Occupational Exposure to Chemotherapy of Pharmacy Personnel at a Single Centre

Ramphal, Raveena; Bains, Tejinder; Goulet, Geneviève; Vaillancourt, Régis

doi:10.4212/cjhp.v68i2.1435

Cited by 11 publications

(14 citation statements)

References 37 publications

(24 reference statements)

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“…In contrast, some other studies have found traces of hazardous drugs in the urine of healthcare workers. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Some of these studies have reported high proportions of workers with such contamination. For example, Hon et al 26 determined the concentration of cyclophosphamide after 24-h urine collection by 103 healthcare workers (201 samples) in six British Columbia hospitals from 2010 to 2011.…”

Section: Discussionmentioning

confidence: 99%

“…9 pg/mL), 5.5 times lower than that of Hon et al; 26 as such, we should have found detectable urinary levels of these drugs, if they were present. Ramphal et al also noted a high rate of urinary contamination among pharmaceutical staff 27 and nurses. 29 Among pharmacy staff, 100% (7/7) of participants who were exposed to cyclophosphamide had urine samples that were positive for this drug (total of 56 urine samples over 24 h, 20 (36%) of which had a positive result).…”

Section: Activitymentioning

confidence: 97%

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Quantification of healthcare workers’ exposure to cyclophosphamide, ifosfamide, methotrexate, and 5-fluorouracil by 24-h urine assay: A descriptive pilot study

Palamini

Dufour

Therrien

et al. 2020

J Oncol Pharm Pract

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The objective of this pilot study was to determine the frequency of urination and the concentration of four hazardous drugs (cyclophosphamide, ifosfamide, methotrexate, and fluorouracil) in workers' 24-h urine samples in relation to exposure to traces with hazardous drugs. Methods: The study was conducted in three healthcare centers in the region of Montr eal, Quebec, Canada. We recruited healthcare workers (nurses and pharmacy technicians) assigned to the hematology-oncology department. Each participant was asked to collect all urine voided during a 24-h period, to fill out an activity journal documenting tasks performed and to document the use of personal protective equipment. Samples were analyzed for cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (FBAL, the main urinary metabolite of 5-fluorouracil). Drugs were quantified by ultraperformance liquid chromatography-tandem mass spectrometry (positive electrospray MRM mode). Results: Eighteen healthcare workers (10 nurses and 8 technicians) were recruited and provided consent to participate. Urine samples were obtained between 1 September and 30 September 2019. The number of urinations over the 24-h collection period ranged from 3 to 11 per participant. A total of 128 urine samples were analyzed for the 18 workers. All urine samples were negative for the four antineoplastics tested. Conclusion: No traces of cyclophosphamide, ifosfamide, methotrexate, or FBAL were found in the 24-h urine samples of 18 healthcare workers practicing in three healthcare facilities in Quebec. Although it was feasible to collect 24-h urine samples in this research project, it appears unrealistic to do so recurrently as part of a large-scale surveillance program.

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Section: Discussionmentioning

confidence: 99%

Section: Activitymentioning

confidence: 97%

Quantification of healthcare workers’ exposure to cyclophosphamide, ifosfamide, methotrexate, and 5-fluorouracil by 24-h urine assay: A descriptive pilot study

Palamini

Dufour

Therrien

et al. 2020

J Oncol Pharm Pract

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“…A self-questionnaire is built, in the light of literature data, concerning work tasks potentially exposing, risk perception 49 50 54–58. In addition, we conducted a pilot study in a healthcare unit that enabled us to carry out a study of the complete organisation around AD and excreta of treated patients and to collect tasks performed, type and wearing of PPE.…”

Section: Methodsmentioning

confidence: 99%

“…In order to limit these exposures and to guarantee the safety of employees, centralised reconstitution units for chemotherapies have been created in healthcare establishments and recommendations have been drawn up by government agencies and other occupational health organisations 3 38. Despite the recommendations and the improvements made in terms of safety on the handling and transport of these drugs, several recent studies show that the problem of contamination is still relevant, both in the working environment23 39–43 and for the professionals themselves 33 35 39 44–51. Currently, scientific reviews report that there is no significant correlation between AD surface monitoring and AD urine monitoring 40.…”

