In the United States, there's a lot of discussion about the difficulties of requiring hospitals and clinics to prove they are not contaminating their workers with toxic drugs. But several other countries already are requiring safeguards.
In the United States, there’s a lot of discussion about the difficulties of requiring hospitals and clinics to prove they are not contaminating their workers with toxic drugs.
But several other countries already are requiring safeguards.
In Holland, health-care workers can choose to be monitored for exposure, and work areas must be tested for contamination. Germany, Austria and Belgium also have aggressive safety programs regulating chemo agents.
The United Kingdom and France impose strict regulation on veterinary practices handling chemo.
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Canadian hospitals do monthly safety inspections, and a major union there is preparing to track nurses’ health histories to see if exposures can be linked to disease.
“Contamination is everywhere, even at the best-organized facilities,” said Paul Sessink, a chemist and toxicologist who has performed monitoring in about 300 hospitals around the world. European countries are moving to make worker-safety regulations stronger, he said, while the U.S. appears almost exclusively focused on patient safety.
In British Columbia, the death of nurse Sally Giles in 1992 resulted in a set of extensive regulations governing everything from the mixing of chemo drugs to delivery and disposal, said Pam Piddocke, health and safety officer for British Columbia Nurses Union, which fought for the regulations.
Giles was an emergency-room nurse who routinely mixed and delivered chemo to patients. She died less than a year after being diagnosed in her 40s with cancer of the bile duct. She and the nurses union believed the cancer was linked to her exposure.
Regulations that emerged from that case require monthly “preventive inspections” to determine workers are following guidelines and equipment is working properly, Piddocke said.
In the U.S., however, neither environmental monitoring nor exposure tracking is mandated. And neither is routinely taking place, said Tom Conner, a research biologist with National Institute for Occupational Safety and Health (NIOSH).
“No one is really following these people to see — are they dying?” Connor said. “No one is following this in a systematic, effective way.”
Yet U.S. studies have shown if testing were done, it likely would indicate most workplaces where chemo is being handled have some degree of contamination.
New research by the U.S. Centers for Disease Control and Prevention (CDC), the largest study of its kind to date, has found continued evidence of contamination and exposure at three major health-care institutions, according to Connor, one of the principal authors of the study.
Once surfaces are exposed to the drugs, they can remain contaminated for months. The study found pharmacies were more often contaminated than oncology-nursing stations.
One of the chemo drugs showed up in the urine of two pharmacists, who were among 70 exposed workers studied at University of Maryland, University of North Carolina and University of Texas.
Results showed that voluntary guidelines in place since 2004 are not enough to protect workers, Connor said. The federal Occupational Safety and Health Administration (OSHA) has no specific standard for protecting workers in the health-care industry from exposure to toxic drugs.
The agency has issued fewer and fewer regulations since the 1990s, said Janice Camp, a senior lecturer in the Occupational and Environmental Health Sciences Department at University of Washington.
“The health-care industry is notoriously bad for being compliant,” said Camp, the UW lecturer. “You hear the same sort of arguments: ‘Oh, it’s so expensive, it’s too hard, the workers won’t do it. It’s too hard to put ventilation in pharmacies because buildings were never designed for that.’
“It’s the same stuff we heard from heavy industry years ago.”
U.S. Sen. Patty Murray, chair of Employment and Workplace Safety Subcommittee, said worker-safety law hasn’t been updated since it was passed in the 1970s, hindering the agency’s ability to keep up with new hazards in the workplace
“In fact, far from modernizing OSHA, a slew of restrictions, requirements and administrative burdens, not to mention funding limitations, have been placed on OSHA over the past 40 years,” she said.
The few standards for regulating toxins that have emerged in recent decades have resulted because a rare cancer or disease was linked to a specific group of workers and a single source of exposures. That’s how standards came about for asbestos, which is linked to mesothelioma, and silica, linked to silicosis.
Washington state, which has its own OSHA plan administered by the Department of Labor and Industries, does not do many inspections of health-care workplaces, said John Furman, occupational-nurse consultant for L&I.
To assess whether its approach with health-care institutions was working, L&I did a “programmed inspection” that targeted a large number of health-care employers a few years ago. It found no major compliance problems in the health-care sector, said Furman.
However, in 2006, the agency did investigate a safety complaint brought by an employee of an outpatient oncology clinic in Centralia and issued citations that were disputed in court, records obtained by InvestigateWest indicate.
The clinic corrected venting in a chemo-mixing area and was fined for not having gowns available that protected against liquid aerosols and splashes. The inspections also included a co-owned clinic in Aberdeen.