If you asked the average "man on the street" to name dangerous professions, chances are nursing and other healthcare professions wouldn't make the list. Yet according to the Bureau of Labor Statistics, hospitals have the second highest rate of nonfatal injury or illness cases. Many of the risks are well known: back injuries and musculo-skeletal disorders from lifting patients; exposure to blood-borne pathogens; and injuries resulting from assault by patients.
Somewhat less obvious are the risks posed by exposure to hazardous drugs. Recently, NIOSH released a lengthy alert about chemotherapeutics and other drugs. As many as 5.5 million healthcare workers -- including nurses, pharmacists, physicians, and veterinarians -- are exposed to antineoplastic and other hazardous drugs in the course of their work:
"Healthcare workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in air or on work surfaces, contaminated clothing, medical equipment, patient excreta, or other sources. Studies have associated workplace exposures to hazardous drugs with health effects such as skin rashes and adverse reproductive events (including infertility, spontaneous abortions or congenital malformations) and possibly leukemia and other cancers. The health risk is influenced by the extent of the exposure and the potency and toxicity of the hazardous drug. Potential health effects can be minimized through sound procedures for handling hazardous drugs, engineering controls and proper use of protective equipment to protect workers to the greatest degree possible."
The NIOSH alert is a "prepublication" report that will undergo further editing before a final release sometime this year. The final report will present a voluntary guideline that will include information on more than 100 drugs and will offer detailed recommendations for control measures that should be taken by employers and employees to reduce risks. Many measures assumed to be adequate in the past may not be sufficient protection in response to the risk.
In an article in entitled Do more to protect health workers from chemo agents that appeared in Hospital Employee Health, Thomas Connor, PhD, a research biologist with NIOSH in Cincinnati and an author of the alert indicated that workers may not be aware of the risk:
"Exposure may occur in these situations: Drugs are reconstituted or diluted. Nurses or others expel air from syringes or give injections, and small amounts are aerosolized. Uncoated tablets are counted or dosed in a unit-dose machine. Health care workers touch contaminated surfaces, patients' body fluids, or contaminated clothing and linens. Workers prime the IV with drug-containing solution or administer the drug with the IV.
Every step along the way, you have the potential for release and exposing the workers, says Connor. I don't think people are aware of it. They can't see it [because the drugs are colorless] and don't think there can be a spill."
Requests for printed copies when they become available can be made through the NIOSH toll-free information number, 1-800-35-NIOSH, or by contacting the NIOSH Publications Office through the NIOSH web page.