Nurses' internal contamination by antineoplastic drugs in hospital centers: a cross-sectional descriptive study

Int Arch Occup Environ Health. 2021 Nov;94(8):1839-1850. doi: 10.1007/s00420-021-01706-x. Epub 2021 May 22.


Objective: The aim of this study was to assess internal antineoplastic drugs (ADs) contamination in the nursing staff in French hospital centers, using highly sensitive analytical methods.

Methods: This cross-sectional study included nurses practicing in care departments where at least one of the five ADs studied was handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The nurses study participation lasted 24 h including collection of three urine samples and one self-questionnaire. All urine samples were assayed by ultra-high-performance liquid chromatography-tandem mass spectrometry methods with very low value of the lower limit of quantification (LLOQ).

Results: 74 nurses were included, 222 urine samples and 74 self-questionnaires were collected; 1092 urine assays were performed. The percentage of nurses with internal AD contamination was 60.8% and low levels of urinary concentrations were measured. Regarding nurses with internal contamination (n = 45), 42.2% presented internal contamination by methotrexate, 37.8% by cyclophosphamide, 33.3% by ifosfamide, 17.8% by 5-fluorouracil metabolite and 6.7% by doxorubicine. Among the positive assays, 17.9% (n = 26/145) were not explained by exposure data from the self-questionnaire but this could be due to the skin contact of nurses with contaminated work surfaces.

Conclusions: This study reported high percentage of nurses with internal ADs contamination. The low LLOQ values of the used analytical methods, allowed the detection of ADs that would not have been detected with the current published methods: the percentage of contamination would have been 17.6% instead of the 60.8% reported here. Pending toxicological reference values, urine ADs concentrations should be reduced as low as reasonably achievable (ALARA principle).

Keywords: Antineoplastic drugs; Biomonitoring; Internal contamination; Nurses; Occupational exposure; Urine analysis.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Antineoplastic Agents / urine*
  • Biological Monitoring
  • Cross-Sectional Studies
  • Cyclophosphamide / urine
  • Doxorubicin / urine
  • Female
  • Fluorouracil / urine
  • Hospitals
  • Humans
  • Ifosfamide / urine
  • Male
  • Methotrexate / urine
  • Middle Aged
  • Nurses*
  • Nursing Staff, Hospital*
  • Occupational Exposure / analysis*
  • Surveys and Questionnaires
  • Young Adult


  • Antineoplastic Agents
  • Doxorubicin
  • Cyclophosphamide
  • Fluorouracil
  • Ifosfamide
  • Methotrexate