5 Antineoplastic Agents (Administer)

MODULE C: Antineoplastic Agents (Administer) Form Approved

7/23/10 OMB No. 10AP-xxxx

Expiration Date: xx/xx/2011

PROGRAMMING INSTRUCTIONS APPEAR IN BLUE.

		During your career, how long have you been administering antineoplastic agents to patients?		Less than one year 1-5 years 6-10 years 11-20 years More than 20 years
	What training, if any, have you received on the safe handling of antineoplastic agents? Please  all that apply.			Association of Pediatric/Hematology Oncology Nurses (APHON) Chemotherapy and Biotherapy course Oncology Nurses Society (ONS) Safe Handling of Hazardous Drugs course ONS Chemotherapy and Biotherapy course Other (Please specify) __________________________________ I have not received training GO to Question 4
	When was the last time you received training on the safe handling of antineoplastic agents?			Within the past 12 months More than 12 months ago

	How familiar are you with the following guidance documents on the safe handling of antineoplastic agents?		Very	Somewhat	Not at All
	a. American Society of Health-System Pharmacists (ASHP) guidelines for handling hazardous drugs		¦	¦	¦
	b. NIOSH Alert on Preventing Exposures to Antineoplastic Agents and Other Hazardous Drugs		¦	¦	¦
	c. Oncology Nurses Society (ONS) Safe Handling of Hazardous Drugs		¦	¦	¦
	d. Occupational Safety and Health Administration (OSHA) guidelines for the management of antineoplastic drugs		¦	¦	¦
If you work for more than one employer, the following questions apply to your primary employer, i.e., the one for which you typically work the most hours. If you are self-employed, consider yourself the employer.
	Does your employer have procedures that address safe administration of antineoplastic agents?		Yes No I don’t know

	During the past 7 calendar days, which of the following antineoplastic agents did you administer to patients? Please  all that apply. display calendar highlighting the past 7 calendar days. applies to all questions with ‘in the past 7 calendar days’.
Aldesleukin Alemtuzumab Alitretinoin Altretamine Aminoglutethimide Amifostine Amsacrine Anastrozole Arsenic trioxide Asparginase Azacitidine BCG live Bevacizumab Bexarotene Bicalutamide Bleomycin Bortezomib Busulfan Capecitabine Carboplatin Carmustine Cetuximab Chlorambucil Cisplatin Cladribine Cyclophosphamide Cytarabine Dacarbazine Dactinomycin Daunorubicin Denileukin Docetaxel Doxorubicin Epirubicin Estramustine Etoposide Exemestane			Floxuridine Fludarabine Fluoxymesterone Flutamide Fluorouracil Fluvestrant Gemcitabine Gemtuzumab ozogamicin Goserelin Hydroxyurea Ibritumomab Tiuxetan Idarubicin Ifosfamide Imatinib mesylate Interferon Alfa Irinotecan Lapatinib Lenalidomide Letrozole Leuprolide Levamisole Lomustine Megestrol Melphalan Mercaptopurine Merchlorethamine Methotrexate Mitomycin-C Mitotane Mitoxantrone Motexafin gadolinium Nilutamide Oprelvekin Oxaliplatin			Paclitaxel Palifermin Pegaspargase Pemetrexed Pentostatin Plicamycin Procarbazine Raloxifene Rituximab Sargramostim Sorafenib Streptozocin Sunitinib Tamoxifen Temozolomide Teniposide Thalidomide Thioguanine Thiotepa Topotecan Toremifene Trastuzumab Trimetrexate Tretinoin Valrubicin Vinblastine Vincristine Vinorelbine Investigational compounds (not yet named) Other (Please specify up to 2 more antineoplastic agents): __________________________ __________________________
	During the past 7 calendar days, on how many days did you administer antineoplastic agents to patients?				1 day 2 days 3 days 4 days 5 days 6 days 7 days
	During the past 7 calendar days, what was the total number of treatments of antineoplastic agents you administered to patients? Note: One treatment equals one or more chemo drugs administered to one patient during one therapy session.				1-2 treatments 3-4 treatments 5-9 treatments 10-20 treatments 21-40 treatments More than 40 treatments
	During the past 7 calendar days, the total number of treatments of antineoplastic agents you administered was...				…more treatments than usual …fewer treatments than usual …about the same number of treatments as usual
	Of the total number of antineoplastic drug treatments you administered during the past 7 calendar days… a. …what percent was liquid? b. …what percent were tablets/capsules?				______% If 100%, skip Questions 11 and 12 _______% fill in difference between 100% and number entered in 10a ­­­­If 100%, skip Questions 15a-d, 17-26 and 41-43.
	Of the total number of antineoplastic drug treatments you administered as tablets or capsules during the past 7 calendar days… a. …what percent of all tablets were crushed? DISPLAY 11b ON SEPARATE SCREEN Of the total number of antineoplastic drug treatments you administered as tablets or capsules during the past 7 calendar days… b …what percent of all capsules were opened?				0% 1-19% 20-39% 40-59% 60-79% 80-99% 100% 0% 1-19% 20-39% 40-59% 60-79% 80-99% 100% IF ‘0%’ in 11a AND 11b, GO to Question 13
	Where were the tablets crushed or capsules opened? Please  all that apply.				Bedside Clinical areas Pharmacy Other (please specify): ___________
	During the past 7 calendar days, in which of the following areas did you administer antineoplastic agents to patients? Please  all that apply.				Patient’s hospital room Operating room Hospital treatment room (e.g., for infusion therapy) Outpatient center/clinic Oncologist’s office Patient’s home Other location (Please specify): ________________________________
If only one response marked in Question 13 Go to Question 15.
		Of the locations you checked above, please indicate the area where you most often administered antineoplastic agents.			list areas marked in Question 13 (use radio buttons)

