1
|
Ladeira C, Møller P, Giovannelli L, Gajski G, Haveric A, Bankoglu EE, Azqueta A, Gerić M, Stopper H, Cabêda J, Tonin FS, Collins A. The Comet Assay as a Tool in Human Biomonitoring Studies of Environmental and Occupational Exposure to Chemicals-A Systematic Scoping Review. TOXICS 2024; 12:270. [PMID: 38668493 PMCID: PMC11054096 DOI: 10.3390/toxics12040270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
Biomonitoring of human populations exposed to chemical substances that can act as potential mutagens or carcinogens, may enable the detection of damage and early disease prevention. In recent years, the comet assay has become an important tool for assessing DNA damage, both in environmental and occupational exposure contexts. To evidence the role of the comet assay in human biomonitoring, we have analysed original research studies of environmental or occupational exposure that used the comet assay in their assessments, following the PRISMA-ScR method (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews). Groups of chemicals were designated according to a broad classification, and the results obtained from over 300 original studies (n = 123 on air pollutants, n = 14 on anaesthetics, n = 18 on antineoplastic drugs, n = 57 on heavy metals, n = 59 on pesticides, and n = 49 on solvents) showed overall higher values of DNA strand breaks in the exposed subjects in comparison with the unexposed. In summary, our systematic scoping review strengthens the relevance of the use of the comet assay in assessing DNA damage in human biomonitoring studies.
Collapse
Affiliation(s)
- Carina Ladeira
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - Peter Møller
- Department of Public Health, Section of Environmental Health, University of Copenhagen, 1172 Copenhagen, Denmark;
| | - Lisa Giovannelli
- Department NEUROFARBA, Section Pharmacology and Toxicology, University of Florence, 50121 Florence, Italy;
| | - Goran Gajski
- Division of Toxicology, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (G.G.); (M.G.)
| | - Anja Haveric
- Institute for Genetic Engineering and Biotechnology, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Ezgi Eyluel Bankoglu
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany; (E.E.B.); (H.S.)
| | - Amaya Azqueta
- Department of Pharmaceutical Sciences, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain;
| | - Marko Gerić
- Division of Toxicology, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (G.G.); (M.G.)
| | - Helga Stopper
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany; (E.E.B.); (H.S.)
| | - José Cabêda
- Guarda Nacional Republicana, Destacamento Territorial de Vila Franca de Xira, Núcleo de Proteção Ambiental, 1500-124 Lisbon, Portugal;
| | - Fernanda S. Tonin
- Pharmaceutical Care Research Group, Universidad de Granada, 18012 Granada, Spain;
| | - Andrew Collins
- Department of Nutrition, University of Oslo, 0316 Oslo, Norway;
| |
Collapse
|
2
|
Vanneste D, Verscheure E, Srinivasan AN, Godderis L, Ghosh M. Systematic review of genotoxicity induced by occupational exposure to antineoplastic drugs. Arch Toxicol 2023; 97:1453-1517. [PMID: 37099053 DOI: 10.1007/s00204-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 04/27/2023]
Abstract
With increasing numbers of cancer cases, the use of antineoplastic agents is expected to rise. This will be accompanied by an increase in occupational exposure, which can cause unwanted health effects in workers. Our aim was to give an overview of genotoxic and epigenetic effects after occupational exposure to antineoplastic agents and to assess the concentration-effect relation. Four databases were searched for papers investigating genotoxic and/or epigenetic effects of occupational exposure to antineoplastic agents. Out of the 245 retrieved papers, 62 were included in this review. In this systematic literature review, we confirmed that exposure of healthcare workers to antineoplastic agents can lead to genotoxic damage. However, we observed a lack of data on exposure as well as genotoxic and epigenetic effects in workers other than healthcare workers. Furthermore, gaps in the current knowledge regarding the potential epigenetic effects caused by antineoplastic drug exposure and regarding the link between internal antineoplastic drug concentration and genotoxic and epigenetic effects after occupational exposure to antineoplastic agents were identified, offering a first step for future research.
Collapse
Affiliation(s)
- Dorian Vanneste
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Eline Verscheure
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Adhithya Narayanan Srinivasan
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Lode Godderis
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Manosij Ghosh
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium.
| |
Collapse
|
3
|
Murahashi T, Suzuki A, Motojima S, Higuchi T. [Occupational Exposure of Pharmacists to Drugs during the Preparation of Powder Drugs in Dispensing Pharmacies]. YAKUGAKU ZASSHI 2021; 141:1109-1116. [PMID: 34471011 DOI: 10.1248/yakushi.21-00099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Occupational exposure of pharmacists to drugs during powder drug preparation in dispensing pharmacies was investigated. First, we determined frequently prescribed tipepidine hibenzate and ambroxol hydrochloride suspended in the air of the dispensing room. The median concentration of the drugs in the air was 0.01 μg/m3 and 0.02 μg/m3, respectively; these values indicate that the air in the dispensing room was contaminated with powder drug. To estimate drug exposure during powder drug preparation, drug dust was collected near the nose of workers. Analysis of the active ingredients of the drugs used in the preparation revealed that eight drugs, including bethanechol, l-carbocisteine, and zonisamide, were detected in the range of 1.5-1220 μg/m3. Assuming that the respiratory volume of an adult was 0.008 m3/min, it was estimated that 0.4-36 μg of the ingredients were exposed per prescription by multiplying concentration, respiratory volume and sampling time (3-5 min). Furthermore, the effect of wearing a medical mask on the drug powder exposure was evaluated using a self-made apparatus. When the amount of drug powder collected on filters that is either covered with or without a medical mask was compared, the covered filter exhibited reduced drug powder accumulation to less than 10% the amount collected on the uncovered filter. The present data suggested that a medical mask might decrease the drug dust allergies in dispensing pharmacists.
Collapse
|
4
|
Gianfredi V, Nucci D, Fatigoni C, Salvatori T, Villarini M, Moretti M. Extent of Primary DNA Damage Measured by the Comet Assay in Health Professionals Exposed to Antineoplastic Drugs: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E523. [PMID: 31947621 PMCID: PMC7013773 DOI: 10.3390/ijerph17020523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Antineoplastic drugs (ANDs) are a broad group of chemicals showing, at the same time, carcinogenic effects. The potential, albeit true, risk of side effects cannot be accepted, especially if resulting from occupational exposure. The aim of this study was to evaluate the association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. METHODS A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/Medline, Web of Science, and Scopus were used to perform the literature search. The databases were examined in July 2019. Sub-group, moderator, and cumulative analyses were conducted. The trim and fill method was used in the case of potential publication bias. RESULTS Twenty studies were included in the qualitative analysis, and 19 in quantitative evaluation. The pooled effect size was 1.27 [(95% confidence interval (CI) = 0.66-1.88), p = 0.000] based on 1569 subjects. The moderator analysis by duration of exposure showed a positive association between duration of exposure and primary DNA damage. CONCLUSIONS This systematic review clearly shows a significant association between occupational exposure to ANDs and the extent of primary DNA damage in health professionals. Considering these results, health professionals should be warned against this potential occupational risk.
Collapse
Affiliation(s)
- Vincenza Gianfredi
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
- Post Graduate School of Hygiene and Preventive Medicine, Department of Experimental Medicine, University of Perugia, Piazzale Gambuli, 06122 Perugia, Italy
| | - Daniele Nucci
- Digestive Endoscopy Unit, IRCCS Istituto Oncologico Veneto, Via Gattamelata 64, 35128 Padova, Italy;
| | - Cristina Fatigoni
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Tania Salvatori
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Milena Villarini
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| | - Massimo Moretti
- Department of Pharmaceutical Sciences (Unit of Public Health), University of Perugia, Via del Giochetto, 06122 Perugia, Italy; (C.F.); (T.S.); (M.V.)
| |
Collapse
|
5
|
Ramazani M, Jaktaji RP, Shirazi FH, Tavakoli-Ardakani M, Salimi A, Pourahmad J. Analysis of apoptosis related genes in nurses exposed to anti-neoplastic drugs. BMC Pharmacol Toxicol 2019; 20:74. [PMID: 31791417 PMCID: PMC6889625 DOI: 10.1186/s40360-019-0372-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-neoplastic agents are widely used in the treatment of cancer and some non-neoplastic diseases. These drugs have been proved to be carcinogens, teratogens, and mutagens. Concern exists regarding the possible dangers of the staff handling anti-cancer drugs. The long-term exposure of nurses to anti-neoplastic drugs is still a controversial issue. The purpose of this study was to monitor cellular toxicity parameters and gene expression in nurses who work in chemotherapy wards and compare them to nurses who work in other wards. METHODS To analyze the apoptosis-related genes overexpression and cytotoxicity effects, peripheral blood lymphocytes obtained from oncology nurses and the control group. THE RESULTS Significant alterations in four analyzed apoptosis-related genes were observed in oncology nurses. In most individual samples being excavated, Bcl-2 overexpression is superior to that of Bax. Prominent P53 and Hif-1α up-regulation were observed in oncology nurses. Moreover, all cytotoxicity parameters (cell viability, ROS formation, MMP collapse, Lysosomal membrane damage, Lipid peroxidation, Caspase 3 activity and Apoptosis phenotype) in exposed oncology nurses were significantly (p < 0.001) higher than those of unexposed control nurses. Up-regulation of three analyzed apoptosis-related genes were observed in nurses occupationally exposed to anti-cancer drugs. CONCLUSION Our data show that oxidative stress and mitochondrial toxicity induced by anti-neoplastic drugs lead to overexpression of apoptosis-related genes in oncology nurses.
Collapse
Affiliation(s)
- Maral Ramazani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Farshad H Shirazi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maria Tavakoli-Ardakani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Salimi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Jalal Pourahmad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Gajski G, Ladeira C, Gerić M, Garaj-Vrhovac V, Viegas S. Genotoxicity assessment of a selected cytostatic drug mixture in human lymphocytes: A study based on concentrations relevant for occupational exposure. ENVIRONMENTAL RESEARCH 2018; 161:26-34. [PMID: 29100207 DOI: 10.1016/j.envres.2017.10.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
Cytostatic drugs are highly cytotoxic agents used in cancer treatment and although their benefit is unquestionable, they have been recognized as hazardous to healthcare professionals in occupational settings. In a working environment, simultaneous exposure to cytostatics may occur creating a higher risk than that of a single substance. Hence, the present study evaluated the combined cyto/genotoxicity of a mixture of selected cytostatics with different mechanisms of action (MoA; 5-fluorouracil, cyclophosphamide and paclitaxel) towards human lymphocytes in vitro at a concentration range relevant for occupational as well as environmental exposure. The results suggest that the selected cytostatic drug mixture is potentially cyto/genotoxic and that it can induce cell and genome damage even at low concentrations. This indicates not only that such mixture may pose a risk to cell and genome integrity, but also that single compound toxicity data are not sufficient for the prediction of toxicity in a complex working environment. The presence of drugs in different amounts and with different MoA suggests the need to study the relationship between the presence of genotoxic components in the mixture and the resulting effects, taking into account the MoA of each component by itself. Therefore, this study provides new data sets necessary for scientifically-based risk assessments of cytostatic drug mixtures in occupational as well as environmental settings.
Collapse
Affiliation(s)
- Goran Gajski
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Carina Ladeira
- Grupo de Investigação em Ambiente e Saúde, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal; Grupo de Investigação em Genética e Metabolismo, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal.
| | - Marko Gerić
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Vera Garaj-Vrhovac
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia.
| | - Susana Viegas
- Grupo de Investigação em Ambiente e Saúde, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal.
| |
Collapse
|
7
|
Lepage N, Canal-Raffin M, Villa A. Propositions pour la mise en œuvre d’une surveillance biologique de l’exposition professionnelle aux médicaments anticancéreux. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2017. [DOI: 10.1016/j.toxac.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Advanced Approaches to Model Xenobiotic Metabolism in Bacterial Genotoxicology In Vitro. ADVANCES IN BIOCHEMICAL ENGINEERING/BIOTECHNOLOGY 2017. [PMID: 27619490 DOI: 10.1007/10_2016_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
During the past 30 years there has been considerable progress in the development of bacterial test systems for use in genotoxicity testing by the stable introduction of expression vectors (cDNAs) coding for xenobiotic-metabolizing enzymes into bacterial cells. The development not only provides insights into the mechanisms of bioactivation of xenobiotic compounds but also evaluates the roles of enzymes involved in metabolic activation or inactivation in chemical carcinogenesis. This review describes recent advances in bacterial genotoxicity assays and their future prospects, with a focus on the development and application of genetically engineering bacterial cells to incorporate some of the enzymatic activities involved in the bio-activation process of xenobiotics. Various genes have been introduced into bacterial umu tester strains encoding enzymes for genotoxic bioactivation, including bacterial nitroreductase and O-acetyltransferase, human cytochrome P450 monooxygenases, rat glutathione S-transferases, and human N-acetyltransferases and sulfotransferases. Their application has provided new tools for genotoxicity assays and for studying the role of biotransformation in chemical carcinogenesis in humans.
Collapse
|
9
|
Abstract
The inherent toxicity of antineoplastic drugs used for the treatment of cancer makes them harmful to healthy cells as well as to cancer cells. Nurses who prepare and/or administer the agents potentially are exposed to the drugs and their negative effects. Knowledge about these drugs and the precautions aimed at reducing exposure are essential aspects of infusion nursing practice. This article briefly reviews the mechanisms of action of common antineoplastic drugs, the adverse outcomes associated with exposure, the potential for occupational exposure from preparation and administration, and recommended strategies for minimizing occupational exposure.
Collapse
|
10
|
Gajski G, Gerić M, Domijan AM, Garaj-Vrhovac V. Combined cyto/genotoxic activity of a selected antineoplastic drug mixture in human circulating blood cells. CHEMOSPHERE 2016; 165:529-538. [PMID: 27681109 DOI: 10.1016/j.chemosphere.2016.09.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 06/06/2023]
Abstract
Antineoplastic drugs are highly cytotoxic chemotherapeutic agents that can often interfere directly or indirectly with the cell's genome. In an environmental or medical setting simultaneous exposure may occur. Such multiple exposures may pose a higher risk than it could be assumed from the studies evaluating the effect of a single substance. Therefore, in the present study we tested the combined cyto/genotoxicity of a mixture of selected antineoplastic drugs with different mechanisms of action (5-fluorouracil, etoposide, and imatinib mesylate) towards human lymphocytes in vitro. The results suggest that the selected antineoplastic drug mixture is potentially cyto/genotoxic and that it can induce cell and genome damage even at low concentrations. Moreover, the changes in the measured oxidative stress parameters suggest the participation of reactive oxygen species in the cyto/genotoxicity of the selected mixture. The obtained results indicate not only that such mixtures may pose a risk to cell and genome integrity, but also that single compound toxicity data are not sufficient for the predicting toxicity in a complex environment. Altogether, the results emphasise the need for further toxicological screening of antineoplastic drug mixtures, especially at low environmentally relevant concentrations, as to avoid any possible adverse effects on the environment and human health.
Collapse
Affiliation(s)
- Goran Gajski
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
| | - Marko Gerić
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
| | - Ana-Marija Domijan
- University of Zagreb, Faculty of Pharmacy and Biochemistry, A. Kovačića 1, 10000 Zagreb, Croatia.
| | - Vera Garaj-Vrhovac
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Ksaverska cesta 2, 10000 Zagreb, Croatia.
| |
Collapse
|
11
|
Sasaki M, Ishii N, Kikuchi Y, Kudoh Y, Sugiyama R, Hasebe M. [Occupational exposures among nurses caring for chemotherapy patients -Quantitative analysis of cyclophosphamide and α-fluoro-β-alanine in urine]. SANGYO EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2016; 58:164-172. [PMID: 27488511 DOI: 10.1539/sangyoeisei.2016-005-e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The aim of this study was to measure the antineoplastic drug content in urine and verify the situation of occupational exposure of the antineoplastic drug among nurses who care for patients undergoing chemotherapy. METHODS Ten female nurses who were caring for patients receiving chemotherapy were the subjects of this study. Urine samples were collected over 24-hour periods, and each sample was analyzed. The excretion of cyclophosphamide (CP) and α-fluoro-β-alanine (FBAL) were measured in the urine of the 10 nurses. CP and FBAL were detected separately using gas chromatography tandem mass spectrometry (GC-MSMS) methods (Exposure Control, the Netherlands). RESULT CP was detected in 24 urine samples of 9 nurses. The total amount of CP excreted ranged from 5.4 to 44.2 ng/24-hours. The mean amount of CP excreted per nurse was 16.8 ng/24-hours. No significant difference was observed between the hospital I and II. FBAL was not detected in any of the urine samples. CP was detected in the urine of the nurses prior to their work shift. Moreover, CP was detected in the urine of the nurses who were not caring for patients in the intravenous drip of CP. There was most what answered that there was hair loss in health condition. CONCLUSION The results reveal that almost all nurses were exposed to cyclophosphamide. Even when the patient in the intravenous drip of CP was not being cared for, it became clear that exposure by CP existed. As the route of the exposure to CP, the inhalation or dermal absorption can be considered. To ensure minimum exposed to antineoplastic drugs, suitable personal protective equipment needs to be equipped also of various scenes of caring for chemotherapy patients. Moreover, it is important to keep an eye on the monitoring of the antineoplastic drug in the environment and a nurse's health condition periodically going forward.
Collapse
|
12
|
Zare Sakhvidi MJ, Hajaghazadeh M, Mostaghaci M, Mehrparvar AH, Zare Sakhvidi F, Naghshineh E. Applicability of the comet assay in evaluation of DNA damage in healthcare providers' working with antineoplastic drugs: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:52-67. [PMID: 27110842 DOI: 10.1080/10773525.2015.1123380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unintended occupational exposure to antineoplastic drugs (ANDs) may occur in medical personnel. Some ANDs are known human carcinogens and exposure can be monitored by genotoxic biomarkers. OBJECTIVE To evaluate the obstacles to obtaining conclusive results from a comet assay test to determine DNA damage among AND exposed healthcare workers. METHODS We systematically reviewed studies that used alkaline comet assay to determine the magnitude and significance of DNA damage among health care workers with potential AND exposure. Fifteen studies were eligible for review and 14 studies were used in the meta-analysis. RESULTS Under random effect assumption, the estimated standardized mean difference (SMD) in the DNA damage of health care workers was 1.93 (95% CI: 1.15-2.71, p < 0.0001). The resulting SMD was reduced to 1.756 (95% CI: 0.992-2.52, p < 0.0001) when the analysis only included nurses. In subgroup analyses based on gender and smoking, heterogeneity was observed. Only for studies reporting comet moment, I2 test results, as a measure of heterogeneity, dropped to zero. Heterogeneity analysis showed that date of study publication was a possible source of heterogeneity (B = -0.14; p < 0.0001). CONCLUSIONS A mixture of personal parameters, comet assay methodological variables, and exposure characteristics may be responsible for heterogenic data from comet assay studies and interfere with obtaining conclusive results. Lack of quantitative environmental exposure measures and variation in comet assay protocols across studies are important obstacles in generalization of results.
Collapse
Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- a Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Mohammad Hajaghazadeh
- b Faculty of Health, Department of Occupational Health , Urmia University of Medical Sciences , Urmia , Iran
| | - Mehrdad Mostaghaci
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Amir Houshang Mehrparvar
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Fariba Zare Sakhvidi
- d Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Elham Naghshineh
- e Faculty of Medicine, Department of Obstetrics/Gynecology, Isfahan University of Medical Sciences , Isfahan , Iran
| |
Collapse
|
13
|
Zhang X, Zheng Q, Lv Y, An M, Zhang Y, Wei Y, Feng W. Evaluation of adverse health risks associated with antineoplastic drug exposure in nurses at two Chinese hospitals: The effects of implementing a pharmacy intravenous admixture service. Am J Ind Med 2016; 59:264-73. [PMID: 26898889 DOI: 10.1002/ajim.22553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the health risks of antineoplastic drugs (ADs) occupational exposure in nurses and to evaluate the effects of implementing a pharmacy intravenous admixture service (PIVAS) in two Chinese hospitals. METHODS The laboratory findings were collected from annual staff physical examination data. Reproductive toxicity and clinical manifestations were self-reported via a questionnaire. RESULTS Hematotoxicity, organ damage, reproductive toxicity, and clinical manifestations associated with AD exposure were markedly higher in oncology nurses than unexposed nurses. Application of PIVAS led to a significant restoration of the blood cell counts and kidney function, and a reduction in adverse reproductive outcomes among oncology nurses. Pronounced symptoms related to AD exposure were alleviated as well. CONCLUSION Oncology nurses who work with AD's experienced more adverse health outcomes than unexposed nurses. The health risks to AD were significantly alleviated by implementing a pharmacy intravenous admixture service.
Collapse
Affiliation(s)
- Xiaoxia Zhang
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Qiaowei Zheng
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Yun Lv
- Shaanxi Province Oncology Hospital; Xi'an China
| | - Mengna An
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Yating Zhang
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Youxia Wei
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Weiyi Feng
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| |
Collapse
|
14
|
Böhlandt A, Groeneveld S, Fischer E, Schierl R. Cleaning Efficiencies of Three Cleaning Agents on Four Different Surfaces after Contamination by Gemcitabine and 5-fluorouracile. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:384-392. [PMID: 25751496 DOI: 10.1080/15459624.2015.1009985] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Occupational exposure to antineoplastic drugs has been documented for decades showing widespread contamination in preparation and administration areas. Apart from preventive measures, efficient cleaning of surfaces is indispensable to minimize the exposure risk. The aim of this study was to evaluate the efficiency of three cleaning agents after intentional contamination by gemcitabine (GEM) and 5-fluorouracile (5-FU) on four different surface types usually installed in healthcare settings. Glass, stainless steel, polyvinylchloride (PVC), and laminated wood plates were contaminated with 20 ng/μl GEM and 2 ng/μl 5-FU solutions. Wipe samples were analyzed for drug residues after cleaning with a) distilled water, b) aqueous solution containing sodium dodecyl sulfate (10 mM) and 2-propanol (SDS-2P), and c) Incides N (pre-soaked) alcoholic wipes. Quantification was performed by high-performance liquid chromatography (HPLC) for GEM and gas chromato-graphy-tandem mass spectrometry (GCMS/MS) for 5-FU. Recovery was determined and cleaning efficiency was calculated for each scenario. Mean recoveries were 77-89% for GEM and 24-77% for 5-FU and calculated cleaning efficiencies ranged between 95 and 100% and 89 and 100%, respectively. Residual drug amounts were detected in the range nd (not detected) - 84 ng GEM/sample and nd - 6.6 ng 5-FU/sample depending on surface type and cleaning agent. Distilled water and SDS-2P had better decontamination outcomes than Incides N wipes on nearly all surface types, especially for GEM. Regarding 5-FU, the overall cleaning efficiency was lower with highest residues on laminated wood surfaces. The tested cleaning procedures are shown to clean glass, stainless steel, PVC, and laminated wood with an efficiency of 89-100% after contamination with GEM and 5-FU. Nevertheless, drug residues could be verified by wipe samples. Pure distilled water and SDS in an alcoholic-aqueous solution expressed an efficient cleaning performance, especially with respect to GEM. The study results demonstrate the need to adapt cleaning procedures to the variety of drugs and surface types to develop effective decontamination strategies.
