New $2.3 Million Workplace Intervention Aims to Reduce Exposure Risk for Oncology Nurses

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The study is designed to promote safety at chemotherapy infusion sites.

ANN ARBOR, Mich. - Researchers at the University of Michigan School of Nursing and Comprehensive Cancer Center have received a $2.3 million grant to study oncology nurses’ exposure to hazardous drugs, including identifying ways to reduce exposure.

“There are significant acute and long-term side effects from hazardous drug exposures in oncology settings, but not enough evidence-based, risk-reduction efforts to protect health care workers,” says Christopher Friese, PhD, RN, AOCN®, FAAN, University of Michigan School of Nursing assistant professor and member of U-M’s Comprehensive Cancer Center and Institute for Healthcare Policy and Innovation.                

Dr. Friese aims to lower the risk through a new study called DEFENS: Drug Exposure Feedback and Education for Nurses’ Safety. The four-year study, with funding from the National Institute for Occupational Safety and Health (NIOSH), will examine oncology nurses’ use of personal protective equipment (PPE) and biological exposure to hazardous drugs at approximately a dozen health care institutions nationwide.

“Nurses are the single largest group of oncology care providers,” says Dr. Friese. “Patients and families work with nurses the most when chemotherapy is part of treatment. It's important to recognize the need for well-prepared oncology nurses to deliver care safely and avoid poor outcomes.” Worker exposure to hazardous drugs like chemotherapy is a “persistent problem” and may result in adverse health effects (NIOSH Alert 2004-165). In a preliminary study, Dr. Friese found that among 242 surveyed oncology nurses, 16.9% reported dermal or eye exposure to hazardous drugs in the past year (Friese CR, Himes-Ferris L, Frasier MN, et al: Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf 21(9):753–759, 2012). Organizational factors such as nursing workloads, practice environments, and performance of safety behavior are associated with an increased risk of spills.

The four-year study has two key components. First, nurses will provide information concerning chemotherapy spills in the clinic and provide blood samples to determine whether the agents are detectable. Second, nurses will receive an educational module on safe drug handling, with and without specific feedback about how to improve their practice. The goal is to increase the number of nurses who use protective equipment likes gowns and gloves on a consistent basis. Eleven of the nation’s leading cancer centers and over 300 nurses will participate.

This multidisciplinary study will also include Duxin Sun, PhD, Co-Investigator, professor at the U-M College of Pharmacy and Director of University of Michigan Pharmacokinetics Core.He will oversee the development, testing, and interpretation of the results obtained from participants’ plasma to detect hazardous drug levels. Marjorie McCullagh, PhD, RN, APHN-BC, COHN-S, Co-Investigator, UMSN associate professor, director of the Occupational Health Training Program and contributing faculty to U-M’s NIOSH-funded Education and Research Center, will contribute to the protocol development surrounding participant recruitment and retention, assist in the interpretation of study results and development of future interventions. 

“Over 20 million doses of chemo are given annually in infusion centers. We believe the data gathered from this study can be used to inform practice and make policy changes that will improve the safety of a large number of health care workers,” says Dr. Friese.

For questions please email, on twitter at @DEFENSStudy or contact Kari Mendelsohn-Victor, MPH at (734) 615-4017.  

Research reported in this release is supported by the National Institute for Occupational Safety and Health under grant number: R01OH010582. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIOSH.

Media Contacts:

Mary Beth Lewis, University of Michigan School of Nursing, (734) 763-1682
Nicole Fawcett, U-M Comprehensive Cancer Center, 734-764-2220