Hospitals and Pharmacies as Sources of Contamination by Cytostatic Pharmaceuticals: Long-Term Monitoring in the Czech Republic

Bláhová, Lucie; Doležalová, Lenka; Kuta, Jan; Kozáková, Šárka; Bláha, Luděk

doi:10.1007/978-3-030-21048-9_3

Cited by 5 publications

(13 citation statements)

References 41 publications

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“…Although available studies investigated occupational exposures to prototypical ADs such as Pt, CP, or FU (Kopp 2012;Odraska et al 2013;Blahova et al 2020), there are gaps in understanding contamination levels by other groups of ADs, especially in less explored regions. To our knowledge, this is the first study that brings information about AD surface contamination in the Slovak Republic.…”

Section: Discussionmentioning

confidence: 99%

“…Another frequently monitored AD with broad use in practice are platinum (Pt)-based ADs such as cis-, carbo-, and oxaliplatin classified as the IARC class 2A (probably carcinogenic to human) (Nussbaumer et al 2012) or 5-fluorouracil (FU, nucleotide analog) used in large quantities to treat solid tumors (Schierl et al 2009). Previous studies documented levels of these representative markers of exposure in various medical settings (Blahova et al 2020;Fleury-Souverain et al 2015;Roland et al 2017), but the information about other ADs commonly used in clinical practice is limited.…”

Section: Responsible Editor: Philippe Garriguesmentioning

confidence: 99%

“…The aliquot of 1 mL of supernatant was used for analyses of organic ADs by LC-MS/MS ("Analyses of surface contamination"), and the aliquot of 0.4 mL was analyzed by ICP-MS ("Analyses of surface contamination") after dilution with 2 mL of 3% hydrochloric acid. (Blahova et al 2020).…”

Section: Wipe Sampling and Extractionmentioning

confidence: 99%

“…Quantification was based on external calibration ( 194 Pt and 195 Pt isotopes) with correction of signal drift and non-spectral interferences on internal standards ( 185 Rh and 209 Bi). Results are reported as a picogram of Pt per square centimeter of surface (Blahova et al 2020).…”

Section: Analyses Of Surface Contaminationmentioning

confidence: 99%

“…The literature points to the long-term exposure to ADs, which can be associated with toxic effects in healthcare professionals (Ensslin et al 1994;Fransman et al 2007b;Kiffmeyer et al 2013;Schierl et al 1998). Workers exposed to ADs in hospitals include pharmacists that handle ADs during preparation (Blahova et al 2020;Kiffmeyer et al 2013;Odraska et al 2014;Sessink et al 1994;Yoshida et al 2013), nurses caring for oncology patients (Hon and Abusitta 2016;Meijster et al 2006;Sottani et al 2017), and other healthcare professionals such as custodians, laundry or rehabilitation staff, private oncology practitioners, and others. (Fransman et al 2007a;Kromhout et al 2000;Kopp 2012).…”

Section: Introductiaonmentioning

confidence: 99%

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Levels and risks of surface contamination by thirteen antineoplastic drugs in the Czech and Slovak hospitals and pharmacies

