Staring meditatively at a painting I'm working on, I notice my fingerprints in oil paint on my coffee mug. Glancing around, I see I've left a small trail of blue, red, and brilliant yellow paint on the surface of the table on which the painting rests. Concentrating on the art, I lost track of what I touched.
I should be more careful. Oil paint pigments are not healthy for skin absorption; because of this, many artists wear the same nitrile gloves used in healthcare while painting. Handling food or beverages while painting is not good studio practice. I know better, both as an artist and as an oncology nurse.
I take the concept of personal protection equipment (PPE) very seriously in the clinic. I don't administer a bag of chemotherapy without double gloving and gowning, even for monoclonal-type drugs such as trastuzumab or rituximab, which some policies say is unnecessary.
Most oncology nurses do the same. However, over years of familiarity and increased workloads, sometimes nurses lighten up on PPE adherence or disregard it altogether. Nurses beyond childbearing years seem more inclined to this shift, but this is counterbalanced by nurses and pharmacists advocating and changing hospital policies for the right to administer or mix chemotherapy in order to remain in their chosen job while pregnant. Though a higher occurrence of miscarriage is associated with chemotherapy exposure, chemotherapy is administered to pregnant cancer patients. Studies will determine the long-term outcomes years from now.
Whatever personal decision a nurse makes regarding PPE use, the governing principle is that exposure to hazardous materials is cumulative. This is obvious, but it's easy to forget additional exposures outside the healthcare environment. For example, at a routine dental appointment, I was told I needed bitewing X-rays. I asked the technician to review my chart and tell me when they were done last. She explained that the new digital X-rays use far less radiation than in the past. "The sunlight through this window exposes you to more radiation than this machine," she stated proudly. "Exactly," I agreed. "That's why I want to minimize extra exposure. I can't control the atmosphere, but I can control how many X-rays I have." She acknowledged my point.
With this in mind, I don't eat food at the nurses' desk, in close proximity to where chemotherapy is checked, and I use PPE for everything. I'm teaching myself to be more mindful of oil paint coming in contact with my skin, too. Little exposures add up in the life of an oncology nurse.
What's your opinion of exposure risk? What is your institution doing to help minimize the risk?