Collapse
Affiliation(s)
- Antje Böhlandt
- a Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Clinical Center , Ludwig Maximilians University , Munich , Germany
| | | | | | | |
Collapse
|
15
|
Ladeira C, Viegas S, Pádua M, Gomes M, Carolino E, Gomes MC, Brito M. Assessment of genotoxic effects in nurses handling cytostatic drugs. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2014; 77:879-87. [PMID: 25072720 DOI: 10.1080/15287394.2014.910158] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Several antineoplastic drugs have been classified as carcinogens by the International Agency for Research on Cancer (IARC) on the basis of epidemiological findings, animal carcinogenicity data, and outcomes of in vitro genotoxicity studies. 5-Fluorouracil (5-FU), which is easily absorbed through the skin, is the most frequently used antineoplastic agent in Portuguese hospitals and therefore may be used as an indicator of surface contamination. The aims of the present investigation were to (1) examine surface contamination by 5-FU and (2) assess the genotoxic risk using cytokinesis-block micronucleus assay in nurses from two Portuguese hospitals. The study consisted of 2 groups: 27 nurses occupationally exposed to cytostatic agents (cases) and 111 unexposed individuals (controls). Peripheral blood lymphocytes (PBL) were collected in order to measure micronuclei (MN) in both groups. Hospital B showed a higher numerical level of contamination but not significantly different from Hospital A. However; Hospital A presented the highest value of contamination and also a higher proportion of contaminated samples. The mean frequency of MN was significantly higher in exposed workers compared with controls. No significant differences were found among MN levels between the two hospitals. The analysis of confounding factors showed that age is a significant variable in MN frequency occurrence. Data suggest that there is a potential genotoxic damage related to occupational exposure to cytostatic drugs in oncology nurses.
Collapse
Affiliation(s)
- C Ladeira
- a Escola Superior de Tecnologia da Saúde de Lisboa , Instituto Politécnico de Lisboa , Lisbon , Portugal
| | | | | | | | | | | | | |
Collapse
|
16
|
Odraska P, Dolezalova L, Kuta J, Oravec M, Piler P, Synek S, Blaha L. Association of surface contamination by antineoplastic drugs with different working conditions in hospital pharmacies. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2014; 69:148-158. [PMID: 24325745 DOI: 10.1080/19338244.2013.763757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study investigates the surface contamination levels of cyclophosphamide and platinum (a marker of platinum-containing drugs) in storage and preparation areas of hospital pharmacies and their relationship to working conditions surveyed by questionnaire. In total, 259 wipe samples were collected in 13 hospital pharmacies over 4 sampling campaigns. After sample extraction with acetate buffer, cyclophosphamide and platinum were determined using high-performance liquid chromatography-tandem mass spectroscopy (HPLC-MS/MS) and inductively coupled plasma mass spectrometry (ICP-MS). Depending on the sampling spot and campaign, median concentrations ranged from <2 to 61 pg/cm(2) and from <0.2 to 6.9 pg/cm(2) for cyclophosphamide and platinum, respectively. Statistical evaluation of monitoring data revealed that the contamination level was significantly influenced by laboratory throughput (expressed as number of chemotherapies prepared per week), personnel expertise (ie, participation of pharmacists with academic education in drug admixture activities), and surface material.
Collapse
Affiliation(s)
- Pavel Odraska
- a Masaryk Memorial Cancer Institute , Brno , Czech Republic
| | | | | | | | | | | | | |
Collapse
|
17
|
Miyake T, Iwamoto T, Tanimura M, Okuda M. Impact of closed-system drug transfer device on exposure of environment and healthcare provider to cyclophosphamide in Japanese hospital. SPRINGERPLUS 2013; 2:273. [PMID: 23853750 PMCID: PMC3698436 DOI: 10.1186/2193-1801-2-273] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 06/12/2013] [Indexed: 11/10/2022]
Abstract
In spite of current recommended safe handling procedures, the potential for the exposure of healthcare providers to hazardous drugs exists in the workplace. A reliance on biological safety cabinets to provide total protection against the exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimize cytotoxic drug exposure in healthcare providers. This study was conducted to compare surface contamination and personnel exposure to cyclophosphamide before and after the implementation of a closed-system drug transfer device, PhaSeal, under the influence of cleaning according to the Japanese guidelines. Personnel exposure was evaluated by collecting 24 h urine samples from 4 pharmacists. Surface contamination was assessed by the wiping test. Four of 6 wipe samples collected before PhaSeal indicated a detectable level of cyclophosphamide. About 7 months after the initiation of PhaSeal, only one of 6 wipe samples indicated a detectable level of cyclophosphamide. Although all 4 employees who provided urine samples had positive results for the urinary excretion of cyclophosphamide before PhaSeal, these levels returned to minimal levels in 2 pharmacists after PhaSeal. In combination with the biological safety cabinet and cleaning according to the Japanese guidelines, PhaSeal further reduces surface contamination and healthcare providers exposure to cyclophosphamide to almost undetectable levels.
Collapse
Affiliation(s)
- Tomohiro Miyake
- />Department of Pharmacy, Ise Red Cross Hospital, Mie, Japan
- />Department of Clinical Pharmacy and Biopharmaceutics, Mie University Graduate School of Medicine, Mie, Japan
| | - Takuya Iwamoto
- />Department of Clinical Pharmacy and Biopharmaceutics, Mie University Graduate School of Medicine, Mie, Japan
- />Department of Pharmacy, Mie University Hospital, Mie, Japan
| | - Manabu Tanimura
- />Department of Pharmacy, Ise Red Cross Hospital, Mie, Japan
| | - Masahiro Okuda
- />Department of Clinical Pharmacy and Biopharmaceutics, Mie University Graduate School of Medicine, Mie, Japan
- />Department of Pharmacy, Mie University Hospital, Mie, Japan
| |
Collapse
|
18
|
Buschini A, Villarini M, Feretti D, Mussi F, Dominici L, Zerbini I, Moretti M, Ceretti E, Bonfiglioli R, Carrieri M, Gelatti U, Rossi C, Monarca S, Poli P. Multicentre study for the evaluation of mutagenic/carcinogenic risk in nurses exposed to antineoplastic drugs: assessment of DNA damage. Occup Environ Med 2013; 70:789-94. [PMID: 24143019 DOI: 10.1136/oemed-2013-101475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES People who handle antineoplastic drugs, many of which classified as human carcinogens by International Agency for Research on Cancer, are exposed to low doses in comparison with patients; however, the long duration of exposure could lead to health effects. The aim of this work was to evaluate DNA damage in white blood cells from 63 nurses who handle antineoplastic drugs in five Italian hospitals and 74 control participants, using different versions of the Comet assay. METHODS Primary DNA damage was assessed by using the alkaline version of the assay on leucocytes, whereas to detect DNA oxidative damage and cryptic lesions specifically, the Comet/ENDO III assay and the Comet/araC assay were performed on leucocytes and lymphocytes, respectively. RESULTS In the present study, no significant DNA damage was correlated with the work shift. The exposed population did not differ significantly from the reference group with respect to DNA primary and oxidative damage in leucocytes. Strikingly, in isolated lymphocytes treated with araC, lower data dispersion as well as a significantly lower mean value for the percentage of DNA in the comet tail was observed in exposed participants as compared with the control group (p<0.05), suggesting a potential chronic exposure to crosslinking antineoplastic drugs. CONCLUSIONS Although stringent rules were adopted at national and international levels to prevent occupational exposure to antineoplastic drugs, data reported in this study support the idea that a more efficient survey on long-lasting exposures at very low concentrations is needed.
