The growing number of cases of cancer-related illness causes a systematic increase in the use of cytostatic drugs. These drugs, used to save the health and lives of patients, pose a serious threat to healthcare professionals and pharmacists who come into contact with these hazardous chemicals during their work. The most vulnerable are people employed in their production, pharmacists preparing cytostatic drugs and nurses administering them in cancer departments. The problem also applies to support staff – employees of medical laboratories, as well as members of cleaning crews. Effective education, universal access to protection measures – which is the responsibility of the employer – and self-discipline are allies in reducing the impact of cytostatics on staff health.
According to some studies, only about 30% of staff use a full set of personal protective equipment at work. This may be due to both the lack of access to such funds, as well as insufficient knowledge of medical personnel or the lack of time for their use due to the shortage of staff in hospital wards.
Cytostatic drugs – destroying cancer cells – have a beneficial effect on the treatment of patients, but they can also be harmful to healthy cells, posing a threat to the staff of cancer departments and pharmacies. These are hazardous substances, among others potentially carcinogenic, teratogenic or mutagenic, with which nurses, doctors, pharmacists and cleaning staff of oncology hospitals are constantly in contact.
Occupational exposure to cytostatics occurs as a result of absorption by the respiratory system, skin and mucous membranes. They enter the body of employees as a result of inhalation or skin contact with preparations, but also contact with secretions and hygiene products of patients.
It is very important that personnel in contact with cytostatics be equipped with appropriate personal protective equipment: protective clothing, gloves, footwear, respiratory protection equipment and eye and face protection intended for work exposed to cytostatics solutions.
– Contact with cytostatics during the work of cancer hospital staff does not mean that they are completely vulnerable. Keeping recommendations on occupational safety, including in the use of personal protective equipment, significantly reduces exposure to these hazardous chemicals. It is recommended to use properly selected clothing and protective gloves, filtering respiratory protection equipment and protective glasses. Such a set should be available without restrictions at all workplaces with cytostatics, because it effectively protects the health of medical personnel – says Dr. Małgorzata Pośniak, head of the Chemical, Dust and Biological Hazards Department at the Central Institute for Labor Protection – National Research Institute.
Due to the lack of established occupational exposure assessment criteria for the majority of chemical substances used as cytostatics, i.e. the values of the highest allowable concentrations in the air at workplaces and the allowable concentrations in biological material, there is a lack of accurate data on the assessment of occupational exposure of workers exposed to these substances. Assessment of occupational exposure to cytostatics is also very difficult, because in cytology wards usually use many cytostatic drugs, and the consumption of individual preparations fluctuates significantly over time. Therefore, it is difficult to assess the impact of a given cytostatic on employees' health. Occupational exposure to cytostatic drugs, however, can cause a variety of diseases, including cancer. Studies have shown that the effects of exposure include:
Significant reduction or elimination of exposure can be achieved thanks to collective protection measures, monitoring of the work environment and individual protection measures, as well as securing the rooms of the cytostatic drug laboratory in hospital pharmacies and rooms for oncologically ill patients.
The employer is responsible for ensuring the safe use of personal protective equipment. In accordance with art. 2376, p. 1 of the Labor Code (Act of 26 June 1974), the employer is obliged to provide the employee with personal protective equipment against the effects of hazardous and harmful to health factors occurring in the work environment and to inform him about the ways of using these means.
Employer’s responsibilities include:
Regardless of the type of hazardous substance, exposure limitation in the work environment should be primarily based on the use of appropriate collective protection measures. Wherever possible, work should be encapsulated. In other cases, based on the analysis of the parameters of the cytostatics collected at the source of emission, an appropriate filter or ventilation system or device appropriate to the type and concentration of contaminants should be selected. The last action that should be taken is the selection of respiratory protection equipment – and then its individual adaptation to the user. The use of the above safety measures and personal protective equipment will ensure minimization of exposure to the harmful effects of cytostatics, and thus will improve the health protection of medical personnel as well as employees of laboratories and cleaning companies. One should also remember about such an important success factor, which is the dissemination of knowledge about the harmful effects of cytostatics.
Employers should also bear in mind that with respect to the above data, among the guidelines of the Chief Sanitary Inspector regarding the planning and operation of the State Sanitary Inspection in the years 2019 – 2020 was supervision of working conditions and compliance by employers of obligations arising from the occupational risk assessment of employees exposed to carcinogens contained in cytostatic drugs.
1 "Occupational threats to cytostatics and prevention measures”, edited by S. Krzemińska, M. Szewczyńska, M. Pośniak CIOP-PIB, Warsaw 2016