Randomized Controlled Trial to Improve Oncology Nurses’ Protective Equipment Use

Details

• Personal Author:
  Friese CR ; McCullagh MC ; Sun D ; Yang J
• Description:
  Objectives: Occupational exposure to hazardous drugs confers well-documented adverse health effects to health care workers. Nurses in ambulatory oncology settings are at high risk given the large volume of drugs administered. Extensive preliminary data show frequent hazardous drug exposure in the ambulatory oncology setting, low perceived risk of drug exposure, inadequate knowledge about personal protective equipment (PPE) use, and low PPE use by nurses, in addition to differences in organizational factors between exposed and unexposed nurses. Despite this knowledge, there is an absence of tested interventions aimed at increasing PPE use among nurses who handle hazardous drugs. This project was aligned with Goals 1 and 3 of the 2013 National Occupational Research Agenda for Healthcare and Social Assistance: to "promote safe and healthy workplaces and optimize safety culture in healthcare organizations," and "reduce or eliminate exposures and adverse health effects caused by hazardous drugs and other chemicals." Methods: A cluster, randomized controlled design was used to evaluate the efficacy of a web-based audit and feedback intervention intended to increase risk perception, reduce barriers to PPE use, and ultimately improve adherence to recommended PPE. Sites randomized to the control condition received a one-hour continuing education module on hazardous drug handling. The primary endpoint of the trial was increased use of personal protective equipment when handling hazardous drugs. A second component of the project was to prospectively describe hazardous drug spills experienced by participants. Blood and plasma samples were obtained from all participants to develop methods to measure hazardous drug exposures among ambulatory oncology nurses. An innovative high performance liquid chromatography multiple reaction monitoring-information dependent acquisition-enhanced production ion analytical method was developed to simultaneously detect the presence of 18 hazardous drugs in human samples. Results: From 2015 to 2017, the investigators partnered with 12 ambulatory oncology settings in the United States to enroll 396 nurses, 257 of whom completed baseline and primary endpoint surveys. Control and intervention sites had suboptimal PPE use before and after the intervention. No significant differences were observed in PPE use, knowledge, or perceived barriers. Participants reported high satisfaction with the study experience. Over 24 months, participants reported 73 unique hazardous drug spills, which ranged in volume from 1 to 200 mL. During spill response, nurses reported wearing disposable gowns (65% of the time), double gloves (52%), single gloves (41%), respirators (28%), and eye shields (26%). No detectable plasma concentrations were measured at baseline, post-intervention and in cases of spills. Conclusions: Hazardous drug exposure confers notable health risks to health care workers. A novel feedback intervention targeted to oncology nursing clinicians did not result in improved personal protective equipment use. Standardized hazardous drug spill reporting and analysis is a promising quality improvement tool to identify and rectify practice gaps. Our project has contributed to the methodology to detect multiple hazardous drugs simultaneously through easily-reproducible methods. To improve the safety and health of oncology clinicians, occupational health care workers, health systems, and professional organizations should consider coordinated, multi-level efforts to implement policy and practice changes. [Description provided by NIOSH]
• Subjects:
  Hazardous Substances Health Personnel Neoplasms Occupational Exposure Occupational Health Personal Protective Equipment Safety
• Keywords:
  Antineoplastic Agents Author Keywords: Antineoplastic Drugs Chemotherapy Hazardous Drugs Health Care Workers Medical Personnel Medicinal Chemicals Nurses Nursing Occupational Exposure Personal Protective Equipment PPE Randomized Trials Registered Nurses Work Organization Workplace Exposure

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• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Michigan ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-35
• NIOSHTIC Number:
  nn:20063184
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R01-OH-010582, 2019 Sep; :1-35
• Contact Point Address:
  Christopher R. Friese, PHD, RN, AOCN, FAAN, University of Michigan School of Nursing, 400 North Ingalls Building, Room 1172, Ann Arbor, MI 48109-5482
• Email:
  cfriese@umich.edu
• Federal Fiscal Year:
  2019
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  University of Michigan
• Peer Reviewed:
  False
• Start Date:
  20140701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20180630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:7df28ffdefc0a769f6a2eb64ab70a3acf7f99a7e735cb29ce09730176e94377add39a14b22b21951679c0c9ebf2dba0de3cb3685d5e5d7b9dd2a25609cb22fc0
• Download URL:
  https://stacks.cdc.gov/view/cdc/219068/cdc_219068_DS1.pdf
• File Type:
  [PDF - 891.50 KB ]