The closest thing to a landmark legal case involved Sally Giles, an oncology nurse in rural British Columbia who died of bile duct cancer in 1992. Giles's husband filed a claim with the province's Workers' Compensation Board, alleging that the disease was work-related. He lost, but the well-publicized case led to stricter provincial regulation.
"What struck me was what dangerous places hospitals were," said John Steeves, a Vancouver lawyer who represented Giles's husband. "It's sort of counterintuitive. We assume the opposite."
A NIOSH Alert , left, issued last March warned health care workers of risks from contact with chemo drugs. The drugs are usually administered to patients intravenously, right.
(Cdc.gov)
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For health care workers who come in contact with chemotherapy drugs, cancer isn't the only worry. According to the NIOSH alert, the drugs also can trigger adverse reproductive effects, including miscarriage, low birth weight, infertility and birth defects.
Measuring Exposures
Beginning in the 1980s, researchers in the United States and Europe found that nurses, pharmacists, veterinarians, housekeepers and others took few precautions when preparing, administering or cleaning up the drugs. As a result, they were routinely exposed to toxic aerosols, powders and liquids.
The Occupational Safety and Health Administration (OSHA) first issued handling guidelines for hazardous drugs in 1986, calling for, among other things, the use of gloves, gowns and biological safety cabinets or respirators with high-efficiency filters. These were voluntary measures, however, not rules. OSHA still has no regulatory standards for cancer-fighting drugs and NIOSH says adherence to the guidelines is spotty.
Over the past six years, chemist Sessink has analyzed "wipe samples" -- residue collected from counters, floors and other surfaces -- from about 30 U.S. hospitals. The results indicated that drug-handling at two-thirds of the hospitals was sloppy and employee exposures were "far higher than we have here [in Europe]," he said. He would not identify the hospitals.
Sessink said he finds it "rather amazing" that the U.S. government took so long to warn workers about the dangers. He wonders if pharmaceutical manufacturers and hospitals -- mindful of possible liability -- had something to do with the delay.
Polovich, who had a hand in the NIOSH alert and sat in on many planning meetings, said she saw no evidence of industry intransigence; indeed, a number of hospital and drug-company representatives were on the advisory panel and endorsed the idea of a nationwide warning. However, she said, she isn't sure why "it took us four years to get the alert published. We were a little frustrated."
Exposure-control technologies are available. Colorado-based Baxa Corp., for example, distributes a plastic device that keeps drugs from escaping vials, syringes or IV connectors. The device, called PhaSeal, costs about $12 per patient dose.
Not every hospital or clinic, however, can afford such equipment or recognizes the need for it. Meanwhile, health care workers are seeing more cancer patients, using higher doses of drugs and delivering them in new combinations.
"I think the potential for [worker] exposures is going to increase," said NIOSH's Connor. Spokesman Blosser said the CDC will continue to discuss the proposed three-hospital study with the OMB. Blosser said there is no reason to believe the initiative is dead.
The study can't begin soon enough for Borwegen, the union official.
"These products are produced under very pristine conditions by drug manufacturers, but once they leave the facility the controls aren't really in place," he said. "Most [health care] workers are clueless about how toxic these agents are."•
Jim Morris is a deputy editor for Congressional Quarterly.
