skin and mucous membranes, allergic reactions and skin rashes. Research has shown that 1 in 5 nurses have experienced chemotherapy drug exposure to their eyes or skin at some point while handling the drugs. The matter is worse for nurses who are handling these drugs while pregnant. Studies are showing that the children of these nurses are more likely to be born with cognitive or psychological abnormalities. Sometimes it causes spontaneous abortion or malformation of the fetus.
The researchers said that unintentional chemotherapy exposure can affect the nervous system, impair the reproductive system and bring an increased risk of developing blood cancers in the future. The situation is pathetic because despite all these risks, many nurses do not use recommended personal protective equipment such as gloves or gowns when handling chemotherapy. Reasons for these are unawareness, limited staffing, heavy workload and lack of physical facilities like chemical fume hood and non-availability of adequate personal protective measures. Exposure to chemotherapy can create hazards for nurses as they bring lifesaving care to patients, but use of protective devices remains low. Nurses who provide care to patients receiving chemotherapy require specialized knowledge to ensure safety of patients and themselves as well as the environment.
Some guidelines to follow:
- Store the drugs in a manner that prevents spillage or breakage if the container falls
- Follow hand washing procedures
- Place absorbent pad on work surface.
- Label all chemotherapeutic drugs.
- Chemotherapeutic drugs must be prepared in Biological safety cabinet/ chemical fume hood
- Vent vials with a needle, use luer lock equipment, cover tip of needle when expelling air.
- Limit access to drug preparation area.
- Avoid eating, drinking, smoking, chewing gum, applying cosmetics and storing food near drug preparation area.
- Appropriate personal protective equipment must be worn like good quality latex gloves, good quality mask (elastomeric half-mask with a multi-gas cartridge and P100-filter), gowns with long sleeves and tight fitting cuffs, head, hair, shoe and sleeve covers, goggles and glasses.
- Safe handling of waste – Place all used supplies in Leak proof, Puncture proof, Labelled containers.
- Package, transport and disposal of chemotherapeutic supplies must be in accordance with the regulations of hazardous waste.
- Clean up spills immediately, Spill Management must be done as per the guidelines
- All personnel who handle chemotherapeutic agents must be trained properly