Questions addressing work practices and use of personal protective clothing and equipment will help us understand what is currently used and under what circumstances. Depending on your job and exposures, these may not be required. skip questions 15 a, b, c and d, if ‘100%’ tablets/capsules in question 10b.

During the past 7 calendar days while administering antineoplastic agents to patients, how often did you…

Always

Sometimes

Never

a. …use a closed-system transfer device (e.g., PhaSeal)?

¦

¦

¦

b. …use Luer-Lock fittings for all needleless systems, syringes, needles, infusion tubing, and pumps?

¦

¦

¦

c. …use a needle-less system?

¦

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¦

d. …use a plastic-backed absorbent pad under injection site?

¦

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¦

e. …replace gloves immediately when damaged or contaminated?

¦

¦

¦

f. …wash hands after removing gloves?

¦

¦

¦

g. …wear shoe covers?

¦

¦

¦

h. …wear a head cover?

¦

¦

¦

During the past 7 calendar days, how often did you store prepared antineoplastic agents in an area restricted to authorized personnel before administering them to patients?

Always Sometimes Never Not applicable, I did not store antineoplastic agents before administering them to patients

skip questions 17-26 if ‘100%’ tablets/capsules in question 10b.

During the past 7 calendar days, which of the following best describes how liquid antineoplastic agents were most commonly received from the pharmacy (or drug preparation area)?

IV tubing primed with antineoplastic agent IV tubing primed with diluents (i.e., a liquid other than antineoplastic agent) IV tubing is not primed Not applicable, I did not receive any liquid antineoplastic agents from a pharmacy or drug preparation area

During the past 7 calendar days, how often did you prime the IV tubing before administering antineoplastic agents to patients?

Always Sometimes Never  GO to Question 20

During the past 7 calendar days, how did you prime the IV tubing? Please  all that apply.

With antineoplastic agent With diluents (i.e., a liquid other than antineoplastic agent)

In the past year, have you accidentally punctured your skin with a sharp while administering antineoplastic agents?

Yes No

During the past 7 calendar days, did a spill or leak of any amount (even a few drops) occur while you were administering liquid antineoplastic agents?

Yes No  GO to Question 27

During the past 7 calendar days, did any of the following cause a spill or leak of liquid antineoplastic agents during administration?

Yes

No

a. Attaching, injecting, or detaching from IV line

¦

¦

b. Drawing up or expelling air from syringe

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¦

c. Bad connection

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d. Excessive pressure in vial

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e. Equipment malfunction

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f. Other (Please specify):________

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¦

During the past 7 calendar days, how many spills or leaks occurred while you were administering liquid antineoplastic agents?

