I know this is an infusion forum and there are plenty of forums through ONS, ASCO and OSHA to have this discussion, but I noticed a comment on an earlier thread about placing a PICC during a chemotherapy infusion that stated that no matter what, a pregnant nurse should not be placing a PICC in a patient actively receiving chemo. I had to comment. My comment is purely for discussion. I am very aware of the 2006 ASHP Report that clearly states that pregnant and breast feeding workers, as well as those intending to get become pregnant or father a child should be offered alternative duty from administering chemotherapy due to the teratogenic risk. I am worried that my position will be viewed a chauvinistic, and I assure you, I am not a chauvinist! The same risk to an unborn fetus (actual or desired) exists to the genetic makeup of a non-actively reproducing staff member. Personal Protective Equipment is intended to mitigate harm to all employees who handle hazardous drugs because SOMEONE has to give it. Why do we remove pregnant nurses from handling hazardous drugs when the EXACT same risk exists for non pregnant staff? Why is teratogenic risk more important than general carcinogenicity? Aren't PPE, BSCs and closed-transfer devices all designed to minimize exposure to hazardous drugs?
I see a lot of hypocrisy in the application of this standard. I see staff refuse to administer any chemo because of perceived risk to their unborn fetus, but scoff at the 2012 addition of Zoledronic Acid to the NIOSH list of HDs. If this standard were extended to all staff members capable of reproduction, my facility would have no one to administer chemotherapy. Why limit it only to those carrying or desiring to carry/father a child? Accidents happen! Then what?
I guess I feel that if PPE is good enough for the gander, it should be good enough for the goose; otherwise, we need to seriously question whether the PPE that is being used is actually preventing anyone from anything. This bizarre exception to PPE implementation is sort of like having a policy at a restaurant that only requires the facility to wash the silverware of customers with cancer. All other can use unwashed silverware. Only the ones with cancer need clean silverware. When I work in a facility that requires me to administer chemo using PPE assuming risk to my genetic make-up, but excuses a pregnant worker because the same risk will have consequences that outweigh the risk to my genetics, I feel de-valued.
What am I missing?
Here is the most recent recommendations for medical surveillance for all HCWs handling all hazardous drugs.
www.cdc.gov/niosh/docs/wp-solutions/2013-103/pdfs/2013-103.pdf
This might help with your questions and frustrations. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
You may also want to comment on the pending revision of USP 800 (see description below)
General Chapter <800> is being presented in advance of its publication in PF 41(2) to allow additional time for public review and comment. To ensure that all comments are addressed, please indicate the line number(s) corresponding to your comments and submit to [email protected]. The General Chapter is available with line numbers at the link below. Comments will be accepted until May 31, 2015.
http://www.usp.org/usp-nf/notices/general-chapter-hazardous-drugs-handling-healthcare-settings
There is a good review article entitled: Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence by Connor, et al. It was published in JOEM, Vol 56 #9, Sept 2014, pages 901-910. Very appropriate to your questions.
I appreciate all of these references analyzing data that has unanimously resulted in guidelines that say basically, "Due to the likely risk of fetal harm especially during the first trimester of pregnancy, efforts should be made to provide alternate duties to healthcare workers who handle antineoplastics and are pregnant, nursing or trying to conceive." This last article even acknowledges that the existing studies are very limited with most sample sizes below 20. All of the studies occurred prior to 2002 and most of the data was collected during the 1980's. In this era of evidence based practice, these study characteristics are hardly incontrovertible! In fact, so much has changed in the safe handling movement since that time, that I question even the most basic applicability! My bottom line remains that if you have drugs that are known to be genotoxic, carcinogenic and teratogenic, why is the teratogenic trait the only one that results in workers being removed from the workplace? Isn't the assumption then, that modern PPE is not good enough to protect pregnant workers, so they must be given alternate duties, leaving the rest of us who aren't actively reproducing to subject ourselves to hazardous drugs behind the false sense of security provided by ineffective PPE for the sake of the patient? If the PPE provided by my workplace isn't good enough to protect my pregnant co-worker, why should I believe it's good enough to protect me? Making the value judgment that the risk is higher for pregnant women is not ethical. I believe this is an example of a double standard.
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA