Cancer caregivers misled by name of protective garment

Michael R. Cohen, R.Ph.

Pharmacists and nurses that prepare and administer cancer chemotherapy drugs are at constant risk of exposure to toxic substances that can harm them personally. When these drugs are spilled or sprayed by accident they can be absorbed through the skin or the vapors can be inhaled. Without a doubt, the biggest fear is that prolonged exposure can lead to gene mutations, reproductive problems and even cancer. A 2010 story about a Pacific Northwest caregiver who developed cancer is particularly alarming.

The Occupational Safety and Health Administration (OSHA) classifies cancer chemotherapy drugs as hazardous, and they've published recommendations for protection from occupational exposure. In addition, in 2004, out of concern about this "second hand" chemotherapy exposure, the U.S. National Institute for Occupational Safety and Health (NIOSH) urged strict precautions and also issued guidelines for handling chemotherapy, including use of protective gear like gowns and gloves. The American Society of Health-System Pharmacists (ASHP), and the Oncology Nursing Society (ONS) also have guidelines that call for donning protective gowns.

Covidien is one of the companies that provides gowns for cancer workers. One of their products is called ChemoPlus. Looking at the product name, health professionals may believe that ChemoPlus Protective Gowns offer the kind of protection that pharmacists or nurses need against personal exposure to chemotherapy drugs. Unfortunately, the name is misleading. ChemoPlus does not afford the kind of worker protection called for in the professional guidelines.

A pharmacist recently notified us that a pharmacy technician he works with experienced an exposure to a non-chemotherapy drug despite wearing this gown. While preparing a dose of iron dextran injection, the technician accidentally sprayed the drug onto her ChemoPlus gown sleeve and found that the solution had seeped through the gown and onto her clothes. The incident caused them to look more closely at the ChemoPlus gown product information. They discovered that, while the product description states that the fabric is "splash resistant," the product catalog does not specifically rate the ChemoPlus Protective gowns as meeting recommendations from OSHA, ASHP and ONS for protection while preparing or administering chemotherapy drugs.

The company does manufacture a different gown called ChemoPlus Poly-Coated that does meet OSHA, ASHP, and ONS recommendations as chemotherapy-tested gowns that are considered appropriate personal protective equipment. But that's not what pharmacy personnel at the hospital were wearing.

We contacted a representative from Covidien, who told us the name ChemoPlus is a brand name and is not an indication of the level of protection against spills. As far as a catalog claim regarding them being made of "splash resistant" fabric, we were told that a chemotherapy drug splashed onto the gown should bead up and roll off; but if pressure is applied to the area, the drug will penetrate through the gown. But the pharmacist reporting the above exposure did not say pressure had been applied.

The company states that only the poly-coated gowns are impervious. We believe the name "ChemoPlus" may have misled this organization and others into thinking they were maximally protected when they were not. That is pretty serious. We know that at least some workers have been placed at risk but don't have any idea how many. During our investigation we contacted several cancer experts who work at cancer centers and none of them were aware of this issue with ChemoPlus gowns. One of our own nurses, who specialized in oncology, remembers wearing the unprotected gown herself, thinking that was all she needed to protect against exposure.

We have asked the company to give serious consideration to renaming their product and also to clarify in very noticeable type that the gown does not protect workers from chemotherapy exposures under many circumstances. Last week we warned healthcare workers using gowns from Covidien that they need to be sure the gowns are poly-coated to meet OSHA, ASHP, and ONS recommendations.   

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