Occupational exposure to platinum drugs during intraperitoneal chemotherapy. Biomonitoring and surface contamination

Ndaw, Sophie; Hanser, Ogier; Kenepekian, V.; Vidal, Michèle; Melczer, Mathieu; Rémy, Aurélie; Robert, Alain; Bakrin, Naoual

doi:10.1016/j.toxlet.2018.05.031

Cited by 35 publications

(42 citation statements)

References 32 publications

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“…However, there was substantially lower 3 meters from the operating table. [15] Our observations support this idea. The rst 5 minutes seem to be the most critical period for contamination of the surgical environment.…”

Section: Discussionsupporting

confidence: 81%

“…The anesthetist site, despite showing a variation in the 75% percentile up to 5 minutes (0 to 2.91), still shows a lower value than the surgeon site. However, it seems to be within the critical exposure range of less than 3 meters suggested by Ndaw et al [15] Also the rst 2 minutes of the injector shows a signi cant differents The rst 2 minutes on the injector showed a signi cant difference, pointing to corroborating the idea that this location, even though it is farther from the centre of the aerosolization, there is a possible contamination site mainly during the injection.Aerosolization occurs mostly up to 5 minutes -in our study, no aerosolization exceeded 6 minutes. At this point, the injection pressure and the therapeutic mist turbulence are at their highest, as pointed out in the video (video-1),treaching the highest levels of contamination.…”

Section: Discussionsupporting

confidence: 65%

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Environmental Contamination Assessment in the Process of Application of Aerosolized Therapeutic Substances

Seitenfus

Barros

Linck

et al. 2021

Preprint

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Background: PIPAC (Pressurized Intraperitoneal aerosol chemotherapy) acts by applying aerosolized chemotherapy in the peritoneal cavity, enhancing tissue penetration of chemotherapeutic agents. This method of chemotherapy delivery still raises concerns related to the operating room's environmental exposure, arousing discussions related to the occupational risks of this technique. This work aims to demonstrate the pattern of aerosolization distribution in the absence of safety mechanisms in an operating room. Methods: A cross-sectional experimental work was carried out of 31 aerosol applications. Aerosolization was performed with a 1% aqueous solution of caffeine Cellulose. Nitrate membranes were used to capture the concentration of caffeine in different sites within the operating room for 5 periods of fixed exposure times.Results: 930 samples obtained in 31 rounds of aerosolization. Comparing the changes in concentration per minute between the different time intervals, there were statistically significant differences between the 0-2 minutes interval and the 15-30 interval (P <0.001). Surgeon site show a significant difference between the times (P=0.010). There were no differences between changes in concentrations in the time intervals for the anesthetist site (P = 0.094). At the injector site, a statistically significant difference (P <0.001). The time assessment between 30-35 exposure showed a median of 0. Conclusions: The study pointed out that the moment of greatest risk of contamination of the surgical environment occurs during aerosolization, especially during the first 15 minutes after the start of aerosolization. The sites that were most exposed to contamination were the patient, the surgeon and the injector, respectively.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionsupporting

confidence: 65%

Environmental Contamination Assessment in the Process of Application of Aerosolized Therapeutic Substances

Seitenfus

Barros

Linck

et al. 2021

Preprint

View full text Add to dashboard Cite

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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%

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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“…Data on the occupational health and safety aspects of the technique were collected, with no evidence of platinum contamination in the operating theatres. As centres across Europe started performing the procedure, verification of its occupational health and safety was repeated. Similarly, as shown in Fig .…”

Section: Resultsmentioning

confidence: 99%

“…Overall, the search identified: 23 stage 0 studies; 18 stage 1 studies and two protocol papers for stage 1 studies; 25 stage 2a studies, one protocol paper and five trial registrations (NCT01854255, NCT02735928, NCT03246321, NCT02604784 and NCT03124394) for stage 2a studies; six stage 2b studies and three protocol papers for stage 2b studies; and three protocol papers for stage 3 studies. Fig .…”

Section: Resultsmentioning

confidence: 99%

Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

Tate

Torkington

2020

BJS Open

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Background The IDEAL (Idea, Development, Evaluation, Assessment, Long‐term study) framework is a scheme of investigation for innovative surgical therapeutic interventions. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a procedure based on laparoscopy to deliver intraperitoneal chemotherapy for peritoneal metastases, introduced in 2011. The aim of this article was to review literature on PIPAC and assess whether development of the technique has followed the IDEAL framework. Methods A search of MEDLINE and Embase was carried out to identify scientific reports on PIPAC published between January 2000 and February 2019. The studies were categorized according to the IDEAL stages. Results Eighty‐six original research papers on PIPAC were identified. There were 23 stage 0, 18 stage 1, 25 stage 2a and six stage 2b studies. Protocol papers for stage 1, 2b and 3 studies, and trial registrations for stage 2a studies, were also identified. The number of centres publishing reports and the number of publications has increased each year. Overall, there has been progression through the IDEAL stages; however, about 60 per cent of clinical reports published in 2018 were stage 1 Idea‐type studies. Conclusion Since its introduction, studies investigating PIPAC have progressed in line with the IDEAL framework. However, the majority of studies reported recently were stage 0 and 1 studies.

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Occupational exposure to platinum drugs during intraperitoneal chemotherapy. Biomonitoring and surface contamination

Cited by 35 publications

References 32 publications

Environmental Contamination Assessment in the Process of Application of Aerosolized Therapeutic Substances

Environmental Contamination Assessment in the Process of Application of Aerosolized Therapeutic Substances

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

Pressurized intraperitoneal aerosol chemotherapy: a review of the introduction of a new surgical technology using the IDEAL framework

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