Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing
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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.
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.
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.
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.
KeywordsInfusions Nursing Occupational drug exposure Healthcare Ambient monitoring Wipe sampling
- 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
- 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
- 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 17:157–167Google Scholar
- Garus-Pakowska A, Sobala, W, Szatko, F (2013) The use of protective gloves by medical personnel. Int J Occup Med Environ Health 26:423–429Google Scholar
- 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
- 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 75:23–31Google Scholar
- Helsel DR (2005) Nondetects and data analysis. Wiley, New YorkGoogle Scholar
- 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):761–770Google Scholar
- 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 88:933–941Google Scholar
- 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 12:669–677Google Scholar
- ISOPP—International Society of Oncology Pharmacy Practicioners Standards Commitee (2007) Safe Handling of Cytotoxics. J Oncol Pharm Pract 13(1):1–81Google Scholar
- 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 85:935–956Google Scholar
- 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):79–85Google Scholar
- R Core Team (2016) R: a language and environment for statistical computing. R Foundation for Statistical Computing, ViennaGoogle Scholar
- 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
- 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 38:135–139Google Scholar
- West BT, Welch KB & Galecki AT (2014) Linear Mixed Models: A Practical Guide Using Statistical Software (2nd ed.). Chapman & Hall/CRC, Boca RatonGoogle Scholar