Female nurses who administer antineoplastic drugs – medications used to treat cancer – don’t always wear protective clothing, according to a new NIOSH study published online in the American Journal of Nursing, accompanied by a video abstract. This is one of the first studies to explore the use of antineoplastic drugs and personal protective equipment among non-pregnant and pregnant female nurses.

Reproductive risks

Nurses are exposed to antineoplastic drugs, or chemotherapeutic drugs, when they administer these drugs in pill or liquid form to patients who are battling all forms of cancer. The drugs, while working to kill rapidly dividing cancerous cells of a patient can also be harmful to the healthy dividing cells of the nurse, including the cells of a developing baby. Only a few studies have explored associations between occupational exposures to antineoplastic drugs and reproductive outcomes.

In order to explore this association further, survey data were collected from more than 40,000 nurses participating in the Nurses’ Health Study 3, a web-based survey of U.S and Canadian nurses that began enrollment in 2010. Non-pregnant nurses reported their use of gloves and gowns when handling or administering antineoplastic drugs within the past month, and pregnant nurses reported their use during the first 20 weeks of pregnancy, a time during which the fetus is highly susceptible to exposure.

Despite long-standing recommendations for the safe handling of antineoplastic and other hazardous drugs, many nurses – including those who are pregnant – reported not wearing protective gloves and gowns, the minimum protective equipment recommended when administering these drugs.

Specifically, of the non-pregnant nurses and pregnant nurses who said they administered antineoplastic drugs during the study period:

• Twelve percent of non-pregnant nurses and 9% of pregnant nurses indicated that they never wore gloves when administering antineoplastic drugs.
• Forty-two percent of non-pregnant nurses and 38% of pregnant nurses reported never using a gown.
• During the first 20 weeks of pregnancy, about one in 10 pregnant nurses did not always wear gloves and one in two did not always wear a protective gown when administering these drugs.

“NIOSH has worked extensively to protect workers who handle antineoplastic drugs, many of which are known or probable human carcinogens,” said Christina Lawson, Ph.D., epidemiologist and lead author of the study. “Many of these drugs can also damage a person’s fertility or harm a pregnancy, for example by causing a miscarriage or birth defects, so we wanted to look at the health of pregnant nurses for this study.”

Study researchers can only hypothesize why some nurses in the study didn’t handle antineoplastic drugs safely. Previous research suggests that reasons may include prioritizing care for patients over their own personal health, lack of concern or awareness by either employee or employer of the toxicity of these drugs, and availability or opportunity to wear protective gloves and gowns.

“These data underscore the need for continued education and training to ensure that both employers and nurses—pregnant and non-pregnant—are fully aware of such hazards and of the recommended precautionary measures,” says Lawson.

The study was the result of a collaboration between NIOSH researchers, and investigators from Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women’s Hospital in Boston, Massachusetts.

For more information about NIOSH’s research and recommendations on healthcare workers, visit the NIOSH healthcare topic page. For more information on reproductive health and the workplace, visit this topic page.

NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses, and deaths. For more information about NIOSH visit www.cdc.gov/niosh/.