Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys
article
Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring technique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 μl of contamination) and a very high inter-observer agreement (ICC = 0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5-250 μg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental set-up. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/m3 of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses involved in administering drugs and nurses caring for treated patients. Estimation of all relevant mass transport rates will be a challenge for the near future. (C) 2000 British Occupational Hygiene Society.
Topics
CyclophosphamideDermal exposureHospitalNursesDrug infusionDrug productsMass transferPhysiological modelsSkinToxic materialsTrace analysisAnti neoplastic drugsDermal exposureIntravenous drug infusionIndustrial hygieneAntineoplastic agentContaminationFluorescenceHospital personnelOccupational healthAir Pollutants, OccupationalAntineoplastic AgentsBenzenesulfonatesEnvironmental MonitoringFluorescent DyesHumanModels, BiologicalNursing Staff, HospitalObserver VariationOccupational ExposureRisk AssessmentSkin AbsorptionSupport, Non-U.S. Gov'tWorkplace
TNO Identifier
87322
Source
Annals of Occupational Hygiene, 44(7), pp. 551-560.
Pages
551-560
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