Collapse
|
19
|
Villarini M, Dominici L, Fatigoni C, Muzi G, Monarca S, Moretti M. Biological Effect Monitoring in Peripheral Blood Lymphocytes from Subjects Occupationally Exposed to Antineoplastic Drugs: Assessment of Micronuclei Frequency. J Occup Health 2013; 54:405-15. [DOI: 10.1539/joh.12-0038-oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Milena Villarini
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Luca Dominici
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Cristina Fatigoni
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Giacomo Muzi
- Department of Clinical and Experimental Medicine (Section of Occupational MedicineRespiratory Diseases and Toxicology), University of PerugiaItaly
| | - Silvano Monarca
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| | - Massimo Moretti
- Department of Medical‐Surgical Specialties and Public Health (Section of Public Health)University of PerugiaItaly
| |
Collapse
|
20
|
Yoshida J, Koda S, Nishida S, Nakano H, Tei G, Kumagai S. Association between occupational exposure and control measures for antineoplastic drugs in a pharmacy of a hospital. ACTA ACUST UNITED AC 2012; 57:251-60. [PMID: 23002276 DOI: 10.1093/annhyg/mes061] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate the association between occupational contamination and exposure levels to antineoplastic drugs and the application of control measures in a hospital work environment. METHODS Wipe samples of equipments were collected at a hospital in Osaka Prefecture, Japan, from 2007 to 2011. These samples were subjected to measurements of cyclophosphamide (CP), gemcitabine (GEM), platinum-containing drugs (Pt), and fluorouracil (5FU). Additionally, 24-h urine samples were collected from pharmacists who handled antineoplastic drugs, which were analyzed for CP and alpha-fluoro-beta-alanine (AFBA). The application of control measures was scored according to a checklist, which consisted of the following five items: safety equipment and maintenance, training and documentation, devices for safe handling, personal protective equipment, and emergency care. The aim was to obtain a score of 80%. RESULTS The median CP, GEM, and 5FU concentrations of all wipe samples were significantly lower during the period when the mean score was >80% (attainment period) versus when the mean score was ≤80% (nonattainment period; all P < 0.001, Mann-Whitney's U-test). Additionally, the median urinary CP and AFBA concentrations of pharmacists during the attainment period tended to be lower than that of those during the nonattainment period (P = 0.061 and 0.061, respectively, using Mann-Whitney's U-test). CONCLUSIONS Contamination and levels of exposure to antineoplastic drugs decreased with a score higher than 80%. The scores of the items on the checklist appeared to adequately reflect the condition of the control measures, as increases in all five items were associated with reductions in the contamination by and levels of exposure to all drugs.
Collapse
Affiliation(s)
- Jin Yoshida
- Department of Environmental Health, Osaka Prefectural Institute of Public Health, 1-3-69, Nakamichi, Higashinari-ku, Osaka-shi, Osaka-fu, 537-0025, Japan.
| | | | | | | | | | | |
Collapse
|
21
|
Polovich M, Clark PC. Factors influencing oncology nurses' use of hazardous drug safe-handling precautions. Oncol Nurs Forum 2012; 39:E299-309. [PMID: 22543401 DOI: 10.1188/12.onf.e299-e309] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine relationships among factors affecting nurses' use of hazardous drug (HD) safe-handling precautions, identify factors that promote or interfere with HD precaution use, and determine managers' perspectives on the use of HD safe-handling precautions. DESIGN Cross-sectional, mixed methods; mailed survey to nurses who handle chemotherapy and telephone interviews with managers. SETTING Mailed invitation to oncology centers across the United States. SAMPLE 165 nurses who reported handling chemotherapy and 20 managers of nurses handling chemotherapy. METHODS Instruments measured the use of HD precautions and individual and organizational factors believed to influence precaution use. Data analysis included descriptive statistics and hierarchical regression. Manager interview data were analyzed using content analysis. MAIN RESEARCH VARIABLES Chemotherapy exposure knowledge, self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate. FINDINGS Nurses were well educated, experienced, and certified in oncology nursing. The majority worked in outpatient settings and administered chemotherapy to an average of 6.8 patients per day. Exposure knowledge, self-efficacy for using personal protective equipment, and perceived risk of harm from HD exposure were high; total precaution use was low. Nurse characteristics did not predict HD precaution use. Fewer barriers, better workplace safety climate, and fewer patients per day were independent predictors of higher HD precaution use. HD handling policies were present, but many did not reflect current recommendations. Few managers formally monitored nurses' HD precaution use. CONCLUSIONS Circumstances in the workplace interfere with nurses' use of HD precautions. IMPLICATIONS FOR NURSING Interventions should include fostering a positive workplace safety climate, reducing barriers, and providing appropriate nurse-patient ratios.
Collapse
|
22
|
Evaluation of the Efficacy of Additional Measures Introduced for the Protection of Healthcare Personnel Handling Antineoplastic Drugs. ACTA ACUST UNITED AC 2012; 57:240-50. [DOI: 10.1093/annhyg/mes057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
23
|
Hon CY, Astrakianakis G, Danyluk Q, Chu W. Pilot Evaluation of Dermal Contamination by Antineoplastic Drugs among Hospital Pharmacy Personnel. Can J Hosp Pharm 2012; 64:327-32. [PMID: 22479084 DOI: 10.4212/cjhp.v64i5.1067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND It is believed that health care workers are exposed to antineoplastic drugs primarily via dermal contact. However, levels of occupational dermal contamination in Canada have not been formally investigated. OBJECTIVE To determine the potential dermal exposure to antineoplastic drugs among hospital pharmacy personnel in a metropolitan area in British Columbia. METHODS Six hospital pharmacies in the Vancouver area participated in this pilot study. Three pharmacy workers (a technician responsible for preparing drugs, a pharmacist responsible for checking drugs before administration, and a technician not responsible for preparing drugs but working in the pharmacy department) were selected from each site, for a total of 18 participants. Each worker's hands were wiped with a premoistened tissue (one wipe per person), and the wipes were subsequently analyzed by high-performance liquid chromatography tandem mass spectrometry to determine levels of both cyclophosphamide and methotrexate (total of 36 analyses). RESULTS At 3 of the 6 sites, at least one hand-wipe sample was above the analytical detection limit. Of the 18 analyses from the 3 "positive" sites, 5 (28%) had measurable levels of cyclophosphamide and methotrexate. Cyclophosphamide was detected in 3 samples (geometric mean 0.98 ng, geometric standard deviation 2.72 ng, range from below limit of detection to 3.96 ng) and methotrexate in 2 samples (geometric mean 0.27 ng, geometric standard deviation 2.57 ng, range from below limit of detection to 0.27 ng). CONCLUSIONS The results of this pilot study suggest that hospital pharmacy workers in Metro Vancouver are probably exposed to antineoplastic drugs, given that detectable levels of drug were found on the hands of some personnel. Further studies are recommended to confirm these findings.
