Oncology Nurses Survey

On a scale of 1-5, with 1 = not concerned and 5 = very concerned, how would you rate your concern about what comes out of a hospital toilet? 

Results: 90% of the nurses rated their level of concern either 4 or 5.

Discussion: For nurses at the bedside, this is indeed an important
safety issue.

How often do you use a plastic-backed pad to cover the toilet before flushing?

Results: Approximately half of the nurses never or almost never use a plastic-backed pad. 

Discussion: Some of the most frequent comments for this question included, “They’re not always available” and “They get sucked into the toilet so I stopped using them.” Research into the use of Personal Protective Equipment (PPE) for hazardous drug administration has shown that when not readily available, nurses aren’t able to take the time to bring supplies back to where it is needed. This appears to be true with the plastic-backed pads. While there is little research on pads being sucked into the toilet, recent laboratory testing confirmed the “Titanic Effect,” whereby the siphonic action of water exiting the bottom of the toilet bowl creates temporary negative pressure which pulls the pad into the water.

How often do you use a respirator when flushing a toilet?

Results: 13% indicated they wore a respirator.

Discussion: The 13% was likely skewed by the COVID-19 pandemic, as N95 availability (with required fit testing) was extremely rare in hospitals prior to the outbreak. It remains to be determined whether respirator usage will increase or decline.

Which of the following are you concerned about when you flush a hospital toilet? (percentages exceed 100% as participants could choose multiple responses).

Results: 70% were concerned about hazardous drug safety. 

Discussion: This is the very reason that the ONS guidelines recommend covering the toilet with a plastic-backed pad. More than half the nurses were also concerned about environment contamination, knowing that even wearing PPE doesn’t stop toilet plume aerosols from contaminating the surfaces in the bathroom and patient room.

Are you aware of data showing bioaerosols can travel outside of the bathroom?

Results: 56% indicated they were aware.

Discussion: More than half of the surveyed nurses know about the risks of bioaerosols but exposure to bacteria and viruses were rated as much less of a concern (36 and 25% respectively) in question 4.  Hazardous drug safety has been given more emphasis than bioaerosol in oncology nursing.