Efforts to Ensure Safety of Hospital Pharmacy Personnel Occupationally Exposed to Antineoplastic Drugs during a Preparation Task

Abstract

Purpose Antineoplastic drugs are often detected in the plasma and urine of medical staff, despite the adoption of safety measures. This study involves ambulatory chemotherapy, which was prepared on a rotating schedule at the Department of Pharmacy. The first objective of this study was to evaluate occupational exposure by measuring epirubicin in the urine and plasma and sister chromatid exchanges (SCE) in the peripheral lymphocytes of the involved pharmacists. The second, to improve a previously reported method for ease of occupational exposure evaluation. The third, to determine environmental contamination. Methods Pharmacists were categorized into three groups based on three patterns, depending on the other tasks they performed. They were alternately responsible for the preparation in each group with the recommended protections. Samples were collected at the end of each work day. High-performance liquid chromatography (HPLC) analysis along with fluorescence detection was performed at a flow rate of 200 mcL/min using 0.1% formic acid, methanol, and acetonitrile (75:5:20). Epirubicin in the samples was extracted by solid-phase extraction. Chromosomes were prepared according to a standard protocol. Results A final concentration of 2 ng/mL was the lower quantification limit. Epirubicin was not detected in the urine and plasma, and the SCE levels were within the normal limits for all the subjects. However, epirubicin was detected in samples collected from the preparation gloves. Conclusions For personnel safety, it is important to periodically evaluate protective measures. Pharmacists on a rotating schedule who work less than 6 hours per week on preparatory tasks were not unduly exposed to antineoplastics.

Evaluation of Environmental Contaminations and Occupational Exposures Involved in Preparation of Chemotherapeutic Drugs

“…We started preparing chemotherapeutic drugs for inpatients since February 2003, and for outpatients since November 2003. We adopted the standard precautionary measures to avoid occupational exposure from the beginning, 15) and we improved measures accordingly. For example, we switched the material of gloves from latex to nitrile rubbers because latex gloves were suspected to facilitate the permeation of hazardous drugs.…”

“…However, epirubicin was not detected in the urine samples of healthcare workers involved in chemotherapy. 15) In this study, we focused on occupational exposures to cyclophosphamide (CP). 16) CP is an alkylating agent, which is converted to its active metabolite phosphpramide mustard.…”

A Method for Risk Assessment Evaluating the Safety, Stability and Efficacy in Clinical Practice of Anticancer Drug Preparations in the Centralized Compounding Unit of the Veneto Institute of Oncology-IRCCS

“…This table represents an invaluable tool as it paves the way to improve the organization of centralized units and planning of preparations, with a consequent reduction of the clinical risk and exposure risk of the operators [ 26 ]. In particular, it contributes to containing economic waste, as it permits the optimal use of vial leftovers, multi-day vial sharing and dose banding procedures, as well as optimization of processing times and human resources [ 21 , 27 , 28 ]. This becomes even more important in the case of expensive biological drugs such as monoclonal antibodies, or for the setup of therapies with prolonged infusion time using elastomeric pumps.…”

Environmental Contaminations and Occupational Exposures Involved in Preparation of Chemotherapeutic Drugs

“…We also focused on occupational exposures to several chemotherapeutic drugs including cyclophosphamide, and concluded the precautionary measures we took were adequate to prevent occupational exposures [Ikeda et al,2007;Maeda et al,2010].…”