Abstract
Purpose
This study aims at experimentally determining the incidence and extent of liquid releases onto the operator’s hands and into the work environment during common nursing operations involving infusions.
Methods
A sequence of operations related to the preparation and administration of infusions was conducted by three subjects for 15 times each using fluorescein marked infusion solutions and two different infusion sets (standard set vs. safety-optimized set). Unintended release of liquid was quantified by glove and surface wipe sampling and HPLC/FD analysis of the samples. Operations concerning the disposal of infusions were also part of the study.
Results
In over 90% of the simulations, a release of infusion solution was observed in a standard workflow, comprising priming and decapping the infusion set, connecting it to a peripheral intravenous (IV) cannula, and detaching it again. Based on median values (229 vs. 26 μl), the release of infusion solution was about ninefold higher when using the non-optimized standard infusion set. During decapping, a hand contamination was found in a majority of cases.
Conclusions
The handling of infusions may involve a risk of nurses’ exposure to active agents by release of infusion solution into the work environment. According to our results with different infusion sets, exposure risks can be reduced technically and by appropriate handling. Nevertheless, hand contaminations found for both sets emphasize the necessity for additional measures such as more consistent use of protective gloves.
References
ASHP—American Society of Health-System Pharmacists (2006) ASHP guidelines on handling hazardous drugs. Am J Health-Syst Pharm 63:1172–1193
ASSTSAS—Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales (2008) Prevention guide—safe handling of hazardous drugs. https://www.irsst.qc.ca/media/documents/PubIRSST/CG-002.pdf. Accessed 01 Sept 2016
Bates D, Mächler M, Bolker B, Walker S (2015) Fitting linear mixed-effects models using lme4. J Stat Softw 67:1–48
BGW—German Social Accident Insurance Institution for the Health and Welfare Services (2008) Zytostatika im Gesundheitsdienst—Informationen zur sicheren Handhabung von Zytostatika. BGW-Expertenschrift. https://www.bgw-online.de/SharedDocs/Downloads/DE/Medientypen/bgw-themen/M620_Zytostatika_im_Gesundheitsdienst_Download.pdf?__blob=publicationFile. Accessed 04 May 2016
Connor T, Lawson C, Polovich M, McDiarmid M (2014) Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. J Occup Environ Med 56:901–910
Friese CR, McArdle C, Zhau T, Sun D, Spasojevic I, Polovich M, McCullagh MC (2015) Antineoplastic drug exposure in an ambulatory setting: a pilot study. Cancer Nurs 38:111–117
Gammon J, Morgan-Samuel H, Gould D (2008) A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs 17:157–167
Garus-Pakowska A, Sobala, W, Szatko, F (2013) The use of protective gloves by medical personnel. Int J Occup Med Environ Health 26:423–429
Gielen K, Goossens A (2001) Occupational allergic contact dermatitis from drugs in healthcare workers. Contact Derm 45:273–279
Hadtstein C (2009) Arzneistoffe mit Verdacht auf sensibilisierende und CMR-Eigenschaften. BGW-Expertenschrift. https://www.bgw-online.de/SharedDocs/Downloads/DE/Medientypen/bgw_forschung/Arzneistoffliste-inkl-Einleitung_Download.pdf?__blob=publicationFile. Accessed 04 May 2016
Halekoh U, Højsgaard S (2014) A Kenward-Roger approximation and parametric bootstrap methods for tests in linear mixed models—the R Package pbkrtest. J Stat Softw 59:1–30
Heinemann A, Werner S, Padberg S, Möller A, Heynemann C, Roßbach B, Hadstein C, Nies E (2015) Safety relevant information on medicines and associated activities—first partial results of the project BESI by BGW. Gefahrstoffe—Reinhaltung der Luft 75:23–31
Helsel DR (2005) Nondetects and data analysis. Wiley, New York