No spills

1-2 spills

3-5 spills

More than 5 spills

Spills or leaks less than 5 ml

¦

¦

¦

¦

Spills or leaks of 5 ml or more

¦

¦

¦

¦

If ’No spills’ marked in BOTH Questions 23A and 23B Go to Question 27. All other responses  Go to Question 24.

How often was/were the spill(s) cleaned up?

Always Sometimes Never  GO to Question 27 I don’t know  GO to Question 27

How often did you yourself clean up the spill(s)?

Always  GO to Question 27 Sometimes Never

Who cleaned up the spill(s)? Please  all that apply.

You Designated spill cleanup team Other (Please specify): ___________________________ I don’t know

Are hazardous drug spill kits readily available?

Yes No I don’t know

During the past 7 calendar days, did your skin come into direct contact with antineoplastic agents during handling or administration?

Yes No

Has exposure monitoring (e.g., air sampling, wipe sampling) been conducted in the past 12 months to assess your or your co-workers’ exposure to antineoplastic agents?

Yes No I don’t know

A medical surveillance program may include work history, physical exam, blood and/or urine tests, etc. Do you participate in a medical surveillance program that addresses potential health effects of exposure to antineoplastic agents?

Yes No, my (primary) employer offers such a program but I did not participate in it. My (primary) employer does not provide such a program I am not aware of whether my employer provides such a program.

Questions addressing work practices and use of personal protective clothing and equipment will help us understand what is currently used and under what circumstances. Depending on your job and exposures, these may not be required.

During the past 7 calendar days, how often did you wear a nonabsorbent gown with closed front and tight cuffs while administering antineoplastic agents to patients?

Always  GO to Question 34 Sometimes Never

What were the reason(s) you did not always wear a nonabsorbent gown with closed front and tight cuffs while administering antineoplastic agents? Please  all that apply.

An engineering control (e.g., closed-system drug transfer device) was being used Skin exposure was minimal Not part of our protocol Not provided by employer No one else who does this work uses them Too uncomfortable or difficult to use Not readily available in work area Cross contamination to other areas is not a concern Concerned about raising the patient’s anxiety Other (Please specify): _________________________________

If only one response marked in Question 32 Go to Question 34.

Of the reasons you checked above, please indicate the most important reason you did not always wear a nonabsorbent gown with closed front and tight cuffs while administering antineoplastic agents.

list reasons areas marked in Question 32 (USE RADIO BUTTONS)

In your current job, have you taken home any clothing that came into contact with antineoplastic agents?

Yes No I don’t know

During the past 7 calendar days, how often did you wear chemotherapy gloves while administering antineoplastic agents to patients? Note: A chemotherapy glove is a medical glove that has been approved by FDA for use when handling antineoplastic agents.

Always Sometimes Never  GO to Question 37 I don’t know if the gloves I wore were chemotherapy gloves  GO to Question 39

When wearing chemotherapy gloves, how often did you wear two pairs (i.e., double glove)?

Always Sometimes Never I don’t know

If ’ ‘always’ marked in Question 35 è Go to Question 39. If ‘sometimes’ marked in Question 35 è Go to Question 37.

What were the reason(s) you did not always wear chemotherapy gloves while administering antineoplastic agents? Please  all that apply.

Skin exposure was minimal Not part of our protocol Not provided by employer No one else who does this work uses them Too uncomfortable or difficult to use Not readily available in work area Cross contamination to other areas is not a concern Concerned about raising the patient’s anxiety Other (Please specify):

If only one response marked in Question 37  Go to Question 39.

