Antineoplastic drugs taken during pregnancy are known to adversely affect pregnancy and the fetus, but little is known about how occupational exposure to these agents affects the nurses who administer them and who care for the patients who receive them.
A recent study in the Netherlands found that occupational exposure to antineoplastic drugs may have adverse effects. Oncology nurses exposed dermally to 0.74 micrograms or more of cyclophosphamide per week may have reduced fertility and an increased risk of delivering a premature or low-birth-weight (less than 2,501 g) infant. Investigators studied 1,519 hospital-based nurses 22 to 37 years old who were pregnant or trying to get pregnant from 1990 to 1997. The nurses completed detailed questionnaires about their pregnancy or attempt to become pregnant, lifestyle risk factors, and work-related risk factors, including how often during their first month of pregnancy or while attempting to get pregnant they were exposed to antineoplastic drugs and whether they used gloves. The amount of exposure for each of six tasks-preparing the drug for administration, administering it, handling a patient's urine, washing a patient, removing bed linens, and cleaning the patient's toilet-was estimated by measuring the amount of cyclophosphamide in the gloves and handwashing samples of a subset of nurses. Preparing the medication resulted in the highest exposure. Wearing gloves significantly reduced the level of exposure for all tasks; for preparing the drug, exposure dropped from 31.9 micrograms for those who did not use gloves to 4.87 micrograms for those who did.
The results suggest that nurses with the highest exposure took longer to become pregnant than nurses who had no exposure and were twice as likely to deliver a low-birth-weight infant. As weekly exposure rose, the risk for those two outcomes also rose.
Measurable levels of antineoplastic drugs have been found in the urine of nurses who work with chemotherapy drugs. While drug preparation and administration obviously pose the greatest risk, exposure to patients' urine for at least 48 hours after chemotherapy administration can also be a significant source. And many studies have found antineoplastic drug residue on countertops, floors, the soles of nurses' shoes, patients' skin, and tables and chairs in patient care areas.
The only protective measure examined in this study was wearing gloves. Both the National Institute for Occupational Safety and Health (NIOSH) and the Oncology Nursing Society (ONS) recommend that antineoplastic drugs be prepared in a biologic safety cabinet before administration. Wearing a closed-front, cuffed gown and two pairs of gloves and washing the hands before putting on and after taking off the gloves and gown can also reduce exposure. The NIOSH guidelines are available at http://www.cdc.gov/niosh/docs/2004-165, and the ONS guidelines are available at http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=4152&nbr=3180#s21.
Fran Mennick, BSN, RN