Collapse
Affiliation(s)
- Chun-Yip Hon
- , MSc(A), CIH, CRSP, is a PhD candidate in the School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia. At the time this study was performed, he was also with Disability Management and Safety, Vancouver Coastal Health, Vancouver, British Columbia
| | | | | | | |
Collapse
|
24
|
Wakui N, Ookubo T, Iwasaki Y, Ito R, Mitui M, Yano Y, Saito K, Nakazawa H. Determination of exposure of dispensary drug preparers to cyclophosphamide by passive sampling and liquid chromatography with tandem mass spectrometry. J Oncol Pharm Pract 2012; 19:31-7. [PMID: 22753612 DOI: 10.1177/1078155212451196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine cyclophosphamide exposure to preparers during tablet crushing and subsequent handling by analyzing indoor air collected using a high-performance volatile organic compounds-solvent desorption (VOC-SD) passive air sampler. METHODS The passive sampler was taped to the mask over the mouth of the preparer and indoor air was collected during crushing and preparation of cyclophosphamide tablets (Endoxan®). After collection, the carbon molecular sieve adsorbent of the passive sampler was placed in a centrifuge tube, and 1 mL of carbon disulfide was used to elute cyclophosphamide from the adsorbent. Liquid-liquid extraction with 1 mL of water was performed, and the aqueous phase was used as the test solution. Cyclophosphamide concentration was determined by liquid chromatography with ultraviolet and tandem mass spectrometry detection. RESULTS Cyclophosphamide concentration was detected in the range of 7.6-157.7 ng/sampler. Our results showed that low-level exposure occurred near the mouth of the preparer, which could present risks for long-term exposure, especially if combined with multiple toxic drug exposures. CONCLUSION The anticancer drug monitoring methodology described here is a simple exposure assessment that can be used to ensure the safety of hospital pharmacy tablet preparers. Furthermore, since the anticancer drug exposure risk is very high for preparers, preparation should be in hood or with face mask.
Collapse
Affiliation(s)
- Nobuyuki Wakui
- Department of Analytical Chemistry, Faculty of Pharmaceutical Sciences, Hoshi University, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Polovich M, Martin S. Nurses' use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum 2012; 38:718-26. [PMID: 22037334 DOI: 10.1188/11.onf.718-726] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine patterns of personal protective equipment (PPE) used by oncology nurses while handling hazardous drugs (HDs) and to assess knowledge of the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert and its effect on precaution use. DESIGN Descriptive, correlational. SETTING The Oncology Nursing Society 31st Annual Congress in Boston, MA, in 2006. SAMPLE 330 nurses who prepared and/or administered chemotherapy. METHODS Nurses described HD safe-handling precaution use by self-report survey. MAIN RESEARCH VARIABLES The availability and use of biologic safety cabinets and PPE. FINDINGS Respondents were well educated (57% had a bachelor's degree or more), experienced (X = 19, SD = 10.2 years in nursing and X = 12, SD = 7.9 years in oncology), and certified (70%; majority OCN®). Forty-seven percent of respondents were aware of the NIOSH Alert. Thirty-five percent of all participants and 93% of nurses in private practice settings reported preparing chemotherapy. Glove use (95%-100%) was higher than that reported in earlier studies, and gown use for drug preparation (65%), drug administration (50%), and handling excretions (23%) have remained unchanged. Double-gloving was rare (11%-18%). Nurses in private practices were less likely to have chemotherapy-designated PPE available, use PPE, and use spill kits for HD spills. CONCLUSIONS Nurses have adopted glove use for HD handling; however, gown use remains comparatively low. Chemotherapy-designated PPE is not always provided by employers. Nurses lack awareness of current safety guidelines. IMPLICATIONS FOR NURSING Nurses must know about the risks of HD exposure and ways to reduce exposure. Employers must provide appropriate PPE and encourage its use. Alternative methods of disseminating safety recommendations are needed.
Collapse
|
26
|
El-Ebiary AA, Abuelfadl AA, Sarhan NI. Evaluation of genotoxicity induced by exposure to antineoplastic drugs in lymphocytes of oncology nurses and pharmacists. J Appl Toxicol 2011; 33:196-201. [PMID: 21935972 DOI: 10.1002/jat.1735] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022]
Abstract
The hazards of handling antineoplastic drugs have been raised and discussed in several studies. Introduction of new antineoplastics together with abuse of safety standards have contributed to the exposure risk for personnel who handle these substances. Interactions of antineoplastic drugs with biological structures vary according to the drug(s) and the individual's genetic susceptibility. This study was carried out to evaluate the genome damage induced by exposure to antineoplastic drugs in nurses (n = 20) and pharmacists (n = 18) working in the Oncology Department of Tanta Cancer Center. Thirty subjects matched in age, gender and smoking habit were selected as controls. Both chromosomal aberration analysis and micronucleus assay were used to evaluate genome damage in peripheral blood lymphocytes of the study subjects. The numbers of aberrant lymphocytes, as well as chromosomal aberration and micronuclei frequencies, were significantly increased in exposed personnel in comparison to matched controls. Compared with pharmacists, nurses showed notably higher level of chromosome damage. On the other hand, no significant difference in micronuclei frequency was observed between nurses and pharmacists. Correlation analyses pointed to the influence of age and duration of occupational exposure on the level of chromosome damage among exposed subjects. The results of this study confirmed that handling antineoplastic drugs without appropriate precautions imposed a genotoxic risk for exposed healthcare workers. These results address the need for regular biomonitoring of exposed personnel. In addition, they call attention to the need for proper implementation of intervention measures aiming to eliminate or significantly reduce worker exposure and prevent untoward biological effects.
Collapse
Affiliation(s)
- Ahmad A El-Ebiary
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | | | | |
Collapse
|
27
|
Suspiro A, Prista J. Biomarkers of occupational exposure do anticancer agents: a minireview. Toxicol Lett 2011; 207:42-52. [PMID: 21911042 DOI: 10.1016/j.toxlet.2011.08.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/27/2011] [Accepted: 08/29/2011] [Indexed: 11/29/2022]
Abstract
The majority of anticancer agents has in common DNA-damaging properties and affects not only target-cells but also non-tumour cells. Its genotoxicity has been demonstrated in experimental models and in cancer patients treated with chemotherapy. Health care personnel involved in the preparation and administration of chemotherapy is therefore at risk for adverse health effects, since most environmental sampling studies demonstrated that there is widespread contamination of work surfaces and equipments with anticancer drugs. Adherence to safety guidelines and proper use of personal protective equipment are insufficient to prevent significant absorption, as evidenced by the presence of detectable amounts of drugs in urine samples and increased frequency of genotoxicity biomarkers. In this minireview, a critical appraisal of the most important biomarkers used for the evaluation of occupational exposure to anticancer agents as well as a summary of the key findings from several studies published in this field is performed.
Collapse
Affiliation(s)
- A Suspiro
- ENSP-UNL, Escola Nacional de Saúde Pública Universidade Nova de Lisboa, UNL, Avenida Padre Cruz, 1600-560 Lisboa, Portugal.
| | | |
Collapse
|
28
|
Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med 2011; 52:1019-27. [PMID: 20881620 DOI: 10.1097/jom.0b013e3181f72b63] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated health care worker exposure to antineoplastic drugs. METHODS A cross-sectional study examined environmental samples from pharmacy and nursing areas. A 6-week diary documented tasks involving those drugs. Urine was analyzed for two specific drugs, and blood samples were analyzed by the comet assay. RESULTS Sixty-eight exposed and 53 nonexposed workers were studied. Exposed workers recorded 10,000 drug-handling events during the 6-week period. Sixty percent of wipe samples were positive for at least one of the five drugs measured. Cyclophosphamide was most commonly detected, followed by 5-fluorouracil. Three of the 68 urine samples were positive for one drug. No genetic damage was detected in exposed workers using the comet assay. CONCLUSIONS Despite following recommended safe-handling practices, workplace contamination with antineoplastic drugs in pharmacy and nursing areas continues at these locations.
