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

Abstract

Many healthcare workers are concerned about the risk of occupational exposures to hazardous drugs. The Japanese Society of Hospital Pharmacists (JSHP) revised the``Guidelines for the Handling of Antineoplastic Drugs in Hospitals'', however, the precautions and awareness of handling drugs varied in institutions. We assessed the levels of environmental contaminations in our hospital and urinary excretion of cyclophosphamide (CP) and ifosfamide (IF) in pharmacists and nurses. In environmental studies, we obtained samples by wiping the surfaces around two biological safety cabinets (BSCs) on eight days for four months. One BSC was equipped in hospital pharmacy and the other was equipped in an oncology ward, and used for preparing chemotherapeutic drugs for outpatients and for inpatients, respectively. We obtained the urine samples from 6 pharmacists and 2 nurses. We used solid phase extraction (SPE) as a convenient extraction procedure and liquid chromatography/mass spectrometry/mass spectrometry (LC/MS/MS) for the analysis of the samples. CP was detected on the working surfaces inside both BSCs, and detected at low levels on the back surfaces of the BSCs and at the working tables around the BSCs. IF over the LLOQ was not detected in both BSCs. CP and IF were not detected in all urine samples of pharmacists and nurses. Detection frequencies and amounts of these drugs were low levels, compared with previous reports in Japan, and our results showed that improving awareness about handling hazardous drugs could reduce the risk of the occupational exposures.

Environmental Contamination with Hazardous Drugs in Quebec Hospitals

“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24] This large group of recently published studies affords a good "snapshot" of current levels of surface contamination in several countries. The studies were conducted in a total of 92 hospitals in 7 countries (28 in Germany, 21 26 in the United States, 12,20,23 16 in Italy, 14,15,22 13 in Japan, 11,13,18,19 6 in Canada, 16 2 in Australia, 24 and 1 in the Czech Republic…”

“…For 8 of the 14 studies, the hospitals had not implemented a CSTD, and the proportion of cyclophosphamide-positive samples ranged from 14% to 94%. [11][12][13][14][15][16][17][18] For the 6 remaining studies, the hospitals had implemented a CSTD, and for 5 of counters used for priming and validation by nurses, floors in front of the hoods, and storage shelves in the pharmacy. The highest cyclophosphamide concentration (28 ng/cm 2 ) was found on the exterior surface of a drug container.…”

A Direct Injection LC/ESI-MS/MS Analysis of Urinary Cyclophosphamide as an Anticancer Drug for Monitoring Occupational Exposure

“…Therefore, we have to measure at least 6.7 pg/mL of cyclophosphamide in the urine. Although several LC/MS/MS methods have been reported for measurement of cyclophosphamide in urine [7][8][9], their sensitivity was insufficient to monitor occupational exposure. The present method covered a linearity range of 3 pg/mL to 3000 pg/mL of concentrations in urine, and the correlation coefficient was more than 0.999.…”

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].…”

“…We took this monitoring on seven days for successive two weeks. An extraction of wiping samples for environmental assessments was modified by our previous report [Maeda et al,2010]. Briefly, we first applied internal standards mixtures, containing 10 g of 3,4-anhydro vincrisitine, 500 ng of carminomycin, trofosfamide, camptothecin and cephalomannine to sampling spots.…”