Measuring extent of surface contamination produced by the handling of antineoplastic drugs in low- to middle-income country oncology health care settings

Abstract

Antineoplastic drugs are known to cause detrimental effects to health care workers who are exposed through work tasks. Environmental monitoring studies are an excellent approach to measure the extent of surface contamination produced by the handling of antineoplastic drugs in the workplace and to assess the potential for occupational exposures in oncology health care settings. The main aim of the study was to establish the extent of surface contamination produced by the handling of antineoplastic drugs in a limited-resource oncology health care facility in Colombia by conducting an environmental monitoring study using affordable analytical instrumentation. Contamination with antineoplastic drugs was widespread in the health care facility under evaluation, which could result in health care worker exposure to antineoplastic drugs. A comprehensive review of current safety guidelines and protocols including assessment of adherence in the health care facility should be done.

Environmental Contamination and Occupational Exposure of Algerian Hospital Workers

“…If we compare our range of surface CP contamination (< LOQ−208.85 ng/cm 2 ), with the literature, which reported concentrations from < LOQ to 14 ng/cm 2 , substantially higher contamination was observed in our study ( 12 , 25 , 27 , 32 – 35 ). Müller-Ramírez et al ( 14 ) reported values ranging from 0.3 to 168.9 ng/cm 2 , which is more in line with our results, while only one study reported ranges exceeding ours with contamination up to 21,300 ng/cm 2 ( 36 ). This concentration was found on a phone in a room next to the preparation room and was probably caused by touching the phone with contaminated gloves and inadequate cleaning.…”

“…For IFO we observed concentrations ranging from < LOQ up to 23.45 ng/cm², which is in line with concentrations (0.08-15.7 ng/cm²) reported by Müller-Ramírez et al (14). Other studies reported substantially lower contamination (12,25,33,35), or considerably higher contamination (< LOQ−95 ng/cm²) (32,37).…”

“…Even though many recommendations and guidelines led to a decrease in occupational exposure, there is still no complete elimination of exposure (11)(12)(13). Several research groups demonstrated that even after introduction of these measures, cytostatic agents remain widespread on various surfaces and objects (3,(12)(13)(14)(15)(16). This can be due to non-compliancy with guidelines, limited resources or inadequacy of protocols (e.g., cleaning).…”

An ethical imperative: Safety and specialization as nursing priorities of WHO Global Initiative for Childhood Cancer

“…To achieve the 2030 target, implementation and scale‐up require recognizing the needs and capacities of health professionals, including nurses. Nurses in LMIC are frequently exposed to occupational hazards due to work environments that lack the required resources for safe care, such as personal protective equipment (PPE) for handling chemotherapy . The absence of specialized education, coupled with frequent rotation of trained staff, leaves nurses ill‐equipped to safely deliver care for children/adolescents with cancer .…”

“…Nurses in LMIC are frequently exposed to occupational hazards due to work environments that lack the required resources for safe care, such as personal protective equipment (PPE) for handling chemotherapy. 6,7 The absence of specialized education, coupled with frequent rotation of trained staff, leaves nurses ill-equipped to safely deliver care for children/adolescents with cancer. 8 The Nurse Specialists of the Global Initiative for Childhood Cancer join public calls for all nurses (particularly those in resourcelimited settings), to be provided with protection when managing hazardous drugs as well as oncology specialization training to ensure optimal nursing care.…”