Cytostatics as hazardous chemicals in healthcare workers’ environment

Abstract

Cytostatics not only induce significant side-effects in patients treated oncologically but also pose a threat to the health of occupationally exposed healthcare workers: pharmacists, physicians, nurses and other personnel. Since the 1970s numerous reports from various countries have documented the contamination of working areas with cytostatics and the presence of drugs/metabolites in the urine or blood of healthcare employees, which directly indicates the occurrence of occupational exposure to these drugs. In Poland the significant scale of occupational exposure to cytostatics is also confirmed by the data collected in the central register of occupational carcinogens/mutagens kept by the Nofer Institute of Occupational Medicine. The assessment of occupational exposure to cytostatics and health risks constitutes employers' obligation. Unfortunately, the assessment of occupational risk resulting from exposure to cytostatics raises a number of concerns. Provisions governing the problem of workers' health protection are not unequivocal because they derive from a variety of law areas, especially in a matter of hazard classification and safety data sheets for cytostatics. Moreover, no legally binding occupational exposure limits have been set for cytostatics or their active compounds, and analytical methods for these substances airborne and biological concentrations are lacking. Consequently, the correct assessment of occupational exposure to cytostatics, the evaluation of health hazards and the development of the proper preventive strategy appear difficult. The authors of this article described and discussed the amendments to the European provisions concerning chemicals in the light of employers' obligations in the field of employees' heath protection against the consequences of exposure to cytostatics. Some modifications aimed at a more effective health protection of workers occupationally exposed to cytostatics were also proposed.

Monitoring surface contamination for thirty antineoplastic drugs: a new proposal for surface exposure levels (SELs)

“…The IARC has classified some active components of ADs into diverse carcinogenicity groups -12 into IARC group 1 "Carcinogenic to humans, " 8 into IARC group 2A "Probably carcinogenic to humans, " and 10 into IARC group 2B "Possibly carcinogenic to humans. " Challenging for employers and occupational and environmental hygiene specialists is the necessity to get into a complex and ambiguous regulatory context which is not able to easily harmonize the communication of classification criteria between manufacturers and users [3]. A step ahead has been moved with the approval of the directive EU 2019/983 by the European Parliament, an amendment of the directive 2004/37/CE, which includes the risks related to exposure to cytotoxic drugs at the workplace.…”

Prevención de accidentes laborales con citostáticos

“…Si bien no se ha logrado establecer cómo actúa su potencial carcinogénico, se los ha vinculado con el desarrollo de cáncer nasofaríngeo, de vejiga y leucemia. Se han documentado cambios cromosómicos específicos del síndrome mielodisplásico y leucemia mieloblástica aguda en los trabajadores expuestos a sustancias citotóxicas 4 .…”

Cytostatics in Indoor Environment: An Update of Analytical Methods

“…Regarding the two articles that developed methods for air contamination assessment, only CYC was analyzed in both cases. In fact, it seems that the most reliable data in the literature from air contamination pertains to CYC [30]. The lack of studies in this topic along with the reduced number of cytostatics they evaluated may be explained by the fact that most cytostatics are not reportedly volatile.…”