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Dangerous Chemo and Patient

While Saving Lives, Chemotherapy can Cause Cancer, Birth Defects and Miscarriages in Others

Hundreds of drugs are used to fight cancer. The most powerful are cytotoxic (cell killing).  They kill cancer cells anywhere in the body. Unfortunately, they also kill fast-growing healthy cells anywhere in the body.  Side effects include hair loss and susceptibility to infection.  The patient can even develop other cancers that don’t appear for several years.  For example, cyclophosphamide, which is used to treat breast cancer, can cause bladder cancer or myelodysplastic syndrome (pre-leukemia) in the patient several years later.

Among these hundreds of drugs, roughly two dozen — cyclophosphamide, doxorubicin, 5-FU and etoposide among them — present an additional danger.  They are excreted in active form, in the few days after each chemotherapy infusion. This means that during the Danger Period, the patient’s sweat, saliva, vomit, urine and feces contain huge quantities of dangerous chemicals.  Anyone who touches these contaminated fluids  — cleaning the toilet, helping the patient as they vomit, or with any other task caregivers selflessly perform — can absorb dangerous amounts of the active cytotoxic drug.

Once inside the caregiver’s body, the cytotoxic drug will attack any fast growing cell, causing cancer or other damage.  If the caregiver is pregnant, their baby can develop birth defects, undetectable for years, or even dieBabies and children, in particular, are at huge risk because so many of their cells are rapidly growing.

How Drug Producers and Hospitals Protect their Employees

The drug producers and hospitals understand the extreme dangers accidental exposure to cytotoxic drugs (also called antineoplastic) pose to their employees.  Every step along the way from drug production through injection into the patient is carefully controlled to minimize the risk to the employees.  For this reason organizations responsible for employee protections (OSHA, NIOSH, Joint Commission and others) recommend strict employee protective guidelines.

These include:

Cytotoxic Drug Production (Merck Band 5)

  • Requires extraordinary layers of protection for employees
  •  Sealed sterile room
  • Robotic production required; absolutely no human intervention
  • Additional fully-contained protective environment suit


Cytotoxic Drug Dispensing

  • Requires negative pressure rigid isolator
  • Specially trained pharmacists


Nursing Staff Recommended Personal Protective Equipment (PPE)

  • Impermeable coveralls and gowns
  • Head covering
  • Closed footwear
  • Overshoes
  • Gloves
  • Safety glasses
  • Respiratory protective devices
  • Please see Oncology Nursing Drug Handbook 2012 by G.M. Wilkes and M. Barton-Burke, Jones and Bartlett Publishers.

 


Dangers Continue Even After Drugs are Injected into Patient

The danger continues even after the cytotoxic drugs have been injected into the patient.  The warnings about the danger of cytotoxic drugs in the patients’ waste were first provided by OSHA to hospitals and their employees in 1986 and have been repeatedly updated.   As stated by OSHA (http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html) “Many HD's [cytotoxic chemotherapy drugs] are known human carcinogens, for which there is no safe level of exposure”.


 OSHA recommendations for employees working with chemotherapy patients and their waste include:

 a. Personal Protective Equipment. Personnel dealing with excreta, primarily urine, from patients who have received HD's in the last 48 hours should be provided with and wear latex or other appropriate gloves and disposable gowns, to be discarded after each use or whenever contaminated, as detailed under Waste Disposal. Eye protection should be worn if splashing is possible. Such excreta contaminated with blood, or other potentially infectious materials as well, should be managed according to the Bloodborne Pathogen Standard. Hands should be washed after removal of gloves or after contact with the above substances.

b. Linen contaminated with HD's or excreta from patients who have received HD's in the past 48 hours is a potential source of exposure to employees. Linen soiled with blood or other potentially infectious materials as well as contaminated with excreta must also be managed according to the Bloodborne Pathogens Standard.109 Linen contaminated with HD's should be placed in specially marked laundry bags and then placed in a labeled impervious bag. The laundry bag and its contents should be prewashed, and then the linens added to other laundry for a second wash. Laundry personnel should wear latex gloves and gowns while handling prewashed material.

c. Reusable Items. Glassware or other contaminated reusable items should be washed twice with detergent by a trained employee wearing double latex gloves and a gown. 


No Protection for Families and Caregivers


Unfortunately, patients and their families do not receive the same warnings. Instead when a chemotherapy patient returns home after infusion (85% of infusions given to out-patients), the family members and other caregivers are exposed to extreme danger. They have no information or protective equipment and will not know for months or years if they have been injured. These injuries could include immune dysfunction, cancer or if pregnant, birth defects and miscarriage.


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