Doing the Dirty Work: Who Handles Antineoplastic Drug Contaminated Excreta and do They Do It Safely?

Antineoplastic drugs (ADs) given to combat cancer, can increase the risk of secondary cancers in those that receive them. ADs are also a hazard to those health‐care workers who have long‐term exposure to the agents. Health‐care workers can become exposed to ADs through spills and splashes, during the administration of the agents and even during exposure to the excreta of patients (most commonly urine and stool). Levels of AD retained in urine, stool, and vomit of patients vary in amount and duration based on the agent, and personal characteristics of the patient. The active drug can be found in bodily fluids for at least 48 hours and up to 7 days post‐administration. Recent research is also beginning to document that ADs are in the work environment and being metabolized by health‐care workers who are not coming into direct contact with the agents or the bodily fluids of patients receiving them such as unit clerks, volunteers, and dieticians. Prior research has documented adverse effects of exposure to ADs for health‐care workers including skin rashes, infertility, birth defects, miscarriage, and an increased risk for cancer, notably leukemia. The research that has been done to date has primarily focused on pharmacists and nurses who are preparing and administering these agents and less on nursing assistants (NAs) who are handling the excreta of patients receiving them. In the United States alone, it is estimated that more than 1,420,570 people work as NAs. NAs provide care under the direction of a licensed health‐care provider. They are often responsible for the majority of assistance with activities of daily living for patients which includes feeding, bathing, toileting, dressing, repositioning patients, and changing their linens. Nurses often delegate tasks like assistance with toileting to NAs. As suggested in an ethnographic study by Jervis, because of their frequent contact with excreta, NAs are at risk of being viewed as “polluted people” who do tasks that are unpleasant to nurses. However, do NAs know how to safely handle the excreta of patients receiving ADs? In the U.S., federal regulations mandate that Certified