Research of workplace contamination and occupational exposure of healthcare professionals to antineoplastic drugs
Authors:
L. Doležalová 1; P. Odráška 1,2,3; L. Gorná 1; J. Kuta 3; M. Oravec 3; M. Prudilová 1; R. Vejpustková 1; L. Bláha 2,3
Authors‘ workplace:
Ústavní lékárna, Masarykův onkologický ústav, Brno, vedoucí organizace prof. MUDr. Jiří Vorlíček, CSc.
1; Oddělení laboratorní medicíny, Masarykův onkologický ústav, Brno, doc. MUDr. Dalibor Valík, Ph. D.
2; RECETOX (Research Centre for Environmental Chemistry and Ecotoxicology)
Přírodovědecká fakulta, Masarykova univerzita, Brno, ředitel prof. RNDr. Ivan Holoubek, CSc.
3
Published in:
Pracov. Lék., 61, 2009, No. 3, s. 117-122.
Category:
Original Papers
Overview
The aim of this study was to investigate the occupational exposure of healthcare professionals to cytotoxic drugs. Our study focused on monitoring of surface contamination of preparation and administration working areas at Masaryk Memorial Cancer Institute, Brno. For this purpose, the most exposed working places were wiped and analyzed for the presence of cyclophosphamide, 5-fluorouracil and platinum containing drugs. Determination of cyclophosphamide was based on high performance liquid chromatography coupled with mass spectrometry (HPLC-MS) and platinum-containing compounds were analysed by inductively coupled plasma mass spectrometry (ICP-MS). Determination of 5-fluorouracil by high performance liquid chromatography with ultraviolet detection (HPLC-UV) showed poor selectivity and robustness. During the monitoring, 163 samples were collected and 130 of them (80%) were positive for at least one of the studied analytes. In total, 92 samples were positive for both cyclophosphamide and platinum together. Considering two types of the working areas monitored (preparation vs. administration departments), the contamination levels were found to be similar and generally comparable with the situation reported in other industrial countries. The study contributed to the identification of major sources of contamination and served as one of the primary impulses leading to better and safer management during handling cytotoxic drug.
Key words:
antineoplastic agents, cytotoxic drugs, occupational exposure, surface contamination
Sources
1. Occupational Safety & Health Administration: Method Evaluation Guidelines for Surface Sampling Methods, Salt Lake Technical Center, USA. Dostupné na www: http://www.osha.gov/dts/sltc/methods/surfacesampling/surfacesampling.html
2. BAKER, G. L., KAHL, L. E., ZEE, B. C., STOLZER, B. L., AGARWAL, A. K., MEDSGER, T. A. Malignancy Following Treatment of Rheumatoid-Arthritis with Cyclophosphamide – Long-Term Case-Control Follow-up-Study. Am. J. Med., 1987, 83, 1, s. 1–9.
3. CONNOR, T. H., ANDERSON, R. W., SESSINK, P. J. M., BROADFIELD, L., POWER, L. A. Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States. Am. J. Health. Syst. Pharm., 1999, 56, 14, s. 1427–1432.
4. CONNOR, T. H., SESSINK, P. J. M., HARRISON, B. R., PRETTY, J. R., PETERS, B. G., ALFARO, R. M., BILOS, A., BECKMANN, G., BING, M. R., ANDERSON, L. M., DECHRISTOFORO, R. Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: Results of three studies. Am. J. Health. Syst. Pharm., 2005, 62, 5, s. 475–484.
5. ČUPR, P., KOPTÍKOVÁ, J., ŠANTROCH, J., BARTOŠ, T., BEDNÁŘOVÁ, Z., MUŽÍK, J., HOLOUBEK, I., DUŠEK, L. Metodické možnosti hodnocení zdravotních rizik na populaŹní úrovni s využitím dostupných environmentálních a epidemiologických dat. Klinická onkologie, 2007, 20, 4, s. 190–196.
6. FLORIDIA, L., PIETROPAOLO, A. M., TAVAZZANI, M., RUBINO, F. M., COLOMBI, A. Measurement of surface contamination from nucleoside analogue antineoplastic drugs by high-performance liquid chromatography in occupational hygiene studies of oncologic hospital departments. Journal of Chromatography B, 1999, 724, 2, s. 325–334.
7. FRANSMAN, W., VERMEULEN, R., KROMHOUT, H. Occupational dermal exposure to cyclophosphamide in Dutch hospitals: A pilot study. Ann. Occup. Hyg., 2004, 48, 3, s. 237–244.
8. FRANSMAN, W., VERMEULEN, R., KROMHOUT, H. Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities. Int. Arch. Occup. Environ. Health., 2005, 78, 5, s. 403–412.
9. FUCHS, J., HENGSTLER, J. G., JUNG, D., HILTL, G., KONIETZKO, J., OESCH, F. DNA damage in nurses handling antineoplastic agents. Mutation Research/Genetic Toxicology, 1995, 342, 1–2, s. 17–23.
10. HEDMER, M., GEORGIADI, A., BREMBERG, E. R. M., JONSSON, B. A. G. Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden. Ann. Occup. Hyg., 2005, 49, 7, s. 629–637.
11. HEDMER, M., JONSSON, B. A. G., NYGREN, O. Development and validation of methods for environmental monitoring of cyclophosphamide in workplaces. Journal of Environmental Monitoring, 2004, 6, 12, s. 979–984.
