Veterinary professionals have higher exposure to chemotherapy drugs than counterparts in human medicine because they are not taking proper precautions, say researchers at the Centers for Disease Control and Prevention (CDC).
The CDC research project — Bridging the Gap between Human and Veterinary Medicine: Different Patients, Same Hazardous Drugs — identified the challenges veterinary professionals encounter in handling these drugs safely.
In studying the risks, the CDC plans to develop training and guidance for veterinarians, veterinary technicians, and veterinary students. Deborah V.L. Hirst, PhD, acting deputy chief of the Engineering and Physical Hazards Branch of the CDC‘s National Institute for Occupational Safety and Health (NIOSH), says she hopes the project will help bridge a gap between veterinary and human medicine in use of technologies and practices that protect workers against hazardous drug exposure.
“The two are very similar in some respects,” Dr. Hirst says. “They’re also very different in how they handle the drugs.”
“Literature has shown us that cost, time, discomfort, and inconvenience are some of the barriers for veterinary healthcare workers and handling hazardous drugs safely (1),” says Dr. Hirst. “During our research, we commonly saw workers wear disposable gowns for the entire day of chemotherapy treatments instead of disposing of them after each treatment or wear the gowns until they were visibly damaged.” They also found some veterinary professionals wearing gowns that were not rated for chemotherapy use.
The researchers also noted that in some veterinary clinics, veterinary staff had to sit on the floor to administer treatment for large breed animals. “Very few hospitals we visited had hydraulic lift tables,” says Dr. Hirst.
The 2018 project also found not all drugs are treated equally by veterinary professionals. “For example, when a veterinary healthcare worker has to prepare the chemotherapy drug Mustargen® for a treatment, they wear a disposable gown, respirator, and gloves,” says Dr. Hirst. “For other drugs like vincristine, the veterinary healthcare worker will wear only a disposable gown and gloves. Whether it is Mustargen® or vincristine, these drugs are harmful to workers and can cause adverse health effects. Also, we have seen veterinary technicians remove protective gloves to shave a patient for their treatment or insert a catheter, which puts them at risk for hazardous drug exposure.”
Another difference is some drugs handled in veterinary oncology are not on the current NIOSH hazardous drug list; however, some drug inserts list the adverse health effects of the drug. Therefore, says Dr. Hirst, “it is important for each veterinary hospital to do an inventory of their drugs and know the risk of each one in order to protect their staff.”
The project did find similarities between veterinary and human health workers in compounding and/or preparing hazardous drugs for their patients. “Another similarity we have found is all the veterinary hospitals we visited used ventilated engineering controls (BSCs) and supplementary controls (closed system drug-transfer devices [CSTDs]), which is what NIOSH recommends when handling hazardous drugs,” says Dr. Hirst.
The 2018 project involved field studies at seven veterinary hospitals throughout the U.S. NIOSH researchers documented the practices and equipment used to prevent exposures as well as used surface wipes to sample for drug contamination. They identified and evaluated hazardous drug engineering controls, which isolate people from the hazard, such as biological safety cabinets and room ventilation.
“We collected surface wipe samples from surfaces in areas where chemotherapy drugs were handled by workers and less obvious places, such as telephones and break areas,” says Dr. Hirst. “The surface wipe samples are helping us document hazardous drug contamination in veterinary oncology and develop more analytical methods for hazardous drugs.”
The project is funded through September 2020. Dr. Hirst says NIOSH will develop a training prototype for testing with small groups of veterinarians, veterinary technicians, and veterinary students once the project ends. Veterinarians will be able to earn continuing education credit.
“One of the major issues or challenges we have encountered with this study is that NIOSH is not widely known in the veterinary profession,” says Dr. Hirst. “Our guidance and recommendations on safe handling of hazardous drugs has not reached veterinary healthcare workers. Information dissemination is key for NIOSH’s veterinary research project. We hope by tailoring guidance specifically for veterinary professionals and students, NIOSH’s recommendations will be adopted and used.”
“I think we have a lot of good recommendations that are out there now, but they’re not packaged in a way that’s easily transferable or viewed — or accessible to the audience,” says Trudi McCleery, a health communication specialist for NIOSH.
The educational materials and information dissemination efforts will provide important, veterinary-specific educational tools for those already practicing or studying to work in the field, says Dr. Hirst. “We plan to develop and publish a short, easy-to-understand Workplace Solutions document, update the NIOSH veterinary webpage, and disseminate messaging through social media. Veterinary healthcare workers and students will learn how to recognize potential sources of exposure; how to protect themselves and co-workers; and thus, how to prevent work-related illnesses. We plan to incorporate information on how to properly avoid handling hazardous drugs including animal waste that is potentially contaminated with hazardous drugs.”
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1 Klahn S . Chemotherapy safety in clinical veterinary oncology. Vet Clin Small Anim 44: 941–963.