‘Secondhand chemo’ puts healthcare workers at risk | By Carol Smith

Sue Crump braced as the chemo drugs dripped into her body. She knew treatment would be rough. She had seen its signature countless times in the ravaged bodies and hopeful faces of cancer patients in hospitals where she had spent 23 years mixing chemo as a pharmacist.
At the same time, though, she wondered whether those same drugs – experienced as a form of “secondhand chemo” — may have caused her own cancer.
Chemo is poison by design. It’s descended from deadly mustard gas first used against soldiers in World War I. Now it’s deployed to stop the advance of cancer.
Crump knew she had her own war on her hands. She wanted to live long enough to see her 21-year-old daughter, Chelsea, graduate college.
And she wanted something else: She wanted young pharmacists and nurses to pay attention to her story.
Crump, who died of pancreatic cancer in September at age 55, was one of thousands of health care workers who were chronically exposed to chemotherapy agents on the job for years before there were even voluntary safety guidelines in place.
Now some of those workers are being diagnosed with cancers that occupational health specialists say could be linked to exposure to the same powerful drugs that have saved hundreds of thousands of patient lives. Experts believe that’s because when nurses, pharmacists, technicians and increasingly, even veterinarians, mix and deliver chemo, accidental spills, sprays and punctures put them in close, frequent contact with hazardous drugs.
Yet an InvestigateWest investigation has found that the federal Occupational Safety and Health Administration does not regulate exposure to these toxins in the workplace, despite multiple studies documenting ongoing contamination and exposures. Studies as far back as the 1970s have linked increased rates of certain cancers to nurses and physicians.
Exposures continue to occur. A just-completed study from the U.S. Centers for Disease Control, 10 years in the making and the largest to date, confirms that chemo continues to contaminate the work spaces where it’s used, and in some cases is still being found in the urine of those who handle it, despite knowledge of safety precautions.
Chemo agents have been classified as hazardous by the Occupational Safety and Health Administration OSHA. since the mid-1980s. Hazardous drugs are those known, or suspected to cause cancer, miscarriages, birth defects, or other serious health consequences.
Deputy Assistant Secretary of Labor for OSHA Jordan Barab said in written response to questions from InvestigateWest that the agency doesn’t have resources to regulate workplace drug exposures, although it is concerned about the issue. “Although this is an important safety and health issue, OSHA has not considered a standard to specifically address hazardous drugs in the healthcare setting,” he wrote.
OSHA has no regulatory authority to enforce safety practices with fines or sanctions, other than under its “General Duty” clause – a catch-all regulation that allows OSHA inspectors to warn an employer if they see something that concerns them.
According to documents obtained by InvestigateWest through the Freedom of Information Act, OSHA has only used the General Duty Clause once in 10 years to cite any health care institution, including hospitals, clinics, dental and veterinary offices, for their handling of hazardous drugs.
In contrast, there are enforceable standards, including “permissible exposure limits” to protect workers from other known cancer-causing hazards, such as benzene, or asbestos. The government also has standards for healthcare workers handling radiation and certain chemicals, such as sterilizing agents.
But not for drugs.
“There is no other occupation population that handles so many known human carcinogens,” said Thomas Connor, a research biologist with the National Institute for Occupational Safety and Health. Connor has spent 40 years studying the effect of chemo agents on workers, and is one of the lead authors on the latest study.
Tracing an individual’s cancer to a particular exposure is difficult. It’s one of the main reasons safety advocates have been thwarted in their efforts to get stricter regulations. But the ranks of those who have became symbols for increased safety includes pharmacists Bruce Harrison of St. Louis and Karen Lewis of Baltimore, veterinarian Brett Cordes of Scottsdale, and nurse Sally Giles of Vancouver, B.C.
All of them eventually got cancer, or in Lewis’ case, a pre-cancerous condition. Cordes was diagnosed four years ago at age 35. Giles was in her 40s, and Lewis and Harrison were in their 50s when diagnosed. All but Lewis and Cordes are now dead.
via Lifesaving Drugs, Deadly Consequences | InvestigateWest.