I would like to express my appreciation to Cynthia Huff, MSN, RN, OCN®, CRNI, CNL, for her article on home safety education for oral chemotherapy in the February 2020 issue of the Clinical Journal of Oncology Nursing. I found it to be very comprehensive and informative, but I would like to address one point.
I would like to express my appreciation to Cynthia Huff, MSN, RN, OCN®, CRNI, CNL, for her article on home safety education for oral chemotherapy in the February 2020 issue of the Clinical Journal of Oncology Nursing (CJON). I found it to be very comprehensive and informative, but I would like to address one point.
The article consistently states to use nitrile gloves when preparing and administering oral chemotherapy. I think it should be emphasized that gloves used for this purpose should be chemotherapy tested and approved. In addition, they may be made from other materials, such as neoprene or latex. The main reason this crossed my mind is that my daughter is allergic to nitrile gloves. She works in health care and is also a student. She has to wear vinyl or latex gloves at work, and because nitrile gloves are the only type available, she also has to provide her own gloves for use at school. The statement to use chemotherapy-tested and -approved gloves changes the focus to the functionality of the glove rather than the specific material the glove is made from.
The Author Responds
Thank you for your letter regarding my article in the February 2020 issue of CJON. The purpose of the article was to introduce a home safety educational framework for healthcare providers to educate patients and caregivers on the safe handling of oral chemotherapy at home. You have brought up a valuable concern about potential dermal allergies to the nitrile gloves recommended by the experts (American Society for Testing and Materials, 2019). Chemotherapy-tested gloves may be a more inclusive term for gloves that can withstand the highly toxic nature of anticancer agents. At this time, no standardized approach exists to safeguard others from unintended hazardous drug exposure in the home setting. Patients and caregivers must be provided with practical risk mitigation strategies to reduce skin exposure. Quality nursing care is based on a comprehensive assessment and takes into account many issues when it comes to the treatment and safety of patients with cancer whose caregivers administer oral chemotherapy.
According to Landeck et al. (2015), nitrile and vinyl gloves have a significant impact in reducing allergic reactions to latex-containing rubber gloves. Nitrile gloves are made from acrylonitrile butadiene and contain no latex protein. However, although ideal for latex-sensitive individuals, they are not as flexible and may cause type IV hypersensitivity reactions, resulting in allergic contact dermatitis. Allergic contact dermatitis reactions occur when a substance triggers an immune response on the skin, causing a raised red rash and sometimes blistering. In some cases, the allergy is not necessarily to the nitrile copolymer but to other chemical substances in the glove that provide maximum protection for the wearer. Alternative glove choices are available that are hypoallergenic; however, they can be expensive and harder to locate in a community setting. Vinyl gloves are inferior in durability and permeability, as well as less protective of chemotherapy drugs compared to other glove materials. Caregivers may decide to use them for oral chemotherapy administration because they are convenient and less expensive.
About the Author(s)
Dena J. Elmore, RN, BSN, OCN®, is a charge nurse in outpatient infusion at the Good Samaritan Hospital in Vincennes, IN. The author takes full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships. Elmore can be reached at firstname.lastname@example.org, with copy to CJONEditor@ons.org. Cynthia Huff, MSN, RN, OCN®, CRNI, CNL, is an assistant unit manager at the Long Beach Medical Center in California. The author takes full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships. Huff can be reached at email@example.com, with copy to CJONEditor@ons.org.
American Society for Testing and Materials. (2019). ASTM D6978-05 standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs. https://www.astm.org/Standards/D6978.htm
Huff, C. (2020). Oral chemotherapy: A home safety educational framework for healthcare providers, patients, and caregivers. Clinical Journal of Oncology Nursing, 24(1), 22–30. https://doi.org/10.1188/20.CJON.22-30
Landeck, L., Gonzalez, E., & Koch, O.M. (2015). Handling chemotherapy drugs—Do medical gloves really protect? International Journal of Cancer, 137(8), 1800–1805. https://doi.org/10.1002/ijc.29058