Quartz is a human carcinogen and a causative agent of silicosis. Exposure levels often exceed exposure limits in the construction industry. The need for effective control measures is high, but the complex structure of the construction industry, the variability in sources of exposure and the frequent changes of worksite makes it difficult to implement even simple and potentially effective control measures. The aim of this study was to evaluate the impact of control measures for reducing quartz dust exposure and to assess the extent of their use. Full-shift respirable dust measurements (n = 61) and short-term measurements among construction workers were performed and results of a questionnaire study among 1335 construction workers were analysed. Full-shift measurements showed respirable quartz exposure levels up to 63 times the maximum allowable concentration (MAC) value (0.075 mg/m(3)). More than half of the measurements were above the MAC value. Control measures were not very strongly associated with the full-shift exposure estimates, but the short-term measurements showed large reduction factors (>70%) when wet dust suppression or local exhaust ventilation was used. The effectiveness of control measures is potentially high, and a significant part of the construction worker population is indeed using them on a regular basis. Still, both the exposure study and questionnaire survey show that the use of respiratory protection is the most widely used preventive measure in the construction industry. Respiratory protection might not always reduce exposure sufficiently. Only the combined use of more than one control measure can reduce exposures to acceptable levels.

Many studies into surface contamination of hospital environments have demonstrated that occupational exposure to cytotoxics through the dermal route remains a possible risk. In this study, we assess the actual dermal exposure of the hands of pharmacy technicians and cleaning personnel in a panel of hospitals performing tasks that pose a risk of exposure. We compare the dermal exposure to a tentative limit value for cyclophosphamide. Pharmacy technicians and cleaning personnel were asked for hand rinsing after performance of nine tasks previously identified as posing a risk of occupational exposure. All samples were analyzed for the presence and quantity of eight antineoplastic drugs. By using data on both the frequency of the performance of the tasks and the measured dermal contamination during these tasks, weekly exposure to the marker drug (cyclophosphamide) was calculated. In five Dutch hospitals, 70 hand rinse samples and 8 blanks were collected. These were analyzed and results were used to calculate weekly exposure. The tentative limit value used was 0.74 mg of cyclophosphamide. For cleaning personnel, all results remained below this threshold value. For pharmacy technicians, the compounding itself also remained well below the limit; however, the task involving preparatory work, as well as the checking of compounded drugs, had a 13% chance of exceeding the limit. All of the highest values were found when employees were not wearing gloves on these tasks. Cleaning personnel and pharmacy technicians compounding cytotoxic drugs in our study were sufficiently protected from occupational exposure. In contrast, pharmacy technicians who perform preparatory and finishing tasks (before and after the actual compounding) are not protected enough when they do not wear gloves.

Nurses working at outpatient clinics or oncology wards are still being exposed to cyclophosphamide, but their exposure decreased considerably between 1997 and 2000, presumably due to the introduction of detailed guidelines and regulations in The Netherlands, the subsequent increased use of LuerLock connections and infusion systems prefilled with saline, and growing hazard awareness of nurses working with antineoplastic drugs.