Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys

Ann Occup Hyg. 2000 Oct;44(7):551-60. doi: 10.1016/s0003-4878(00)00050-8.

Abstract

Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring technique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 microl of contamination) and a very high inter-observer agreement (ICC=0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5-250 microg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental set-up. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/m(3) of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses involved in administering drugs and nurses caring for treated patients. Estimation of all relevant mass transport rates will be a challenge for the near future.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Air Pollutants, Occupational / analysis
  • Antineoplastic Agents / analysis*
  • Benzenesulfonates / analysis*
  • Environmental Monitoring / instrumentation
  • Environmental Monitoring / methods*
  • Fluorescent Dyes / analysis*
  • Humans
  • Models, Biological*
  • Nursing Staff, Hospital*
  • Observer Variation
  • Occupational Exposure / analysis*
  • Risk Assessment / methods*
  • Skin Absorption*
  • Workplace

Substances

  • Air Pollutants, Occupational
  • Antineoplastic Agents
  • Benzenesulfonates
  • Fluorescent Dyes
  • Tinopal