Canadian Occupational Safety

24 Canadian Occupational Safety | www.cos-mag.com O ver the past year, the Alberta Union of Provincial Employees (AUPE) has received 150 complaints from its members about exposure to one of the most toxic classes of chemical agents used in health care. Cytotoxic drugs, also known as antineoplastic drugs, have a toxic effect on cells within the body and are most often used in chemotherapy to treat cancer. "It was alarming to us that we would walk into a health- care facility and hear or witness licensed, practical nurses, heath-care aids distributing cytotoxic medications or other hazardous medications without any form of personal pro- tective equipment," says Trevor Hansen, occupational health and safety and disability representative at AUPE, which rep- resents more than 90,000 workers. "Generally, employers in the health-care industry here in Alberta were not properly advising their workers of the medication and the impact to the worker… They were not doing their due diligence." To date, the union has filed seven formal occupational health and safety complaints to the Ministry of Labour for different employers throughout the province in regards to a lack of training, education and personal protective equip- ment (PPE) for cytotoxic drugs. OHS officers visited each workplace and in every single case, a compliance order was issued, Hansen says. Every year, the number of cancer cases in Canada increases. The Can- adian Cancer Society says nearly one in two Canadians will be diagnosed with the disease in their lifetime and one in four will die from cancer. With chemotherapy being one of the principal treatments for cancer, there are global increases in the develop- ment and use of antineoplastic agents worldwide, according to the Interna- tional Agency for Research on Cancer. Currently, there are more than 100 dif- ferent antineoplastic agents available. These drugs not only attack cancer cells, but they are non-selective and affect normal cells, too. Acute reac- tions can include skin irritation, eye and mucous membrane irritation, nausea, vomiting, hair loss and rashes. Due to the latency period of some of these medications, chronic issues can show up five, 10, 15 years later, such as damage to the liver, kidney, lung and heart, Hansen says. Many antineoplastic drugs are carci- nogenic, meaning that exposure could cause cancer. Studies have shown an increased risk for leukemia, non-Hog- skin lymphoma, bladder cancer and liver cancer among exposed workers. The drugs are also teratogenic, meaning that they can affect fetal development. There is a fair amount of literature regarding reproductive toxicities and cytotoxic drugs, such as infertility issues, miscarriages, still- births and birth defects. Employees who are pregnant, trying to conceive or breastfeeding should be reassigned to tasks where they won't be exposed to cytotoxic drugs. Hansen says reproductive issues are a concern among his union members who work with these drugs. "Now they are trying to relate it back to things like miscarriages they have had, the inability to conceive children… It's really hard to specify that this was the direct result of deal- ing with these types of drugs without being properly protected, but once that information becomes available, people's minds start to ask that ques- tion," he says. "And had they been properly protected, perhaps they wouldn't have to ask." All workers who may come into contact with cytotoxic drugs have to be aware of all of these risks, receive rel- evant training and wear the necessary PPE to protect themselves. According to Carex Canada, occupations with potential exposure include: pharma- cists and pharmacy assistants, nurses and licensed nurse practitioners, physicians, veterinarians and their assistants, environmental service work- ers (janitors and caretakers), shippers and receivers, industrial laundry work- ers and pharmaceutical manufacturing workers. Hansen adds that correctional officers can be at risk if offenders have been receiving cancer treatment. Carex Canada estimates about 75,000 Canadian workers are exposed to antineoplastic agents. There is no safe level of exposure to cancer-causing agents. Detectable levels of cytotoxic drugs have been reported in the urine of pharmacists, pharmacy technicians, nurses and workers in drug manufac- turing plants. The largest occupational group exposed is pharmacy staff (phar- macists, technicians and assistants), with 42,900 workers exposed. ROUTES TO EXPOSURE Cytotoxic drugs come in liquid form, which can be administered through IV or injection, as well as pill form, which sometimes needs to be split in half or crushed so the patient can swallow it easier. Along with being used to treat cancer, the drugs can also be used for rheumatoid arthritis, psoriasis, mul- tiple sclerosis and some viral diseases, such as HIV. Workers can be exposed through skin absorption (direct contact with the drug or indirect contact with contaminated surfaces or han- dling patient excreta); inhalation (breathing in drug vapours or dust); accidental injection (needles or other sharps that puncture the skin); and ingestion (not washing hands prior to eating or putting contaminated pen- cils and pens in the mouth). In health care, workers along the entire medication circuit can be Workers exposed to chemotherapy drugs — from nurses to housekeeping staff — at increased risk for cancer, organ damage, reproductive issues By Amanda Silliker

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