Antineoplastic Drug Exposure in an Ambulatory Setting

Abstract

Background Exposure to antineoplastic drugs confers health risks to workers, yet little is known about the exposure after a drug spill. Nor has the relationship between exposure and organizational factors such as staffing and work environment been studied. Objective To evaluate drug spills prospectively using biological measures and correlate drug spills with organizational factors. Methods Prospective questionnaires with 8-hour timed urine samples were collected from nursing and pharmacy personnel who reported a drug spill in one academic health center's infusion center. Urine was collected similarly from workers who did not report a spill. Liquid chromatography tandem mass spectrometry techniques identified detectable drug levels. After the prospective sampling period, workers were surveyed on workloads, practice environment, and safety behaviors. Results From 81 eligible individuals, 40 participated in the prospective study and 19 completed retrospective questionnaires. Four spills were reported by 9 personnel as multiple employees were exposed to drug spills. Four participants who reported a spill showed detectable levels of antineoplastic drugs. Four participants who did not report a spill had detectable levels of docetaxel. Compared with respondents who did not report a spill, collegial relations with physicians were significantly poorer for workers who reported spills. Conclusions The study protocol successfully captured drug spill reports and biological samples. Workers have detectable levels of antineoplastic drugs through both drug spills and environmental contamination.

Accessible analytical methodology for assessing workplace contamination of antineoplastic drugs in limited-resource oncology health-care settings

“…Assessing workplace environmental contamination by measuring levels of drug residues on work surfaces plays a key role when assessing occupational exposures to ANDs (Friese et al 2015;Kiffmeyer et al 2013;Fabrizi et al 2012;Nussbaumer et al 2011;Floridia et al 1999;Maeda and Miwa 2013;Sabattini et al 2005). Biological monitoring studies, on the other hand, constitute a more accurate estimation of drug uptake and internal occupational exposure.…”

Lessons Learned From a Practice‐Based, Multisite Intervention Study With Nurse Participants

“…Our team has documented that 18 percent of surveyed ambulatory oncology nurses experienced an unplanned hazardous drug spill in the past six months (Friese et al, 2014). Hazardous drug exposure is correlated with substantial short- and long-term health effects, such as nausea, vomiting, airway irritation, reproductive problems, and rare cancers (National Institute for Occupational Safety and Health, 2004).…”

Cytostatics as hazardous chemicals in healthcare workers’ environment

“…The direct evidence for skin absorption is the presence of cytostatics, or their metabolites, in biological material samples (exhaled air, body fluids, tissues) of the exposed person. Since 1996 the presence of a number of cytostatics (cyclophosphamide, methotrexate, ifosfamide, epirubicin, cisplatin, carboplatin) or their metabolites in the urine of medical staff (nurses, pharmacists, MDs) has been evidenced in numerous studies described in over 60 publications [24][25][26][27][28][29][30][31][32]. In 1 of the studies conducted in 4 Polish hospitals, the cytostatics contamination of the working environment at drug preparation and administration was assessed [26].…”