Opinion

Nurses’ safety when administering SACT must be given the priority it deserves

Too many healthcare providers rely on personal protective equipment alone for their staff

Too many healthcare providers rely on personal protective equipment alone for their staff


Without robust protection regimes, nurses risk exposure to systemic anti-cancer therapy agents. Picture: Alamy

Nurses administering systemic anti-cancer therapy (SACT) agents are at risk of consistent exposure to hazardous drugs that are known to cause health hazards. Long and short-term effects have been noted as including nausea, headaches, dizziness, hair loss and fertility problems (Sessink 2016). They are often putting themselves at risk without adequate protection and awareness, and despite the existence of specific guidance, there are still major inconsistencies in practice that may leave nurses vulnerable to occupational exposure to these hazardous agents.

Protection against exposure to SACT agents should be applied in a specific order (HSE 2014):

  1. Use of totally enclosed systems where reasonably practicable.
  2. Control of exposure at source, for example by using adequate extraction systems and appropriate organisational measures.
  3. Issue personal protective equipment (PPE) where adequate control cannot be achieved by other measures alone.

Closed-system transfer devices are under-used

However, many healthcare providers rely on PPE alone without considering the use of the other identified measures such as closed-system transfer devices (CSTDs), which is extremely worrying. A document titled Guidance on Handling of Injectable Cytotoxic Drugs in Clinical Areas in NHS Hospitals in the UK (Santillo et al 2018) is aimed primarily at nursing staff handling these agents in clinical areas. It identifies recommendations detailing specific measures that should be implemented to reduce the risk of occupational exposure for nurses administering cytotoxic drugs and recommends the use of CSTDs during the administration process. This is currently not reflected in clinical practice across the board and needs to be rectified to prevent nurses being further exposed to these harmful drugs.

‘The potential health issue for nurses cannot be ignored due to the mounting evidence of the risks and adverse effects experienced by nurses administering SACT agents’

The recent Cochrane review of the use of closed systems for handling cytotoxic chemotherapy, commissioned by the UK Oncology Nursing Society, concluded there is no evidence to support or otherwise the routine use of closed-system drug transfer devices in addition to safe handling of infusional hazardous drugs (Gurusamy et al 2018). However, this review was based mainly on evidence in pharmaceutical areas and only two studies included administration areas. There is also ambiguity in relation to the aims of the review. It refers to healthcare staff and does not define how this group is constituted. The cost-effectiveness of CSTDs is included in the review, which is not evident in the title or aims at the outset. The main focus of the review relates to pharmacy areas.   

The risk to health cannot be ignored

However, this potential health issue for nurses cannot be ignored due to the mounting evidence of the risks and adverse effects experienced by nurses administering SACT agents. Therefore, we strongly recommend SACT safety awareness takes priority and that CSTDs are implemented immediately for administration of SACT to protect workers from harm when administering SACT. Every treatment, every day, every time.

To find out more about our SACT Safety Campaign, @sactsafety4all, or the SACT Safety Facebook page. Our aim is simple: to campaign to protect workers from harm when administering SACT.


References

Gurusamy K, Best L, Tanguay C et al (2018) Closed System Drug-transfer Devices plus safe handling of hazardous drugs, versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff (Review). (Last accessed: 3 December 2018.)

Health and Safety Executive (2014) Safe handling of cytotoxic drugs in the workplace. (Last accessed: 3 December 2018.)

Santillo M, Field A, Henderson J et al (2018) Guidance on Handling of Injectable Cytotoxic Drugs in Clinical Areas in NHS Hospitals in the UK, NHS Pharmaceutical Quality Assurance Committee 2018. (Last accessed: 3 December 2018.)

Sessink P (2016) Preventing exposure to cytotoxic drugs. Hospital Pharmacy Europe. (Last accessed: 3 December 2018.)


Samantha Toland, senior lecturer in haematology, school of nursing and midwifery, Birmingham City University

 

 

Alison Simons, senior lecturer, pathway award leader, haematology and cancer, school of health sciences, Birmingham City University

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