Care for health care workers

40-Sai-Bala-M Sai Bala M.

Innovations in drug formulations have altered the course of treatment for several life-threatening diseases. But with it also comes the threat of consequences of long-term exposure of health care workers while compounding, administering and handling the waste created out of new drugs. The National Institute for Occupational Safety and Health (NIOSH) estimated 5.5 million health care workers face the risk of exposure to hazardous drugs and chemicals. Chronic exposure to antineoplastic drugs (ADs) has been found to result in reproductive, liver, renal, lung and cardiac toxicity. Bone marrow suppression, mucosal ulcers and cancer have also been noticed.

Though several anecdotal reports of antibiotic resistance in health care workers have been noticed, not much is documented or scientifically studied. The consequences of exposure to drugs can be prevented to a large extent by safe handling of drugs and limiting exposure as much as possible. It is imperative to explore the need and availability of technology and products along with the evidence-based guidelines for safe administration and handling of drugs and chemicals.

Today, we have the technology to not only cure a patient but also to protect our valuable health care workers from harmful risks of exposure to drugs. The development of specific guidelines related to drug exposure by several health care societies has helped workers in the west. In the Indian health care setting, too, there is increased awareness and adherence to use of personal protective equipment and biosafety cabinets for the use of ADs. The advent of closed system drug transfer device (CSTD) is an addition in this regard. The design of CSTD works on the principle of a closed circuit, mechanically prohibiting the transfer of environmental contaminants into a system and the escape of hazardous drug or vapour concentrations outside the system. By using the CSTD, health care workers can prevent the risk of exposure from leakages and accidental discharges during and after administration.

According to the guidelines of NIOSH, the dialogue on minimising occupational hazard for nurses has been doing the rounds since 2004. However, nurses and doctors are still prone to drug exposure despite improvements in safety policy. In a study carried out to map the presence of genetic toxicity in the nurses administering anti-cancer drugs, the nurses presented significant DNA damage. More studies are required to understand the effects of exposure to antibiotics and many other potent drugs on the exposed health professionals. Also, we need to weigh the risks and benefits of each technology and adopt them aptly rather than refusing to use them in the name of cost.

Let us, therefore, educate health providers on the need to adhere to safe handling practices, and urge organisations to adopt better technology and products to safeguard the health care task force. Every health care professional must pledge to safeguard their patients and themselves by updating their knowledge and following best practices.

The writer is nursing director at AIMS, Kochi.


● Chronic exposure to antineoplastic drugs (anti-cancer drugs)

● Genetic toxicity due to anti-cancer drugs· Exposure to blood-borne pathogens and infectious diseases

● Needle-stick and other sharp objects-related injuries

● Exposure to contaminated needles