12. HEMMINKI, K., KYYRONEN, P., LINDBOHM, M. L. Spontaneous-Abortions and Malformations in the Offspring of Nurses Exposed to Anesthetic-Gases, Cytostatic Drugs, and Other Potential Hazards in Hospitals, Based on Registered Information of Outcome. J. Epidemiol. Community Health, 1985, 39, 2, s. 141–147.
13. KIFFMEYER, T., KUBE, C., OPIOLKA, S., SCHMIDT, K. G., SCHOPPE, G. M. S. P. J. Vapour pressures, evaporation behaviour and airborne concentrations of hazardous drugs: implications for occupational safety. The Pharmaceutical Journal, 2002, 268, s. 331–337.
14. KROMHOUT, H., HOEK, F., UITTERHOEVE, R., HUIJBERS, R., OVERMARS, R. F., ANZION, R., VERMEULEN, R. Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Ann. Occup. Hyg., 2000, 44, 7, s. 551–560.
15. KRSTEV, S., PERUNICIC, B., VIDAKOVIC, A. Work practice and some adverse health effects in nurses handling antineoplastic drugs. Med. Lav., 2003, 94, 5, s. 432–439.
16. MASON, H. J., BLAIR, S., SAMS, C., JONES, K., GARFITT, S. J., CUSCHIERI, M. J., BAXTER, P. J. Exposure to antineoplastic drugs in two UK hospital pharmacy units. Ann. Occup. Hyg., 2005, 49, 7, s. 603–610.
17. MASON, H. J., MORTON, J., GARFITT, S. J., IQBAL, S., JONES, K. Cytotoxic drug contamination on the outside of vials delivered to a hospital pharmacy. Ann. Occup. Hyg., 2003, 47, 8, s. 681–685.
18. McDEVITT, J. J., LEES, P. S. J., MCDIARMID, M. A. Exposure of Hospital Pharmacists and Nurses to Antineoplastic Agents. J. Occup. Environ. Med., 1993, 35, 1, s. 57–60.
19. MICOLI, G., TURCI, R., ARPELLINI, M., MINOIA, C. Determination of 5-fluorouracil in environmental samples by solid-phase extraction and high-performance liquid chromatography with ultraviolet detection. Journal of Chromatography B, 2001, 750, 1, s. 25–32.
20. MINOIA, C., TURCI, R., SOTTANI, C., SCHIAVI, A., PERBELLINI, L., ANGELERI, S., DRAICCHIO, F., APOSTOLI, P. Application of high performance liquid chromatography tandem mass spectrometry in the environmental and biological monitoring of health care personnel occupationally exposed to cyclophosphamide and ifosfamide. Rapid Commun. Mass Spectrom., 1998, 12, 20, s. 1485–1493.
21. NYGREN, O., GUSTAVSSON, B., STROM, L., FRIBERG, A. Cisplatin contamination observed on the outside of drug vials. Ann. Occup. Hyg., 2002, 46, 6, s. 555–557.
22. SCHMAUS, G., SCHIERL, R., FUNCK, S. Monitoring surface contamination by antineoplastic drugs using gas chromatography-mass spectrometry and voltammetry. Am. J. Health. Syst. Pharm., 2002, 59, 10, s. 956–961.
23. SESSINK, P. J. M., BOER, K. A., SCHEEFHALS, A. P. H., ANZION, R. B. M., BOS, R.P. Occupational Exposure to Antineoplastic Agents at Several Departments in a Hospital - Environmental Contamination and Excretion of Cyclophosphamide and Ifosfamide in Urine of Exposed Workers. Int. Arch. Occup. Environ. Health, 1992, 64, 2, s. 105–112.
24. SESSINK, P. J. M., KROESE, E. D., VANKRANEN, H. J., BOS, R. P. Cancer Risk Assessment for Health-Care Workers Occupationally Exposed to Cyclophasphamide. Int. Arch. Occup. Environ. Health, 1995, 67, 5, s. 317–323.
25. SESSINK, P. J. M., TIMMERSMANS, J. L., ANZION, R. B. M., BOS, R. P. Assessment of Occupational Exposure of Pharmaceutical Plant Workers to 5-Fluorouracil – Determination of Alpha-Fluoro-Beta-Alanine in Urine. J. Occup. Environ. Med., 1994, 36, 1, s. 79–83.
26. SESSINK, P. J. M., VANDEKERKHOF, M. C. A., ANZION, R. B. M., NOORDHOEK, J., BOS, R. P. Environmental Contamination and Assessment of Exposure to Antineoplastic Agents by Determination of Cyclophosphamide in Urine of Exposed Pharmacy Technicians – Is Skin Absorption an Important Exposure Route. Arch. Environ. Health, 1994, 49, 3, s. 165–169.
27. URSINI, C. L., CAVALLO, D., COLOMBI, A., GIGLIO, M., MARINACCIO, A., IAVICOLI, S. Evaluation of early DNA damage in healthcare workers handling antineoplastic drugs. Int. Arch. Occup. Environ. Health, 2006, 80, 2, s. 134–140.
28. VANDENBROUCKE, J., ROBAYS, H. How to protect environment and employees against cytotoxic agents, the UZ Ghent experience. Journal of Oncology Pharmacy Practice, 2001, 6, 4, s. 146–152.
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Hygiene and epidemiology Hyperbaric medicine Occupational medicineArticle was published in
Occupational Medicine
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