A Pooled Analysis to Study Trends in Exposure to Antineoplastic Drugs Among Nurses

Fransman, Wouter; Peelen, Susan; Hilhorst, Simone; Roeleveld, Nel; Heederik, Dick; Kromhout, Hans

doi:10.1093/annhyg/mel081

Cited by 46 publications

(12 citation statements)

References 24 publications

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“…Contamination of infusion pumps after drug administration started is similar to earlier reports (19,33,42). In fact, Hon et al (34) claim that infusion pumps are most often touched by nurses during drug administration.…”

Section: Discussionsupporting

confidence: 75%

“…In addition, long-term occupational exposure has been associated with increased risk of hair loss, infections (attributed to lower white blood cell count and immunosuppression), organ toxicity (e.g. liver, kidney, lung, and cardiac toxicity), myelotoxicity, mucosal ulcers, fatigue, bleeding, and headaches (19). Furthermore, occupationally exposed individuals have a higher incidence of DNA damage, chromosomal abnormalities, and cancer consistent with the inherent carcinogenic properties of these drugs (15,20,21).…”

mentioning

confidence: 99%

“…Some studies reported traces of several cytotoxic drugs on work surfaces serving for receiving, storing, preparing, and validating preparations in hospital pharmacies (29)(30)(31)(32)(33) and even on surfaces in administration areas (33,34). Some reported cytotoxic drugs in biological samples (blood and urine) from healthcare workers (19,(35)(36)(37) and some reported contamination of work surfaces even after their cleaning (4,(37)(38)(39)(40).…”

mentioning

confidence: 99%

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Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Viegas

Oliveira

Carolino

et al. 2018

Archives of Industrial Hygiene and Toxicology

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Healthcare workers who prepare or administer cytotoxic agents run the risk of exposure, and the risks for health are real even at doses lower than those applied in cancer patients, because, in theory, no dose is safe. The most common and problematic route of exposure is through the skin, especially as work surfaces can remain contaminated even after cleaning. This pilot study aimed to demonstrate the importance of having an effective surface decontamination protocol by determining surface contamination with cyclophosphamide, 5-fluorouracil, and paclitaxel as the most common cytotoxic drugs in an oncology day service. Samples were collected before and after drug handling and analysed with high performance liquid chromatography with diode array detection (HPLC-DAD). Of the 29 samples collected before drug handling 23 were contaminated, five of which with more than one drug. Of the 30 samples collected after drug handling 25 were contaminated, eight of which with more than one drug. The two time points did not significantly differ, which evidences a widespread contamination and ineffective cleaning. This calls for revising the cleaning protocol and handling procedure to place contamination under control as much as possible.

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Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Viegas

Oliveira

Carolino

et al. 2018

Archives of Industrial Hygiene and Toxicology

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“…To acknowledge the skewed distributions of exposures of nurses to antineoplastic agents [17], and to ensure that only those with reasonable possibilities of exposure were attributed exposure-time, a multiplicative weighting (0.00, 0.0625, 0.25, and 1.00) was assigned to the exposure probabilities from the algorithm (none, unlikely, possible, and probable exposure, respectively). In addition, part-time employment was assigned a weight of 0.5 and full-time employment a weight of 1.0.…”

Section: Methodsmentioning

confidence: 99%

Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

et al. 2010

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BackgroundTo determine the relationships of potential occupational exposure to antineoplastic drugs with cancer incidence and adverse pregnancy outcomes in a historical prospective cohort study of female registered nurses (RNs) from British Columbia, Canada (BC).MethodsFemale RNs registered with a professional regulatory body for at least one year between 1974 and 2000 formed the cohort (n = 56,213). The identifier file was linked to Canadian cancer registries. An RN offspring cohort from 1986 was created by linkages with the BC Birth and Health Status Registries. Exposure was assessed by work history in oncology or cancer agencies (method 1) and by estimating weighted duration of exposure developed from a survey of pharmacists and nursing unit administrators of all provincial hospitals and treatment centers and the work history of the nurses (method 2). Relative risks (RR) were calculated using Poisson regression for cancer incidence and odds ratios (OR) were calculated for congenital anomaly, stillbirth, low birth weight, and prematurity incidence, with 95% confidence intervals.ResultsIn comparison with other female RNs, method 1 revealed that RNs who ever worked in a cancer center or in an oncology nursing unit had an increased risk of breast cancer (RR = 1.83; 95% CI = 1.03 - 3.23, 12 cases) and their offspring were at risk for congenital anomalies of the eye (OR = 3.46, 95% CI = 1.08 - 11.14, 3 cases). Method 2 revealed that RNs classified as having the highest weighted durations of exposure to antineoplastic drugs had an excess risk of cancer of the rectum (RR = 1.87, 95% CI = 1.07 - 3.29, 14 cases). No statistically significant increased risks of leukemia, other cancers, stillbirth, low birth weight, prematurity, or other congenital anomalies in the RNs' offspring were noted.ConclusionsFemale RNs having had potential exposure to antineoplastic drugs were not found to have an excess risk of leukemia, stillbirth, or congenital anomalies in their offspring, with the exception of congenital anomalies of the eye, based on only three cases; however, elevated risks of breast and rectal cancer were observed.

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“…1-5 Antineoplastic drugs (ADs) are among the most commonly used hazardous drugs identified as carcinogenic by the International Agency for Research on Cancer (IARC). 6-7 Governmental bodies 8 and professional associations 9-10 have published guidelines on safe handling of ADs, yet guideline adoption is suboptimal.…”

Section: Introductionmentioning

confidence: 99%

Antineoplastic Drug Exposure in an Ambulatory Setting

et al. 2015

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Background Exposure to antineoplastic drugs confers health risks to workers, yet little is known about the exposure after a drug spill. Nor has the relationship between exposure and organizational factors such as staffing and work environment been studied. Objective To evaluate drug spills prospectively using biological measures and correlate drug spills with organizational factors. Methods Prospective questionnaires with 8-hour timed urine samples were collected from nursing and pharmacy personnel who reported a drug spill in one academic health center's infusion center. Urine was collected similarly from workers who did not report a spill. Liquid chromatography tandem mass spectrometry techniques identified detectable drug levels. After the prospective sampling period, workers were surveyed on workloads, practice environment, and safety behaviors. Results From 81 eligible individuals, 40 participated in the prospective study and 19 completed retrospective questionnaires. Four spills were reported by 9 personnel as multiple employees were exposed to drug spills. Four participants who reported a spill showed detectable levels of antineoplastic drugs. Four participants who did not report a spill had detectable levels of docetaxel. Compared with respondents who did not report a spill, collegial relations with physicians were significantly poorer for workers who reported spills. Conclusions The study protocol successfully captured drug spill reports and biological samples. Workers have detectable levels of antineoplastic drugs through both drug spills and environmental contamination.

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A Pooled Analysis to Study Trends in Exposure to Antineoplastic Drugs Among Nurses

Cited by 46 publications

References 24 publications

Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs

Antineoplastic Drug Exposure in an Ambulatory Setting

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