Skip to main content

Cover Story: Self-Care Musts for Those Who Care for Others


In any work environment, there are ways that individuals can be negatively impacted by what’s around them. However, in the Health Care and Social Assistance (HSA) sector, two new studies published by researchers at the National Institute for Occupational Safety and Health (NIOSH) show that many HSA workers are either not sufficiently aware of certain hazards in their environment or do not take the precautions necessary to protect themselves from such hazards.


Protective Clothing and Antineoplastic Drugs


A study conducted by NIOSH researchers and published in the American Journal of Nursing reported that female nurses who administer antineoplastic drugs (medications used to treat cancer) do not always wear protective clothing. This study appearing in the American Journal of Nursing is one of the first of its kind to explore the use of antineoplastic drugs and personal protective equipment among non pregnant and pregnant female nurses.


Antineoplastic drugs, or chemotherapeutic drugs, are a regular part of many nurses’ workdays, and exposure to such drugs is inevitable without the proper protective clothing. After nurses administer these drugs in pill or liquid form to patients with cancer, the drugs work to destroy all rapidly dividing cancerous cells within the body of the patient. Yet, when a nurse is administering the drug and becomes exposed to it, the same drug that kills harmful rapidly dividing cells also kills healthy rapidly dividing cells within the nurse. This drug will also continue to kill healthy rapidly dividing cells within the body of a developing baby inside that nurse.


The knowledge of the necessity of protective clothing when administering such drugs has been present for a long time, but awareness of the real correlation between exposure to antineoplastic drugs and reproductive outcomes has been close to nonexistent due to the lack of studies conducted to explore such a relationship further.


In 2010, enrollment began for nurses to participate in the Nurses’ Health Study’s investigation into this correlation. Data was collected from more than 40,000 nurses who reported on their use of gloves and gowns when handling or administering antineoplastic drugs. For non-pregnant female nurses, they reported on their use of protective  clothing within the past month; for pregnant nurses, they reported on their use during the first 20 weeks of  pregnancy. The specific first 20 week period of pregnancy for pregnant nurses was an important number to consider  for the researchers, as this time is a period of great susceptibility to exposure for the fetus.


Nurses’ Health Study Results


Despite recommendations for the use of protective clothing when administering antineoplastic drugs, the study found that during the administration of these drugs:


  • 9% of pregnant nurses and 12% of non-pregnant nurses never wore gloves
  • 38% of pregnant nurses and 42% of non-pregnant nurses never used a gown
  • 10% of pregnant nurses did not always wear gloves
  • 50% of pregnant nurses did not always wear a protective gown


“NIOSH has worked extensively to protect workers who handle antineoplastic drugs, many of which are known or probable human carcinogens,” said Christina Lawson, Ph.D., epidemiologist and lead author of the study. “Many of  these drugs can also damage a person’s fertility or harm a pregnancy, for example by causing a miscarriage or birth defects, so we wanted to look at the health of pregnant nurses for this study.”


Researchers in the Nurses’ Health Study may not be certain of why nurses in this study did not prioritize the use of protective clothing when handling antineoplastic drugs, but previous studies suggest some possible reasons: nurses may be more concerned with the health of their patients’ over their own, nurses may not be aware of the extent to which antineoplastic drugs are toxic, or nurses may not have the support of their employers with sufficient access to protective gowns and gloves.


“These data underscore the need for continued education and training to ensure that both employers and nurses —pregnant and non-pregnant—are fully aware of such hazards and of the recommended precautionary measures,” says Lawson.



Hearing Loss Among HSA Workers


In another study conducted by NIOSH that was recently published in The Hearing Journal, researchers found a strong prevalence of hearing loss among healthcare and social assistance workers. The study took place as a part of NIOSH’s ongoing Occupational Hearing Loss (OHL) Surveillance Project, which has studied more than 1.4 million noise-exposed workers. The NIOSH OHL Surveillance Project used millions of collected audiograms from thousands of companies to report on the prevalence, incidence, and adjusted risk of hearing loss among these noise-exposed workers.


According to NIOSH’s published report, the HSA sector stood out in that it “demonstrated a prevalence of hearing loss that was inconsistent with known or perceived noise exposures.” Although the number of HSA workers who experience hearing loss was in line with other industries in which noise-exposure was an issue, what was different for the HSA sector was that of the 18% of HSA workers who experienced hearing loss, only 13% reported any actual  exposure to hazardous noise. This is among the lowest reported rate of perceived noise exposure throughout all industries.


The NIOSH OHL Surveillance Project found that across the HSA industry, the average for noise-exposed HSA  workers who experienced hearing loss was 19%. The NIOSH OHL Surveillance Project decided to investigate this  number further and looked closer at spaces in the industry where either only medical care was conducted or only  social assistance was conducted, or some combination of both were conducted. Five subsectors of the HSA industry  that received further inquiry included child day care services; community food and housing, and emergency and  other relief services; offices of other health practitioners; offices of physicians; and medical and diagnostic laboratories. These five sub-sectors  had significantly more risk of developing hearing loss than the couriers and  messengers industry, which is an industry with similar numbers of noise-exposed workers with hearing loss as the HSA industry.


The NIOSH paper presents several potential causes of this higher risk. Of these listed causes, exposure to antineoplastic drugs due to a lack of protective clothing is included. Antineoplastic drugs have known ototoxic effects that leave nurses and pharmacy workers at a greater risk for hearing loss if they do not protect themselves  adequately. Other potential causes include the lack of protective hearing tools when exposed to noise and the exposure to excessively loud background noise in the working environment.


Furthermore, the study found that 74% of HSA workers do not wear protective hearing implements, and that since many HSA workers work shifts longer than eight hours, exposure to background noise may be a strong contributing factor.


Upon the obtainment of these findings, the NIOSH research team looked into a previous study of the usage of  antineoplastic drugs by workers in the HSA sector. This previous study had looked at reports of spills of drugs and  had found that those HSA workers who reported spills in their workplace environment were scored lower by their  colleagues for their “collegial relations with physicians.” This suggests that the accurate reporting of any errors when  using antineoplastic drugs in the workplace may be considered in line with not acting like a “team player” within the
HSA sector.



Awareness and Prevention


The data collected from both of these studies conducted by NIOSH indicates that HSA workers are at a higher risk for both hearing loss and other health issues caused by exposure to antineoplastic drugs. What is known is that there are ways to prevent further exposure, but what is unknown is why the appropriate prevention methods have not been a priority in the past for some HSA workers.


These studies conducted by NIOSH researchers shows us that one clear direction for the future is the need for  further training for employers and employees to promote the use of protective hearing implements and protective clothing as necessary. This research also reveals that there is much more to be done in order to understand the  reasons why HSA workers may not be taking the precautionary measures available to protect themselves from hazards in their environment, so that the industry is able to sufficiently address those reasons within the workplace environment.


By Alana Hippensteele, Editor, American Cleaning & Hygiene