Environmental and Biological Monitoring of Platinum-Containing Drugs in Two Hospital Pharmacies Using Positive Air Pressure Isolators

Abstract

Environmental and biological monitoring of platinum containing drugs was implemented in two French hospital pharmacies using positive air pressure isolators and having similar working procedures when preparing antineoplastic drugs. Wipe sampling of surfaces, gloves, and vials was performed in the preparation room and in storage areas. All employees involved in the preparation of antineoplastic drugs were tested for urinary platinum on Monday before work and Friday after shift. Only traces of platinum were detected on surfaces in the preparation room outside the isolators (less than 1.61 pg cm(-2)). However, in one center, significant contamination was found in the storage area of the drug vials, which can most likely be linked to the rupture of a platinum vial and due to inefficient cleaning procedures. Surfaces inside the isolators were found to be contaminated (maximum: 198.4 pg cm(-2)). A higher level of contamination was detected in one pharmacy and could be explained by the lack of overgloving with regular changes during the preparation process. Nitrile gloves used during drug handling outside the isolator showed the highest platinum concentration (maximum: 5.86 ng per pair). With regards to platinum urine concentration, no significant difference was found between exposed and unexposed pharmacy personnel. Isolator technology combined with individual protective measures seems to be efficient to protect workers from occupational exposure to antineoplastic drugs, whereas specific individual protective procedures implemented were focussing on the risk of handling vials outside the isolator (e.g. high frequency of glove changing). Moreover, overgloving inside the isolator would contribute to substantially decrease inner surface contamination and should be recommended in order to limit the transfer of chemical contamination to the end products.

Occupational Exposure to Antineoplastic Drugs in Twelve French Health Care Setting: Biological Monitoring and Surface Contamination

“…A low percentage of contaminated workers, less than 20%, were reported in Europe [ 16 , 17 , 18 , 19 , 20 , 21 ]. Some other studies reported higher proportions of contaminated HCWs, >50% [ 22 , 23 , 24 ]. The results of these different studies are highly variable, probably due to the differences in study protocols, the investigated substances, or the limits of quantification of analytical methods.…”

NTP Monograph on the Systematic Review of Occupational Exposure to Cancer Chemotherapy Agents and Adverse Health Outcomes

“…Of the 19 studies that also evaluated control (also called unexposed) subjects, seven studies reported samples above the level of detection for both exposed and control subjects (Ensslin et al 1994a;Fransman et al 2007b;Kopp et al 2013a;, which suggested that environmental contamination that may be the issue. For example, in a small study of pharmacy personnel, reported that the urine samples both exposed and unexposed pharmacy staff tested positive for cyclophosphamide on the day they received training on use of the urine sample kits in the oncology laboratory (i.e., the five unexposed pharmacy staff were exposed by entering the oncology pharmacy).…”