Current practice and perceptions of safety protocols for the use of intraperitoneal chemotherapy in the operating room: results of the IP-OR international survey

Abstract

Objectives To assess the risk perception and the uptake of measures preventing environment-related risks in the operating room (OR) during hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC). Methods A multicentric, international survey among OR teams in high-volume HIPEC and PIPAC centers: Surgeons (Surg), Scrub nurses (ScrubN), Anesthesiologists (Anest), Anesthesiology nurses (AnesthN), and OR Cleaning staff (CleanS). Scores extended from 0–10 (maximum). Results Ten centers in six countries participated in the study (response rate 100%). Two hundred and eleven responses from 68 Surg (32%), 49 ScrubN (23%), 45 Anest (21%), 31 AnesthN (15%), and 18 CleanS (9%) were gathered. Individual uptake of protection measures was 51.4%, similar among professions and between HIPEC and PIPAC. Perceived levels of protection were 7.57 vs. 7.17 for PIPAC and HIPEC, respectively (p<0.05), with Anesth scoring the lowest (6.81). Perceived contamination risk was 4.19 for HIPEC vs. 3.5 for PIPAC (p<0.01). Information level was lower for CleanS and Anesth for HIPEC and PIPAC procedures compared to all other responders (6.48 vs. 4.86, and 6.48 vs. 5.67, p<0.01). Willingness to obtain more information was 86%, the highest among CleanS (94%). Conclusions Experience with the current practice of safety protocols was similar during HIPEC and PIPAC. The individual uptake of protection measures was rather low. The safety perception was better for PIPAC, but the perceived level of protection remained relatively low. The willingness to obtain more information was high. Intensified, standardized training of all OR team members involved in HIPEC and PIPAC is meaningful.

Consensus statement on safety measures for pressurized intraperitoneal aerosol chemotherapy

“…Several studies examined gloves, hands, devices, injectors, trocars, and floor wiping samples for platin traces and reported highly variable contamination levels [ 6 , 8 , 9 ]. Differences in current practices regarding the PPE required for performing PIPAC have been observed among expert centers [ 18 ]. In this Delphi study, there was a large consensus for the PPE needed to perform PIPAC safely.…”

“…Availability of emergency kits in case of accidental exposure was unknown for 50% of responders. Most OR team members seek supplementary information about the risks related to CA administration [ 18 ]. Another recent study demonstrated that nonmedical caregivers in the OR are aware of the occupational hazards related to the use of CA.…”

“…The present study methodology consisted of a two-round Delphi consensus process and was developed in agreement with current standards for developing consensus guidelines [ 20 ]. The project was initiated in early 2020 following two surveys on current PIPAC safety practices and perception [ 18 , 19 ]. The study was performed under the precepts established by the Declaration of Helsinki.…”

“…Participation in an International Society for the Study of Pleura and Peritoneum (ISSPP) PIPAC training course is required for technology access, and the safety protocols are an essential component of this course [ 17 ]. However, a recent survey amongst PIPAC expert centers worldwide showed variable adherence to protective measures [ 18 ]. For example, many PIPAC centers now recommend using filtering facepiece (FFP)-2 masks, which were not originally considered necessary by the DEKRA organization.…”

Evaluation of the environmental contamination and exposure risk in medical/non-medical staff after oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy

“…However, to our knowledge, no study measured the platinum concentration in both blood and urine samples. Moreover, despite this encouraging preliminary evidence and the rigorous safety protocol put in place for the medical (Alyami et al, 2020) and non-medical staff (Al Hosni et al, 2020), the use of PIPAC, and also of other types of intraperitoneal chemotherapy procedures, such as hyperthermic intraperitoneal chemotherapy, is still considered as an occupational hazard and requires continuous updating and education (Al Hosni et al, 2020;Clerc D et al, 2021).…”