Risk-proof work environments
“We must dilute the chemotherapy drugs ourselves. The rooms are small and not ventilated. We are inhaling these drugs every day,” said Mary Moyo — not her real name — a nurse in the only cancer center in Zimbabwe, a public facility with less than 20 oncology nurses for a population of nearly 15 million. The risk of exposure, notably by skin contact, spans throughout a hospital’s medical distribution: from reception of the drugs, to mixing them, dilution or reconstitution, administration, and, finally, their disposal.
Until two years ago, Moyo used to wear makeshift masks and gowns made of linen, a material permeable to hazardous drugs. Then, gowns and N95 masks were gradually introduced, but COVID-19 has led to shortages: “Some days we use N95 masks for the entire shift; others we get simpler masks or none at all,” she said. “All I can do to protect myself is spend as little time as possible in drug preparation rooms.”
Similar concerns are being reported in countries such as the Philippines, Nicaragua, and Panama, where the scarcity of protective equipment adds to preexisting safety concerns.
Oncology head nurse at Perpetual Help Medical Center in the Philippines, Jimvert Camarillo emphasized the lack of engineering controls such as closed-system drug transfer devices, or CSTD, which mechanically prevent the escape of hazardous drugs. “We are still using conventional needles to compound and administer chemotherapy, so leakages are our main problem,” he said.
Jimvert Camarillo, head nurse, Cancer and Infusion Center, University of Perpetual Help DALTA Medical Center
Photo: Jimvert Camarillo
For lack of better alternatives, it is not uncommon for nurses in LMICs to put together their own kits to clean up spills or use improvised cabinets to prepare treatments. But make-do solutions fail to conform with international standards.
“I have seen units with inappropriate biosafety cabinets for preparing chemotherapy that actually blow out onto the nurse instead of pulling the air away from her,” Challinor said. “In some LMICs, chemotherapy may be stored in a refrigerator together with baby formula.”
Conditions in North America also vary. Some female nurses confess they left the profession once they got pregnant, given the risks to babies. Laureen Plommer, an oncology nurse for 27 years and clinical educator for systemic therapy, asked herself before starting a family: “Do I want to be around all these drugs?”
“I did leave oncology for a few years while I was having my kids,” Plommer admitted.
But there have been improvements. When Plommer returned, the center she worked at had started implementing a closed delivery system, which she said helped protect her should something go amiss with the PPE.
Laureen Plommer, clinical educator for systemic therapy, and Melanie Kuhelj, clinical specialist hazardous drugs safety, talk about why they left oncology nursing before starting a family.
Source: BD