Collapse
|
29
|
Villarini M, Dominici L, Piccinini R, Fatigoni C, Ambrogi M, Curti G, Morucci P, Muzi G, Monarca S, Moretti M. Assessment of primary, oxidative and excision repaired DNA damage in hospital personnel handling antineoplastic drugs. Mutagenesis 2010; 26:359-69. [PMID: 21112930 DOI: 10.1093/mutage/geq102] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The International Agency for Research on Cancer has classified several antineoplastic drugs in Group 1 (human carcinogens), among which chlorambucil, cyclophosphamide (CP) and tamoxifen, Group 2A (probable human carcinogens), among which cisplatin, etoposide, N-ethyl- and N-methyl-N-nitrosourea, and Group 2B (possible human carcinogens), among which bleomycins, merphalan and mitomycin C. The widespread use of these mutagenic/carcinogenic drugs in the treatment of cancer has led to anxiety about possible genotoxic hazards to medical personnel handling these drugs. The aim of the present study was to evaluate work environment contamination by antineoplastic drugs in a hospital in Central Italy and to assess the genotoxic risks associated with antineoplastic drug handling. The study group comprised 52 exposed subjects and 52 controls. Environmental contamination was assessed by taking wipe samples from different surfaces in preparation and administration rooms and nonwoven swabs were used as pads for the surrogate evaluation of dermal exposure, 5-fluorouracil and cytarabine were chosen as markers of exposure to antineoplastic drugs in the working environment. The actual exposure to antineoplastic drugs was evaluated by determining the urinary excretion of CP. The extent of primary, oxidative and excision repaired DNA damage was measured in peripheral blood leukocytes with the alkaline comet assay. To evaluate the role, if any, of genetic variants in the extent of genotoxic effects related to antineoplastic drug occupational exposure, the study subjects were genotyped for GSTM1, GSTT1, GSTP1 and TP53 polymorphisms. Primary DNA damage significantly increased in leukocytes of exposed nurses compared to controls. The use of personal protective equipment (i.e. gloves and/mask) was associated with a decrease in the extent of primary DNA damage.
Collapse
Affiliation(s)
- Milena Villarini
- Department of Medical-Surgical Specialties and Public Health University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Yoshida J, Koda S, Nishida S, Yoshida T, Miyajima K, Kumagai S. Association between occupational exposure levels of antineoplastic drugs and work environment in five hospitals in Japan. J Oncol Pharm Pract 2010; 17:29-38. [PMID: 20699333 DOI: 10.1177/1078155210380485] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the present study was to evaluate the measurement of contamination by antineoplastic drugs for safer handling of such drugs by medical workers. We investigated the relationship between the contamination level of antineoplastic drugs and the conditions of their handling. METHODS Air samples and wipe samples were collected from equipment in the preparation rooms of five hospitals (hospitals A-E). These samples were subjected to measurement of the amounts of cyclophosphamide (CPA), fluorouracil (5FU), gemcitabine (GEM), and platinum-containing drugs (Pt). Twenty-four-hour urine samples were collected from the pharmacists who handled or audited, the antineoplastic drugs were analyzed for CPA and Pt. RESULTS Pt was detected from air samples inside BSC in hospital B. Antineoplastic drugs were detected from wipe samples of the BSC in hospitals A, B, D, and E and of other equipment in the preparation rooms in hospitals A, B, C, and D. Cyclophosphamide and 5FU were detected from wipe samples of the air-conditioner filter in hospital A, and CPA was detected from that in hospital D. Cyclophosphamide was detected from urine samples of workers in hospitals B, D, and E. CONCLUSION The contamination level of antineoplastic drugs was suggested to be related with the amount of drugs handled, cleaning methods of the equipment, and the skill level of the technique of maintaining negative pressure inside a vial. In order to reduce the contamination and exposure to antineoplastic drugs in the hospital work environment very close to zero, comprehensive safety precautions, including adequate mixing and cleaning methods was required in addition to BSC and closed system device.
Collapse
Affiliation(s)
- Jin Yoshida
- Department of Environmental Health, Osaka Prefectural Institute of Public Health, Higashinari-ku, Osaka, Japan.
| | | | | | | | | | | |
Collapse
|
31
|
Halsen G, Krämer I. Assessing the risk to health care staff from long-term exposure to anticancer drugs--the case of monoclonal antibodies. J Oncol Pharm Pract 2010; 17:68-80. [PMID: 20667850 DOI: 10.1177/1078155210376847] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Today the occupational health and safety risk involved when handling most anticancer drugs is well recognized and, as a result of regulatory requirements, safety measures have been established. There is little knowledge about the occupational hazard posed by handling monoclonal antibodies assigned to ATC Class L01XC. The aim of our study was to evaluate the occupational risk of monoclonal antibodies. Using the information obtained in a systematic review of the literature, the potentially dangerous properties of the active drug substances were assessed using a specially devised algorithm. As a result, all monoclonal antibodies in question were categorized as substances with developmental toxicity. In addition, gemtuzumab ozogamicin was categorized as mutagenic. In view of the high molecular weights and the proteinogenic nature of monoclonal antibodies, the route of exposure for health care staff is limited to inhalation, unless there is an accident. Employers should implement the necessary administrative and engineering controls. Employees should adhere to the standards in order to avoid occupational exposure. The hazard assessment algorithm devised and the evaluation procedure may also be used for other drugs considered to be dangerous.
Collapse
Affiliation(s)
- Gabriele Halsen
- Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Cologne, Germany
| | | |
Collapse
|
32
|
Antineoplastic Drugs as a Potential Risk Factor in Occupational Settings: Mechanisms of Action at the Cell Level, Genotoxic Effects, and Their Detection Using Different Biomarkers. Arh Hig Rada Toksikol 2010; 61:121-46. [DOI: 10.2478/10004-1254-61-2010-2025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antineoplastični Lijekovi Kao Čimbenik Rizika u Radnom Okolišu: Mehanizmi Djelovanja na Razini Stanice i Pregled Metoda za Otkrivanje Njihovih Genotoksičnih UčinakaU članku je prikazana osnovna podjela antineoplastičnih lijekova prema mehanizmima djelovanja na razini stanice. Objašnjeni su mehanizmi genotoksičnosti najvažnijih vrsta lijekova koji se primjenjuju u okviru uobičajenih protokola za liječenje zloćudnih novotvorina. Navedena je važeća klasifikacija antineoplastika prema kancerogenom potencijalu, podaci o mutagenom potencijalu te je prikazana njihova podjela u skladu s anatomsko-terapijsko-kemijskim sustavom klasifikacije. Sustavno su prikazani najvažniji rezultati svjetskih i hrvatskih istraživanja na populacijama radnika izloženih antineoplasticima, provedenih u razdoblju 1980.-2009. s pomoću četiri najčešće primjenjivane metode: analize izmjena sestrinskih kromatida, analize kromosomskih aberacija, mikronukleus-testa i komet-testa. Objašnjena su osnovna načela navedenih metoda te raspravljene njihove prednosti i nedostaci. Biološki pokazatelji daju važne podatke o individualnoj osjetljivosti profesionalno izloženih ispitanika koji mogu poslužiti unaprjeđenju postojećih uvjeta rada i upravljanju rizicima pri izloženosti genotoksičnim agensima. Na osnovi prednosti i nedostataka citogenetičkih metoda zaključeno je da je mikronukleus-test, koji podjednako uspješno dokazuje klastogene i aneugene učinke, jedna od najboljih metoda dostupnih za otkrivanje štetnih djelovanja antineoplastičnih lijekova koji su u aktivnoj primjeni.
