I'm a nursing student and I posted a little while back about being frightened to go to a 6-week oncology ward rotation because of the chemotherapy drugs. During the time I was there, I spent about 45 minutes in the pharmacy in the clean room watching how the pharmacists mixed the chemo under the biological safety cabinet with the vertical air flow - I didn't touch anything (and was wearing PPE, though because we had the hood, we just had normal paper masks and no respirators), but afterwards I was terrified that there was chemo in the air and I've been having trouble getting it out of my head now that I might develop cancer due to this exposure as well as tiny exposures in the ward that might have occured. This probably sounds really paranoid, and probably is, but I just regret so much being in there because it wasn't part of my normal rotation, but rather just an opportunity offered to me (and I took it mainly to be polite, not because I actually wanted to see, which was stupid). Then again, the pharmacist told me that she would be more concerned about the exposure the nurses get in the wards touching the pre-prepared IV bags and administering the drugs, and I know that OSHA doesn't recommend respirators when mixing the drugs as long as it is done in the safety cabinet. I guess it just freaked me out because I was expecting it to be totally closed off with gloves attached. Please tell me that I'm not going to die from cancer because I spent a 45 minutes in there (I know, I'm being ridiculously paranoid, but it's nice to hear from others)?
Anyway, now that I'm in another ward (mainly nephrology ward with kidney failure patients and diabetics), I was just starting to feel better about the whole oncology ward thing. I ended up only spending a total of 2 weeks there and I never had to handle the chemo myself, although I was nearby when my mentor administered it. I was just starting to stop thinking about getting cancer all the time when I discovered that there are hazardous drugs in many different wards in a hospital. Chemo drugs are used in labor and delivery, to treat rheumatoid athritis, used in the operating room, etc. I just discovered the other day that one patient I have been treating is a kidney transplant patient (it's an older transplant, which is why I didn't know) and has been receiving a daily dose of cyclosporine, an immunosupressant to combat rejection. And through my own research, I discovered that although it is not genotoxic, it is a human carcinogen and it secretes in part inactivated into feces, vomit, and a bit into urine as well, and it's listed as a hazardous drug by NIOSH. I had just cleaned up spilled feces on bed linens and emptied this patient's urine bag many many times wearing only one pair of normal latex gloves and taking no special precautions. After discovering that this is classed as a hazardous drug, I was really surprised to find that no one had told me, nor was it written anywhere on the patient's papers as a warning that he was taking a hazardous drug. Thank goodness it was in tablet form or I'd be even more upset. I'm not too worried about my current exposure (though I am a bit), but I'm planning to sign a contract next week to work at this ward for 3 months during my summer vacation and now I'm actually considering turning down the job because I'm scared. I want to talk to the head nurse about it, but I have a feeling nothing will change just because some student points it out. Also I really need a summer job and I'm not sure where I could get one where this wouldn't be a possible issue.
I'm also starting to question whether or not this type of hospital nursing is right for me, as I'm realizing more and more that many drugs not associated with cancer treatment are hazardous and that it seems that staff is not even informed of the dangers nor do they know to handle these drugs any differently than any others. It makes me feel paranoid about any drugs, because I feel like if I don't research every drug I see, no one else is going to tell me to be careful. I have a 6-week rotation in a surgical ward next, and then a 4-week rotation in the ICU. I just keep wondering what kinds of scary drugs could be used in those wards that no one will tell me about or follow proper safety protocol for. I think they wouldn't bother me so much if it was made known what patient has gotten what drug and what safety precautions need to be taken. But it seems like no one pays attention or even knows.
So here's the deal - my dream is to become a NICU or a pediatric nurse. I know in pediatrics I would be likely to run into a lot of these other drugs, but I wonder if there will be hazardous drugs in the NICU? The other thing I'm considering is to switch gears in my school and become a public health nurse instead, which is hard to explain because I think they don't have those in the US. Basically they work with preventative medicine, and my dream there would be working with healthy children that come in for regular check-ups to track development and give vaccinations. I'm relatively certain they never handle any hazardous drugs, or hardly any drugs at all, for that matter (aside from vaccinations). But that would be a big decision to make based on a fear that might not be reasonable. I feel like a have a sudden drug-phobia and I really need someone to either reassure me that I'm being silly, or tell me that I'm right, and there does need to be stricter safety protocols in place.
And could someone please tell me if I'm likely to encounter hazardous drugs in the ICU? My rotation there is not for a couple of months, so I still have the opportunity to change it to another ward.
Also, if anyone could possibly give me a list of common hazardous drugs not related to cancer treatment and tell me where they are likely to be used and what kind of precautions should be taken, it would make me feel a lot better.
