Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring technique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 ml of contamination) and a very high inter-observer agreement (ICC=0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5-250 mg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental setup. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/m 3 of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses involved in administering drugs and nurses caring for treated patients. Estimation of all relevant mass transport rates will be a challenge for the near future.

This study characterized occupational exposure to pesticides in fruit growing in The Netherlands to assess determinants of exposure. Large-scale exposure surveys were carried out during application of pesticides and during reentry activities. Data on contamination inside the fruit growers' homes were obtained, and total potential exposure for the fruit grower and his family during the growing and harvesting season was estimated. Repeated measurements on the same subject were collected to study components of exposure variability. Relative contribution of the respiratory route and different skin sites to total exposure were assessed. Captan was used as a marker for exposure. Inhalable dust exposure was measured with a personal monitor and potential dermal exposure with skin pads and hand rinsing. Dislodgeable foliar residue was measured by taking leaf punches. For respiratory exposure and potential dermal exposure, differences were observed between several tasks. Workers were categorized according to tasks performed depending on the exposure measure(s) (e.g., hands, forehead, inhalable dust) considered relevant for a specific study purpose. In general, within-worker variability of all exposure measurements was larger than between-worker variability. Variability in dermal exposure on the same body location was small relative to variability between different body locations. Differences in total exposure, including exposure inside the home, between the fruit grower and the son were small. Exposure of the wife was two to three times lower than for the fruit grower and the son. As exposure per unit of time was in the same order of magnitude for different tasks, individual time spent on these tasks is crucial for estimating total potential exposure. Repeated measurements are necessary to estimate individual exposure accurately because of the large within-worker variability.

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A series of studies investigated occupational exposure to pesticides among fruit growers in The Netherlands during spraying and reentry of orchards between 1990 and 1992 to identify and quantify determinants of exposure. Determinants of exposure are discussed as a starting point for hazard identification and control. Captan was used as a marker for exposure. Cabin use of the tractor was the most prominent determinant of dermal exposure during spraying. For respiratory exposure, factors related to preparation of pesticides were most prominent. A long duration of exposure may reflect a different exposure situation compared with a short duration of exposure. As different determinants of exposure prevailed for each subgroup, consideration should be given to constructing exposure models for each group separately. Dislodgeable foliar residue (DFR) was the most prominent determinant of exposure for both respiratory and dermal exposure during reentry. However, no significant relation between DFR and dermal exposure of forehead and sternal area was found, perhaps because there was no direct contact with foliage here. Therefore, use of a transfer factor based on DFR to estimate total dermal exposure is only a crude estimate. The half-life of captan on crops varied from 10-17 days, so substantial exposure when entering the orchard is very likely, particularly when spraying frequency is high. The main starting points for reduction of exposure are use of a cabin, DFR, and individual time spent on different tasks. Determinants that are constant over time (cabin use) may have an especially great influence on grouping workers, according to long-term exposure in epidemiological studies. As determinants of exposure vary for the different exposure routes and body locations (for dermal exposure), the measure of interest for a specific study design will decide which determinants are most relevant.

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