Of the reasons you checked above, please indicate the most important reason you did not always wear chemotherapy gloves while administering antineoplastic agents.

list reasons marked in Question 37 (USE RADIO BUTTONS)

	During the past 7 calendar days, did you perform any of the following activities while wearing gloves that had been used to administer antineoplastic agents?			Yes	No
	a. Use phone/cell phone/pager			¦	¦
	b. Touch a computer keyboard, mouse, monitor or calculator			¦	¦
	c. Handle files or charts			¦	¦
	d. Touch door knobs, cabinets or drawers			¦	¦
	e. Eat, drink, chew gum or smoke			¦	¦
	f. Use pen or pencil			¦	¦
	g. Touch waste basket/garbage bags			¦	¦
	h. Use restroom			¦	¦
	i. Apply cosmetics (e.g., lip balm)			¦	¦
	j. Touch IV pump or bed controls			¦	¦
	k. Use a non-disposable stethoscope			¦	¦
	During the past 7 calendar days, did you remove and later put back on the gloves you had worn while administering antineoplastic agents?			Yes No
	During the past 7 calendar days, how often did you wear eye or face protection (e.g., goggles, face shield) while administering liquid antineoplastic agents to patients? Do not include personal eye glasses			Always  GO to Question 44 Sometimes Never
	What were the reason(s) you did not always wear eye or face protection while administering liquid antineoplastic agents? Please  all that apply.			An engineering control (e.g., closed-system drug transfer device) was being used Exposure was minimal Not part of our protocol Not provided by employer No one else who does this work uses them Too uncomfortable or difficult to use Not readily available in work area Concerned about raising the patient’s anxiety Other (Please specify): ______________________________
If only one response marked in Question 42  Go to Question 44.

	Of the reasons you checked above, please indicate the most important reason you did not always wear eye or face protection while administering liquid antineoplastic agents.	list reasons marked in Question 42 (USE RADIO BUTTONS)

	During the past 7 calendar days, did you wear any of the following while administering antineoplastic agents? Please  all that apply.
	N95 respirator (includes surgical N95 respirator)								Half-facepiece air purifying respirator with particulate cartridge(s)
	Powered air purifying respirator (PAPR)								Standard surgical mask
	None of above								q I don’t know
DISPLAY FOLLOWING NOTE ON A SEPARATE SCREEN (EXCEPT THOSE WHO MARKed ‘I DON’T KNOW’): the following questionS ask about respirators. Standard surgical MASKS ARE NOT respirators. IF Respondent marked ‘N95 RESPIRATOR’, ‘HALF-FACEPIECE AIR PURIFYING RESPIRATOR’ OR ‘POWERED AIR PURIFYING RESPIRATOR’ in question 44 Go to Question 45 IF Respondent marked ‘standard surgical mask’ OR ‘none of the above’ IN QUESTION 44  Go to Question 46 IF RESPONDENT MARKED ‘i don’t know’ in question 44 Go to INSTRUCTIONS IN Question 48
				How often did you wear a N95 respirator, half-facepiece air purifying respirator with particulate cartridge or a powered air purifying respirator while administering antineoplastic agents?						Always  Go to Question 48 Sometimes
		What were the reason(s) you did not always wear a N95 respirator, a half-facepiece air purifying respirator with particulate cartridge, or a powered air purifying respirator while administering antineoplastic agents? Please  all that apply.				An engineering control (e.g., closed-system drug transfer device) was being used Exposure was minimal Not part of our protocol Not provided by employer No one else who does this work uses them Too uncomfortable or difficult to use Not readily available in work area Concerned about raising the patient’s anxiety Other (Please specify): ______________________________
If Respondent marked more than one reason in Question 47  Go to Question 48. Otherwise è Go to instructions before question 48.
			Of the reasons you checked above, please indicate the most important reason you did not always wear a respirator while administering antineoplastic agents.			list reasons marked in Question 46 (use radio buttons)
If Respondent marked “N95 respirator” or “Half-facepiece air purifying respirator with particulate cartridge” in Question 44  Go to Question 48. Otherwise è EXIT MODULE AND GO TO CORE MODUULE IF THIS IS THE FIRST HAZARD MODULE COMPLETED IF THIS IS THE SECOND HAZARD MODULE COMPLETED, end SURVEY. END WITH‘Thank you’ statement.
		Have you been fit-tested for the respirator(s) you use for administering antineoplastic agents?				Yes No è EXIT MODULE AND GO TO CORE MODULE IF THIS IS THE FIRST HAZARD MODULE COMPLETED IF THIS IS THE SECOND HAZARD MODULE COMPLETED, end SURVEY. END WITH‘Thank you’ statement.

Thank you for participating in the NIOSH Health and Safety Practices Survey of Healthcare Workers. Your answers have been submitted.

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