Collapse
|
33
|
Yoshida J, Tei G, Mochizuki C, Masu Y, Koda S, Kumagai S. Use of a closed system device to reduce occupational contamination and exposure to antineoplastic drugs in the hospital work environment. ACTA ACUST UNITED AC 2009; 53:153-60. [PMID: 19261696 DOI: 10.1093/annhyg/men081] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The aim of the preset study was to evaluate the applicability of a closed system device to protect against occupational contamination and exposure to antineoplastic drugs in the work environment of a hospital. METHODS We compared the contamination by and exposure to cyclophosphamide (CPA) between a conventional mixing method and a mixing method using a closed system device. Wipe samples in the preparation room, gloves samples and 24-h urine samples of pharmacists preparing antineoplastic drugs were collected. Working surfaces inside the biological safety cabinet (BSC), front side of the air grilles of the BSC, stainless steel trays, working table and floor were wiped. At first, sample collection was done on 5 days over an interval of 2 weeks using the conventional mixing method. After 2 weeks training for using the closed system device, sample collection was done 5 days over an interval of 2 weeks using the closed system device. RESULTS When pharmacists prepared antineoplastic drugs by the conventional method, CPA was detected from all wipe samples, and the mean and median concentrations of CPA were 1.0 and 0.16 ng cm(-2), respectively (range was from 0.0095 to 27 ng cm(-2)). When pharmacists prepared antineoplastic drugs with a closed system device, CPA was detected from 75% of the wipe samples at mean and median concentrations of 0.18 and 0.0013 ng cm(-2), respectively (the range was from lower than detection limit to 4.4 ng cm(-2)). Using the closed system device significantly reduced the surface contamination of CPA for all wipe sampling points in the preparation room (Mann-Whitney's U-test). The range of CPA of glove samples used in the conventional method and closed system device ranged from lower than detection limit to 3200 ng per glove-pair and from lower than detection limit to 740 ng per glove-pair, respectively. Using the closed system device significantly reduced the gloves contamination of CPA (Mann-Whitney's U-test). The range of urinary CPA of six pharmacists preparing the antineoplastic drugs with the conventional method and closed system device ranged from lower than detection limit to 170 ng day(-1) and from lower than detection limit to 15 ng day(-1), respectively. Using the closed system device significantly reduced the amount of urinary CPA in pharmacists preparing the antineoplastic drugs (Wilcoxon's signed ranks test). CONCLUSIONS We concluded that a closed system device can reduce occupational contamination and exposure to antineoplastic drugs in the hospital work environment.
Collapse
Affiliation(s)
- Jin Yoshida
- Department of Environmental Health, Osaka Prefectural Institute of Public Health, 1-3-69, Nakamichi, Higashinari-ku, Osaka 537-0025, Japan.
| | | | | | | | | | | |
Collapse
|
34
|
Ehrlich VA, Nersesyan AK, Hoelzl C, Ferk F, Bichler J, Valic E, Schaffer A, Schulte-Hermann R, Fenech M, Wagner KH, Knasmüller S. Inhalative exposure to vanadium pentoxide causes DNA damage in workers: results of a multiple end point study. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1689-93. [PMID: 19079721 PMCID: PMC2599764 DOI: 10.1289/ehp.11438] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 07/31/2008] [Indexed: 05/21/2023]
Abstract
BACKGROUND Inhalative exposure to vanadium pentoxide (V(2)O(5)) causes lung cancer in rodents. OBJECTIVE The aim of the study was to investigate the impact of V(2)O(5) on DNA stability in workers from a V(2)O(5) factory. METHODS We determined DNA strand breaks in leukocytes of 52 workers and controls using the alkaline comet assay. We also investigated different parameters of chromosomal instability in lymphocytes of 23 workers and 24 controls using the cytokinesis-block micronucleus (MN) cytome method. RESULTS Seven of eight biomarkers were increased in blood cells of the workers, and vanadium plasma concentrations in plasma were 7-fold higher than in the controls (0.31 microg/L). We observed no difference in DNA migration under standard conditions, but we found increased tail lengths due to formation of oxidized purines (7%) and pyrimidines (30%) with lesion-specific enzymes (formamidopyrimidine glycosylase and endonuclease III) in the workers. Bleomycin-induced DNA migration was higher in the exposed group (25%), whereas the repair of bleomycin-induced lesions was reduced. Workers had a 2.5-fold higher MN frequency, and nucleoplasmic bridges (NPBs) and nuclear buds (Nbuds) were increased 7-fold and 3-fold, respectively. Also, apoptosis and necrosis rates were higher, but only the latter parameter reached statistical significance. CONCLUSIONS V(2)O(5) causes oxidation of DNA bases, affects DNA repair, and induces formation of MNs, NPBs, and Nbuds in blood cells, suggesting that the workers are at increased risk for cancer and other diseases that are related to DNA instability.
Collapse
Affiliation(s)
- Veronika A. Ehrlich
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Armen K. Nersesyan
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christine Hoelzl
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Franziska Ferk
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Julia Bichler
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Eva Valic
- Austrian Workers Compensation Board, Vienna, Austria
| | - Andreas Schaffer
- Department of Medicine II, Medical University of Vienna, Austria
| | - Rolf Schulte-Hermann
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Fenech
- Commonwealth Scientific and Industrial Research Organisation, Human Nutrition, Adelaide, Australia
| | | | - Siegfried Knasmüller
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Address correspondence to S. Knasmüller, Institute for Cancer Research, Borschkegasse 8a, 1090 Vienna, Austria. Telephone: 43-1-4277-65142. Fax: 43-1-4277-6519. E-mail:
| |
Collapse
|
35
|
Sasaki M, Dakeishi M, Hoshi S, Ishii N, Murata K. Assessment of DNA damage in Japanese nurses handling antineoplastic drugs by the comet assay. J Occup Health 2008; 50:7-12. [PMID: 18285639 DOI: 10.1539/joh.50.7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To clarify genotoxic effects of occupational exposure to antineoplastic drugs in Japan, we examined DNA damage, assessed by the comet assay, in 121 female nurses and 46 female clerks working at three hospitals in the northeast of Japan. The comet assay is considered to be a sensitive and rapid method for DNA strand break detection in individual cells, and tail length and tail moment are used as the comet parameters. Concerning the basal characteristics, the 46 control subjects had higher rates of smoking and coffee-drinking habits and lower hemoglobin than the 121 nurses (p<0.05). The log-transformed tail length in the nurses was significantly longer than that in the control subjects after adjusting for possible covariates such as age and smoking habit (p<0.05). Also, the log-transformed tail length was significantly longer, in the 57 nurses who had handled antineoplastic drugs in the last six months, than that in the 46 control subjects (p<0.05); but, no significant difference in tail length or tail moment was seen between the two nurse groups with and without experience of handling hazardous drugs (p>0.05). These results suggest that Japanese nurses who have worked at hospitals using antineoplastic drugs may have a potential risk of DNA damage. To minimize this risk in Japan, use of biological safety cabinet and appropriate protective equipment, in addition to staff education and training, should be implemented in the healthcare environment.
Collapse
Affiliation(s)
- Makiko Sasaki
- Department of Environmental Health Sciences, Akita University School of Medicine, Akita, Japan
| | | | | | | | | |
Collapse
|
36
|
Yoshida J, Kosaka H, Nishida S, Kumagai S. Actual Conditions of the Mixing of Antineoplastic Drugs for Injection in Hospitals in Osaka Prefecture, Japan. J Occup Health 2008; 50:86-91. [DOI: 10.1539/joh.50.86] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jin Yoshida
- Department of Environmental HealthOsaka Prefectural Institute of Public HealthJapan
| | - Hiroshi Kosaka
- Department of Environmental HealthOsaka Prefectural Institute of Public HealthJapan
| | - Shozo Nishida
- Division of PharmacotherapyKinki University School of PharmacyJapan
| | - Shinji Kumagai
- Department of Environmental HealthOsaka Prefectural Institute of Public HealthJapan
| |
Collapse
|