Section: Introductionmentioning

confidence: 99%

Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study

et al. 2019

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IntroductionAntineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination.Methods and analysisThis trial will be conducted in two French hospital centres: University Hospital of Bordeaux and IUCT-Oncopole of Toulouse. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The trial will be conducted with the following steps: (1) development of analytical methods to quantify AD urine biomarkers, (2) study of the workplace and organization around AD in each care department (transport and handling, professional practices, personal and collective protection equipments available) (3) development of a self-questionnaire detailing professional activities during the day of inclusion, (4) nurses inclusion (urine samples and self-questionnaire collection), (5) urine assays, (6) data analysis.Ethics and disseminationThe study protocol has been approved by the French Advisory Committee on the Treatment of Information in Health Research (CCTIRS) and by the French Data Protection Authority (CNIL). Following the opinion of the Regional Committee for the Protection of Persons, this study is outside the scope of the provisions governing biomedical research and routine care (n°2014/87). The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings.Trial registration numberNCT03137641.

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“…Levels seem to decrease since the introduction of technical improvements such as CSTDs [30], standardized working and cleaning strategies and environmental contamination controls on practice quality [21,27,31,32,49,50]. But it is also substantially dependent from the sufficient adherence to recommended practices, which are -as even shown in recent studies -often insufficiently followed [47,51,52]. In the present study, the participating pharmacies received a report of their individual contamination results after each monitoring and the TGV based classification together with recommendations for safer handling.…”

Section: Long-term Monitoring Of Surface Contaminationmentioning

confidence: 99%

Benefits of Wipe Sampling: Evaluation of Long-Term 5-Fluorouracil and Platinum Monitoring Data

Böhlandt

Schierl

2016

Pharmaceutical Technology in Hospital Pharmacy

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AbstractObjectives:The aim of this study was to evaluate environmental contamination levels from a large dataset of long-term monitoring data of 5-fluorouracil and platinum-containing drugs in pharmacies, and to investigate the contaminations over 15 years.Methods:Wipe sampling for 5-fluorouracil and platinum (marker for cis-, carbo- and oxaliplatin) was performed on-site from various surfaces in hospital and retail pharmacies with a validated sampling procedure over a period of 15 years. The 5-fluorouracil concentrations were quantified by GCMSMS and platinum concentrations by voltammetry. Statistical evaluation was performed with respect to sampling locations and years, and over the course of time.Results:Overall, 3,584 wipe samples for 5-fluorouracil and 2,955 wipe samples for platinum were analysed and contamination was detected at all surface types in all 151 examined pharmacies with ranges from ND (not detectable) to 1,725,000 pg/cm² and ND to 23,068 pg/cm², respectively. Median concentrations from the different locations ranged between ND and 4.3 pg/cm² (5-fluorouracil) and 0.2 and 1.8 pg/cm² (platinum) with highest loads inside the biological safety cabinets/isolators and storage areas. Evaluation of contamination over the course of 15 years showed a substantial decrease, especially in the years after introduction of guidance values.Conclusions:Long-term evaluation of surface wipe samples for antineoplastic drug contamination with repeated monitoring seems to be a beneficial tool to characterize the actual exposure situation and to assess surface contamination over time. Wipe sampling is a suitable control means to evaluate the work practices and the effectiveness of applied safety and hygiene measures and to identify the potential exposure risk for health care workers.

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Occupational Exposure to Chemotherapy of Pharmacy Personnel at a Single Centre

Abstract: Background: Cyclophosphamide is one of the most commonly used chemotherapy drugs worldwide. Data concerning environmental contamination and biological exposure of pharmacy personnel to this and other chemotherapy drugs are limited.

Cited by 11 publications

References 37 publications

Quantification of healthcare workers’ exposure to cyclophosphamide, ifosfamide, methotrexate, and 5-fluorouracil by 24-h urine assay: A descriptive pilot study

Quantification of healthcare workers’ exposure to cyclophosphamide, ifosfamide, methotrexate, and 5-fluorouracil by 24-h urine assay: A descriptive pilot study

Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study

Benefits of Wipe Sampling: Evaluation of Long-Term 5-Fluorouracil and Platinum Monitoring Data

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