Doležalová

Bláhová

Kuta

et al. 2021

Environ Sci Pollut Res

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The consumption of hazardous antineoplastic drugs (ADs) used in anticancer chemotherapies is steadily increasing representing thus risks to both human health and the environment. Hospitals may serve as a contamination source, and pharmacists preparing the antineoplastic drugs (ADs) as well as nurses administering chemotherapy and caring for oncology patients are among the healthcare professionals being highly exposed. Here, we present the results of systematic monitoring (2018-2020) of surface contamination by 13 ADs in the pharmacies and hospitals in the Czech Republic (CZ; large-scale monitoring, 20 workplaces) and Slovak Republic (SK; pilot study at 4 workplaces). The study evaluated contamination by three commonly monitored ADs, i.e., 5-fluorouracil (FU), cyclophosphamide (CP), and platinum (total Pt representing cis-, carbo-, and oxaliplatin) together with ten less explored ADs, i.e., gemcitabine (GEM), ifosfamide (IF), paclitaxel (PX), irinotecan (IRI), docetaxel (DOC), methotrexate (MET), etoposide (ETOP), capecitabine (CAP), imatinib (IMAT), and doxorubicin (DOX). Floors and desktop surfaces in hospitals (chemotherapy application rooms, nurse working areas) were found to be more contaminated, namely with CP and Pt, in both countries when compared to pharmacies. Comparison between the countries showed that hospital surfaces in SK are generally more contaminated (e.g., CP median was 20 times higher in SK), while some pharmacy areas in the CZ were more contamined in comparison with SK. The newly studied ADs were detected at lower concentrations in comparison to FU, CP, and Pt, but some markers (GEM, IF, PX, and IRI) were frequently observed, and adding these compounds to routine monitoring is recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Responsible Editor: Philippe Garriguesmentioning

confidence: 99%

Section: Wipe Sampling and Extractionmentioning

confidence: 99%

Section: Analyses Of Surface Contaminationmentioning

confidence: 99%

Section: Introductiaonmentioning

confidence: 99%

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Levels and risks of surface contamination by thirteen antineoplastic drugs in the Czech and Slovak hospitals and pharmacies

Doležalová

Bláhová

Kuta

et al. 2021

Environ Sci Pollut Res

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Chromosomal damage in occupationally exposed health professionals assessed by two cytogenetic methods

Kadlčíková

Musilová

Hradská

et al. 2022

Archives of Environmental & Occupational Health

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Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program

Chabut

Tanguay

Gagné

et al. 2021

J Oncol Pharm Pract

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Introduction Healthcare workers exposure to antineoplastic drugs can lead to adverse health effects. Guidelines promote the safe handling of antineoplastic drugs, but no safe exposure limit was determined. Regular surface sampling contributes to ensuring workers safety. Methods A cross-sectional monitoring is conducted once a year with voluntary Canadian centers, since 2010. Twelve standardized sampling sites were sampled. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng/cm2) were: 0.001 for cyclophosphamide and gemcitabine; 0.3 for docetaxel and ifosfamide; 0.04 for 5-fluorouracil and paclitaxel; 0.003 for irinotecan; 0.002 for methotrexate; 0.01 for vinorelbine. Results The surfaces from 109 centers were sampled between 01/01/2020–18/06/2020. Twenty-six centers delayed their participation because of the COVID-19 pandemic. 1217 samples were analyzed. Surfaces were frequently contaminated with cyclophosphamide (34% positive, 75th percentile 0.00165 ng/cm2) and gemcitabine (16% and <0.001 ng/cm2). The armrest of patient treatment chairs (84% to at least one drug), the front grille inside the biological safety cabinet (BSC) (73%) and the floor in front of the BSC (55%) were frequently contaminated. Centers that prepared ≥5000 antineoplastic drugs annually had higher concentration of cyclophosphamide on their surfaces (p < 0.0001). Contamination measured on the surfaces was reduced from 2010 to 2020. Conclusions This large-scale study showed reproducible long term follow up of the contamination of standardized sites of Canadian centers and a reduction in surface contamination from 2010 to 2020. Periodic surface sampling help centers meet their continuous improvements goals to reduce exposure as much as possible. The COVID-19 pandemic had a limited impact on the program.

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Hospitals and Pharmacies as Sources of Contamination by Cytostatic Pharmaceuticals: Long-Term Monitoring in the Czech Republic

Cited by 5 publications

References 41 publications

Levels and risks of surface contamination by thirteen antineoplastic drugs in the Czech and Slovak hospitals and pharmacies

Levels and risks of surface contamination by thirteen antineoplastic drugs in the Czech and Slovak hospitals and pharmacies

Chromosomal damage in occupationally exposed health professionals assessed by two cytogenetic methods

Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program

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