Hon C-Y, Teschke K, Demers PA, Venners S (2014) Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system. Ann Occup Hyg 58(6):761–770
Hon C-Y, Teschke K, Shen H, Demers PA, Venners S (2015a) Antineoplastic drug contamination in the urine of Canadian healthcare workers. Int Arch Occup Environ Health 88:933–941
Hon C-Y, Teschke K, Shen H (2015b) Health care workers’ knowledge, perceptions, and behaviors regarding antineoplastic drugs: survey from British Columbia, Canada. J Occup Environ Hyg 12:669–677
ISOPP—International Society of Oncology Pharmacy Practicioners Standards Commitee (2007) Safe Handling of Cytotoxics. J Oncol Pharm Pract 13(1):1–81
Keohane CA, Bane AD, Featherstone E et al (2008) Quantifying nursing workflow in medication administration. J Nurs Admin 38:19–26
Kopp B, Schierl R, Nowak D (2013) Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health 86:47–55
Kromhout H, Hoek F, Uitterhoeve R, Huijbers R, Overmars RF, Anzion R, Vermeulen R (2000) Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. Ann Occupl Hyg 44:551–560
Lee L (2013) NADA: Nondetects and data analysis for environmental data. http://CRAN.R-project.org/package=NADA. Accessed 09 Aug 2016
Nakagawa S, Schielzeth H (2010) Repeatability for Gaussian and non-Gaussian data: a practical guide for biologists. Biol Rev Camb Philos Soc 85:935–956
NIOSH—National Institute for Occupational Safety and Health (2004) Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings. NIOSH Alert. http://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf. Accessed 30 Nov 2016
NIOSH—National Institute for Occupational Safety and Health (2014) Hazardous drugs in healthcare settings. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings. http://www.cdc.gov/niosh/docs/2014-138/pdfs/2014-138.pdf Accessed 04 May 2016
Polovich M, Gieseker K (2011) Occupational hazardous drug exposure among non-oncology nurses. Medsurg. Nursing 20(2):79–85
R Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Ramphal R, Bains T, Vaillancourt R, Osmond MH, Barrowman N (2014) Occupational exposure to cyclophosphamide in nurses at a single center. J Occup Environ Med 56:304–312
Sessink PJM, Boer AP, Scheefhals APH, Anzion RBM, Bos RP (1992) Occupational exposure to antineoplastic agents at several departments in a hospial. Int Arch Occup Environ Health 64:105–112
Sigma–Aldrich (2016) Safety Data Sheet Fluorescein sodium salt (Version 6. 4, 06.08.2013). http://www.sigmaaldrich.com/MSDS/MSDS/DisplayMSDSPage.do?country=GB&language=EN-generic&productNumber=F6377&brand=SIAL&PageToGoToURL=http%3A%2F%2Fwww.sigmaaldrich.com%2Fcatalog%2Fproduct%2Fsial%2Ff6377%3Flang%3Den. Accessed 04 May 2016
Sottani C, Porro B, Imbriani M, Minoia C (2012) Occupational exposure to antineoplastic drugs in four Italian health care settings. Toxicol Lett 213:107–115
Spivey S, Connor TH (2003) Determining sources of workplace contamination with antineoplastic drugs and comparing conventional IV drug preparation with a closed system. Hosp Pharm 38:135–139
Swinnen I, Ghys K, Kerre S, Constandt L, Goossens A (2013) Occupational airborne contact dermatitis from benzodiazepines and other drugs. Contact Derm 70:227–232
West BT, Welch KB & Galecki AT (2014) Linear Mixed Models: A Practical Guide Using Statistical Software (2nd ed.). Chapman & Hall/CRC, Boca Raton
Acknowledgements
The authors thank Marie-Luise Kimbel for language revision of the manuscript. This study was funded by the German Social Accident Insurance Institution for the Health and Welfare Services (BGW).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
This manuscript contains data of the doctoral thesis in preparation of V. Segner.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Segner, V., Kimbel, R., Jochems, P. et al. Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing. Int Arch Occup Environ Health 90, 275–284 (2017). https://doi.org/10.1007/s00420-017-1196-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00420-017-1196-0