Monitoring occupational exposure to cancer chemotherapy drugs

Somatic mutations at the T-cell antigen receptor in antineoplastic drug-exposed populations: comparison with sister chromatid exchange frequency

“…Furthermore, patients receiving therapeutic doses of these drugs may develop a wide range of acute and chronic adverse events, including second neoplasms (Valagussa and Bonadonna 1998). For this reason, health care workers handling cytotoxic agents have been considered at genotoxic risk and have been widely investigated in the past decades using a number of biological markers and methods for exposure assessment, both nonspeci®c (i.e., cytogenetic damage, point mutations, or 32 P-post-labeling adducts in peripheral blood lymphocytes, urinary mutagenicity) and speci®c for a given compound (immunological methods for DNA adducts, speci®c analytical methods) (reviewed in Baker and Connor 1996). Among several assays, the analysis of sister chromatid exchange (SCE) in phytohemagglutinin (PHA)-stimulated lymphocytes appeared to be the only reliable method to detect possible eects of low-level exposures among health care workers handling cytotoxic agents (reviewed in Sorsa et al 1985;Sorsa and Anderson 1996).…”

“…Among several assays, the analysis of sister chromatid exchange (SCE) in phytohemagglutinin (PHA)-stimulated lymphocytes appeared to be the only reliable method to detect possible eects of low-level exposures among health care workers handling cytotoxic agents (reviewed in Sorsa et al 1985;Sorsa and Anderson 1996). Results from these cytogenetic studies were sometimes contradictory (Lambert et al 1982;Fucic et al 1998;Hagmar et al 1998; references in Baker and Connor 1996), possibly because of dierences in exposures, protective measures, dosimetry procedures, and the presence of known confounders including smoking, dietary habits, medications, or other additional chemical exposures.…”

A Survey of the Status of Hazardous Drug Awareness and Control in a Sample Massachusetts Nursing Population

“…Over the next three decades, numerous research projects and publications identified a variety of chemicals to which health care providers and nurses were exposed. (1) The projects described the means to perform occupational monitoring of respiratory or dermal exposures. They covered a variety of drugs and identified workers who had been exposed as indicated by either environmental exposure assessment or, in some cases, by biological exposure indicators through medical surveillance.…”

“…(4−6) During the 1980s and 1990s, in association with the results of the published findings, other papers were written that described and promoted additional methods to monitor and document exposures and to protect workers. (1) Engineering controls were recommended, administrative programs for control and training were proposed, and the use of effective personal protective equipment (PPE) was encouraged. (7,8) In September 2004, the Department of Health and Human Services Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) issued "NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings."…”

Organizational Safety Culture/Climate and Worker Compliance With Hazardous Drug Guidelines: Lessons From The Blood-Borne Pathogen Experience

“…[7][8][9][10] In the last 20 years, evidence of worker exposure has accumulated. In both the pharmacy and clinical care areas there is documentation of environmental drug contamination; 11-14 multiple studies have reported increases in genotoxicity measures; [1][2][3][4][15][16][17][18][19] and recovery of drugs in the urine of HCWs has been documented. In some cases drugs have been recovered in the urine of HCWs proximal to, but not handling these agents, implying work environment contamination.…”