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Marie P, Christophe C, Manon R, Marc M, Charleric B, Patrice V. Environmental monitoring by surface sampling for cytotoxics: a review. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:52. [PMID: 28063118 DOI: 10.1007/s10661-016-5762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Abstract
Environmental monitoring is usually conducted by surface sampling to detect and quantify the presence of cytotoxic drugs after their reconstitution and administration. This technique reveals the origins of residual contamination and is an important component in order to protect healthcare workers from the potential risk of occupational exposure. The aim of this work is to compare various techniques and results of surface sampling for cytotoxics. For each technique, sample processing methods and their analysis were compared from literature data. Sampling is often performed by the wiping technique. After treatment, various single or multicompound technical analyses are used, in particular liquid or gas chromatography involving different detection methods: ultraviolet, mass spectrometry, plasma torch, and voltammetry. Some methods are validated to ensure reliability. Despite published guidelines and the use of isolator technology for the preparation of cytotoxic drugs, workplace contamination persists, leading to chemotherapeutic agents' exposure of healthcare workers. Efforts need to be maintained with particular emphasis on harmonization and on determining alert level for cytotoxic contamination.
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Affiliation(s)
- Petit Marie
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Curti Christophe
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
| | - Roche Manon
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France.
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central des Opérations Pharmaceutiques (SCOP), Administration Centrale, rue Brochier, 13005, Marseille, France.
| | - Montana Marc
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Oncopharma, Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Bornet Charleric
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Pharmacie Usage Intérieur Hôpital de la Conception, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Vanelle Patrice
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
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Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. J Occup Environ Med 2015; 56:901-10. [PMID: 25153300 DOI: 10.1097/jom.0000000000000249] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle antineoplastic drugs. METHODS A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed. RESULTS Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time to pregnancy also suggested an increased risk for subfertility. CONCLUSIONS Antineoplastic drugs are highly toxic in patients receiving treatment, and adverse reproductive effects have been well documented in these patients. Health care workers with long-term, low-level occupational exposure to these drugs also seem to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered.
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Sottani C, Porro B, Comelli M, Imbriani M, Minoia C. An analysis to study trends in occupational exposure to antineoplastic drugs among health care workers. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2593-605. [DOI: 10.1016/j.jchromb.2010.04.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 04/07/2010] [Accepted: 04/21/2010] [Indexed: 11/25/2022]
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Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D. Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes. Epidemiology 2007; 18:112-9. [PMID: 17099323 DOI: 10.1097/01.ede.0000246827.44093.c1] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nurses and other hospital workers are exposed to antineoplastic drugs during daily activities. Previous studies suggest that antineoplastic drugs at occupational exposure levels may be toxic to reproduction, but these studies are not consistent or conclusive. METHODS Self-administered questionnaires were completed by 4393 exposed and nonexposed nurses employed between 1990 and 1997 (79% response). Questions were asked about pregnancy outcome, work-related exposures, and lifestyle. Exposure to antineoplastic drugs was estimated using task-based dermal exposure measurements and self-reported task frequencies. Time to pregnancy was modeled using survival analysis, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for other reproductive outcomes using multiple logistic regression analysis. Associations were further explored by nonparametric regression modeling. RESULTS Nurses highly exposed to antineoplastic drugs took longer to conceive than referent nurses (adjusted hazard ratio = 0.8; CI = 0.6-0.9). Exposure to antineoplastic drugs was associated with premature delivery (OR per unit increase in ln[exposure] = 1.08; CI = 1.00-1.17) and low birth weight (OR per unit increase in ln[exposure] = 1.11; 1.01-1.21). Penalized smoothed spline plots corroborated these log-linear relations. Spontaneous abortion, stillbirth, congenital anomalies, and sex of offspring appeared not to be related to exposure to antineoplastic drugs. CONCLUSION Antineoplastic drugs may reduce fertility and increase poor neonatal outcomes among occupationally exposed oncology nurses.
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Affiliation(s)
- Wouter Fransman
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
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McDiarmid MA, Condon M. Organizational safety culture/climate and worker compliance with hazardous drug guidelines: lessons from the blood-borne pathogen experience. J Occup Environ Med 2005; 47:740-9. [PMID: 16010200 DOI: 10.1097/01.jom.0000165751.21088.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The health risks posed to health care workers (HCW) handling antineoplastic and other hazardous drugs (HDs) are well established. However, despite nearly 20 years of professional practice standards, compliance with safe handling procedures is poor. METHOD We present documentation of undercompliance with recommended safety procedures for HDs. Then, we examine a similar problem, HCW compliance with blood-borne pathogen universal precautions (UP) and its partial solution tied to the strength of a facility's safety culture. Lessons learned here may be applicable to the HD issue. RESULTS It is proposed that analyzing a facility's safety culture may enlarge our understanding of the barriers contributing to HD under-compliance and suggest strategies to improve it. CONCLUSION The Safety Culture paradigm offers many targets for intervention to enhance and promote worker compliance with safe HD handling practices thus mitigating internal exposure.
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Affiliation(s)
- Melissa A McDiarmid
- Occupational Health Program, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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