Title
Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys
Author
Kromhout, H.
Hoek, F.
Uitterhoeve, R.
Huijbers, R.
Overmars, R.F.
Anzion, R.
Vermeulen, R.
Publication year
2000
Abstract
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.
Subject
Cyclophosphamide
Dermal exposure
Hospital
Nurses
Drug infusion
Drug products
Mass transfer
Physiological models
Skin
Toxic materials
Trace analysis
Anti neoplastic drugs
Dermal exposure
Intravenous drug infusion
Industrial hygiene
Antineoplastic agent
Contamination
Fluorescence
Hospital personnel
Occupational health
Air Pollutants, Occupational
Antineoplastic Agents
Benzenesulfonates
Environmental Monitoring
Fluorescent Dyes
Human
Models, Biological
Nursing Staff, Hospital
Observer Variation
Occupational Exposure
Risk Assessment
Skin Absorption
Support, Non-U.S. Gov't
Workplace
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TNO identifier
87322
Source
Annals of Occupational Hygiene, 44 (7), 551-560
Document type
article