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Kamba PF, Kaggwa B, Munanura EI, Okurut T, Kitutu FE. Why regulatory indifference towards pharmaceutical pollution of the environment could be a missed opportunity in public health protection. a holistic view. Pan Afr Med J 2017; 27:77. [PMID: 28819498 PMCID: PMC5554629 DOI: 10.11604/pamj.2017.27.77.10973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/22/2017] [Indexed: 12/05/2022] Open
Abstract
The last generation has witnessed bludgeoning of the world's population, a spike in disease burden, and unprecedented levels of pharmaceutical consumption and production. Unfortunately, pharmaceuticals have left their industrial and household confines and leaked into the environment. Pharmaceuticals are now major environmental pollutants, and are ubiquitous in waters and soils. Unlike other environmental contaminants, pharmaceutical pollutants are not yet regulated globally, simply because acute risk assessments show insignificant human health hazard. But the pitfalls of pharmaceutical pollutants extend beyond acute effects to delayed effects from bioaccumulation, amplified effects from drug-drug interactions, exacerbation of drug resistance, and reduction in aquatic and terrestrial food production. Therefore, ignoring pharmaceutical pollutants deprives society of holistic public health protection.
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Affiliation(s)
- Pakoyo Fadhiru Kamba
- Department of Pharmacy, School of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Bruhan Kaggwa
- Department of Pharmacy, School of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Edson Ireeta Munanura
- Department of Pharmacy, School of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Tom Okurut
- National Environment Management Authority (NEMA), Plot 17/19/21 Jinja Road, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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102
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Warembourg C, Cordier S, Garlantézec R. An update systematic review of fetal death, congenital anomalies, and fertility disorders among health care workers. Am J Ind Med 2017; 60:578-590. [PMID: 28514021 DOI: 10.1002/ajim.22711] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Health care workers (HCWs) are occupationally exposed to various hazards, some associated with adverse pregnancy outcomes in previous reviews. This systematic review aims at synthesizing the recent literature on occupational exposures among HCWs related to fetal death, congenital anomalies, and fertility disorders. METHODS We searched the Medline database from 2000 to 2015 for articles about all potential occupational exposures of women and men working in this sector. RESULTS We retained 32 studies, most of them (n = 30) among women HCWs. Studies based on job title reported excess risks of some congenital anomalies (especially nervous and musculoskeletal systems) among HCWs compared to non-HCWs but no evidence about fetal death. Excess risks associated with specific exposures includes reports of some congenital anomalies for women exposed to anesthetic gases. Exposure to some sterilizing agents and, with less evidence, to antineoplastic drugs and to ionizing radiation, is associated with increased risks of miscarriage but not stillbirth. Strenuous work schedules appear to be associated with fertility disorders, but the evidence is limited. Only a few studies have been published since 2000 about non-ionizing radiation, or about fertility disorders related to chemical or physical agents, or about male HCWs. CONCLUSIONS Despite the establishment of recommendations to limit exposures of HCWs, some excess risks of adverse pregnancy outcomes are still reported and need to be explained.
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Affiliation(s)
- Charline Warembourg
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
| | - Sylvaine Cordier
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
| | - Ronan Garlantézec
- Institut national de la santé et de la recherche médicale (Inserm); U1085, Institut de recherche en santé, environnement et travail (Irset); Rennes France
- Université de Rennes 1; Rennes France
- Service de santé publique et d’épidémiologie; CHU de Rennes; Rennes France
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103
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Walton AL. Doing the Dirty Work: Who Handles Antineoplastic Drug Contaminated Excreta and do They Do It Safely? Asia Pac J Oncol Nurs 2017; 4:120-121. [PMID: 28503643 PMCID: PMC5412148 DOI: 10.4103/apjon.apjon_8_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- AnnMarie Lee Walton
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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104
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Böhlandt A, Sverdel Y, Schierl R. Antineoplastic drug residues inside homes of chemotherapy patients. Int J Hyg Environ Health 2017; 220:757-765. [PMID: 28372941 DOI: 10.1016/j.ijheh.2017.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
Chemotherapy treatment of cancer patients has shifted from inpatient to outpatient administration. Thus, family members are potentially exposed to cytotoxic drug residues from patients' excretions inside their homes. The study's aim was to evaluate the surface contamination and the potential uptake of antineoplastic drug residues by family members at home of chemotherapy patients. Overall, 265 wipe samples from 13 homes were taken at two times after chemotherapy from different surfaces (toilet, bathroom, kitchen). 62 urine samples were collected from patients and family members on three days. Samples were analyzed for cyclophosphamide, 5-fluorouracil (urine: FBAL) and platinum (as marker for cis-, carbo- and oxaliplatin). Substantial contamination was found on every surface type (PT: 0.02-42.5pg/cm2, 5-FU: ND-98.3pg/cm2, CP: ND-283.3pg/cm2) with highest concentrations on toilet and bathroom surfaces. While patients' urinary drug concentrations often were elevated for more than 48h after administration, no drug residues were detectable in the family members' urine. This study provided an insight in the exposure situation against antineoplastic drug residues at home of chemotherapy patients. As contamination could be found on various surfaces adequate hygienic and protective measures are necessary to minimize the exposure risk for cohabitants.
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Affiliation(s)
- Antje Böhlandt
- Occupational, Social and Environmental Medicine, LMU Munich, Germany.
| | - Yulia Sverdel
- Occupational, Social and Environmental Medicine, LMU Munich, Germany.
| | - Rudolf Schierl
- Occupational, Social and Environmental Medicine, LMU Munich, Germany.
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105
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Adverse pregnancy outcomes in healthcare workers: a Korean nationwide population-based study. Int Arch Occup Environ Health 2017; 90:501-506. [DOI: 10.1007/s00420-017-1213-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 02/17/2017] [Indexed: 12/23/2022]
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106
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Connor TH, Celano P, Frame JN, Zon RT. Summary of the Workshop on the Safe Handling of Hazardous Drugs Cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical Oncology. J Oncol Pract 2017; 13:199-205. [DOI: 10.1200/jop.2016.017384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Thomas H. Connor
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH; The Cancer Center at Greater Baltimore Medical Center, Baltimore, MD; Charleston Area Medical Center, Charleston, WV; and Michiana Hematology Oncology, South Bend, IN
| | - Paul Celano
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH; The Cancer Center at Greater Baltimore Medical Center, Baltimore, MD; Charleston Area Medical Center, Charleston, WV; and Michiana Hematology Oncology, South Bend, IN
| | - James N. Frame
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH; The Cancer Center at Greater Baltimore Medical Center, Baltimore, MD; Charleston Area Medical Center, Charleston, WV; and Michiana Hematology Oncology, South Bend, IN
| | - Robin T. Zon
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH; The Cancer Center at Greater Baltimore Medical Center, Baltimore, MD; Charleston Area Medical Center, Charleston, WV; and Michiana Hematology Oncology, South Bend, IN
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107
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Crickman R. Chemotherapy Safe Handling: Limiting Nursing Exposure With a Hazardous Drug Control Program. Clin J Oncol Nurs 2017; 21:73-78. [PMID: 28107320 DOI: 10.1188/17.cjon.73-78] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nurses and other healthcare workers are at risk for adverse health consequences from occupational exposure to hazardous drugs. OBJECTIVES An evidence-based program for nurses was implemented to improve safe handling practices and reduce exposure to hazardous drugs. METHODS A quasiexperimental design was used, with pre- and post-tests of knowledge about chemotherapy exposure and pre- and post-test observations of compliance with donning and doffing personal protective equipment (PPE). Surface wipe tests were conducted to determine hazardous drug contamination in care areas. A toolkit of interventions, including hazardous drug identification, standardization of PPE, and education, was used. FINDINGS Mean knowledge scores of chemotherapy improved after education. Correct donning of PPE was high before and after the intervention, and the correct doffing sequence improved postintervention. One sample was positive for 5-fluorouracil, affirming the difficulty of maintaining an environment free of contamination.
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108
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Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing. Int Arch Occup Environ Health 2017; 90:275-284. [DOI: 10.1007/s00420-017-1196-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
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109
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Redic KA, Fang K, Christen C, Chaffee BW. Surface contamination of hazardous drug pharmacy storage bins and pharmacy distributor shipping containers. J Oncol Pharm Pract 2016; 24:91-97. [PMID: 27856922 DOI: 10.1177/1078155216679027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose This study was conducted to determine whether there is contamination on exterior drug packaging using shipping totes from the distributor and carousel storage bins as surrogate markers of external packaging contamination. Methods A two-part study was conducted to measure the presence of 5-fluorouracil, ifosfamide, cyclophosphamide, docetaxel and paclitaxel using surrogate markers for external drug packaging. In Part I, 10 drug distributor shipping totes designated for transport of hazardous drugs provided a snapshot view of contamination from regular use and transit in and out of the pharmacy. An additional two totes designated for transport of non-hazardous drugs served as controls. In Part II, old carousel storage bins (i.e. those in use pre-study) were wiped for snapshot view of hazardous drug contamination on storage bins. New carousel storage bins were then put into use for storage of the five tested drugs and used for routine storage and inventory maintenance activities. Carousel bins were wiped at time intervals 0, 8, 16 and 52 weeks to measure surface contamination. Results Two of the 10 hazardous shipping totes were contaminated. Three of the five-old carousel bins were contaminated with cyclophosphamide. One of the old carousel bins was also contaminated with ifosfamide. There were no detectable levels of hazardous drugs on any of the new storage bins at time 0, 8 or 16 weeks. However, at the Week 52, there was a detectable level of 5-FU present in the 5-FU carousel bin. Conclusions Contamination of the surrogate markers suggests that external packaging for hazardous drugs is contaminated, either during the manufacturing process or during routine chain of custody activities. These results demonstrate that occupational exposure may occur due to contamination from shipping totes and storage bins, and that handling practices including use of personal protective equipment is warranted.
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Affiliation(s)
| | | | - Catherine Christen
- 3 Department of Pharmacy Services, University of Michigan Health System, Michigan, USA
| | - Bruce W Chaffee
- 3 Department of Pharmacy Services, University of Michigan Health System, Michigan, USA
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110
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Poupeau C, Tanguay C, Caron NJ, Bussières JF. Multicenter study of environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in 48 Canadian hospitals. J Oncol Pharm Pract 2016; 24:9-17. [DOI: 10.1177/1078155216676632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible. Objectives To monitor environmental contamination with cyclophosphamide, ifosfamide, and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination. Methods This is a descriptive study. Twelve standardized sites were sampled in each participating center (six in the pharmacy and six in patient care areas). Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. Descriptive statistical analyses were done and results were compared with a Kolmogorov–Smirnov test for independent samples. Results In 2015, 48 hospitals participated in this study (48/202, 24%). Overall, 34% (181/525) of the samples were positive for cyclophosphamide, 8% (41/525) for ifosfamide, and 6% (31/525) for methotrexate. The 75th percentile value of cyclophosphamide surface concentration was 6.9 pg/cm2. For ifosfamide and methotrexate, they were lower than the limit of detection. Centers who prepared more antineoplastic drugs per year and centers who used more cyclophosphamide per year showed significantly higher surface contamination ( p < 0.0001). Over the years, we observed a reduction in surface contamination. Conclusion In comparison with other multicenter studies that were conducted in Canada, the concentration of antineoplastic drugs measured on surfaces is decreasing. Regular environmental monitoring is a good practice in order to maintain contamination as low as reasonably achievable.
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Affiliation(s)
- Céline Poupeau
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Cynthia Tanguay
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Nicolas J Caron
- Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
| | - Jean-François Bussières
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
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111
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Canal-Raffin M, Khennoufa K, Martinez B, Goujon Y, Folch C, Ducint D, Titier K, Brochard P, Verdun-Esquer C, Molimard M. Highly sensitive LC-MS/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide, ifosfamide, and methotrexate antineoplastic drugs and routine application. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1038:S1570-0232(16)31088-1. [PMID: 28029545 DOI: 10.1016/j.jchromb.2016.10.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
Highly sensitive ESI-LC-MS/MS methods were developed for urinary biological monitoring of occupational exposure to cyclophosphamide (CP), ifosfamide (IF), and methotrexate (MTX), which are hazardous antineoplastic drugs frequently handled by healthcare professionals. Extraction methods consisted of liquid/liquid extraction for simultaneous urinary CP and IF assays, and of solid phase extraction for the urinary MTX assay. A good linearity (r2>0.997), precision (CV<14.6%), and accuracy (bias<9.9%) were achieved for all compounds. The limit of detection (LOD) was 10pg/ml and the lower limit of quantification (LOQ) was 20pg/ml for all three drugs. Applying these methods in routine, more than 116 healthcare professionals occupationally exposed to antineoplastic drugs were monitored and 635 urines were analysed. Eleven healthcare professionals (9.5%) were found to be contaminated to at least one of the three antineoplastic drugs. Among analysed urines, 22 samples were found positives. The measured concentrations ranged from 20.1 to 1850pg/ml and, for six samples, concentrations were at CP trace level, between the LOD and LOQ values (10-20pg/ml). Such efficient analytical tools combining high specificity with high sensitivity are essential for reliable detection and routine biological monitoring of healthcare professionals occupationally exposed to these widely used antineoplastic drugs. These methods allow to monitor the healthcare professionals exposure to antineoplastic drugs in the aim to assess the effectiveness of collective and individual protective measures.
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Affiliation(s)
- Mireille Canal-Raffin
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France; INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France.
| | - Karim Khennoufa
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Béatrice Martinez
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
| | - Yves Goujon
- Association d'Hygiène Industrielle Bordeaux (AHI33), 33070 Bordeaux, France
| | - Celia Folch
- Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France
| | - Dominique Ducint
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Karine Titier
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France
| | - Patrick Brochard
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
| | - Catherine Verdun-Esquer
- INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Service de Médecine du Travail et de Pathologies Professionnelles, CHU de Bordeaux, 33076 Bordeaux, France
| | - Mathieu Molimard
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, 33076 Bordeaux, France; INSERM U1219, ISPED, Université de Bordeaux, 33076 Bordeaux, France; Univ. of Bordeaux, 33076 Bordeaux, France
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112
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Poupeau C, Roland C, Bussières JF. [Not Available]. Can J Hosp Pharm 2016; 69:376-387. [PMID: 27826155 PMCID: PMC5085322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND There is increasing evidence that traces of hazardous drugs occur in the urine of health care professionals who are exposed to these drugs. OBJECTIVE To review the scientific literature regarding urinary monitoring of health care professionals exposed to antineoplastic drugs through their work. DATA SOURCES A search of PubMed using the Medical Subject Headings 'occupational exposure' and 'antineoplastic agents' and of Google Scholar using the terms 'antineoplastic', 'urine', and 'occupational exposure'. STUDY SELECTION AND DATA EXTRACTION The analysis covered all articles in English or French pertaining to health care professionals exposed to hazardous drugs in the workplace, published from January 1, 2010, to December 31, 2015. Articles that did not discuss the results of urine tests and those concerning veterinarians, as well as literature reviews, editorials, letters to the editor, and conference abstracts, were excluded. DATA SYNTHESIS Twenty-four articles were retained. The studies were conducted in 52 health care institutions in 7 countries. They included 826 workers exposed to hazardous drugs and 175 controls, specifically nurses (n = 16 studies), pharmacists (n = 10), pharmacy technicians (n = 8), physicians (n = 7), health care aides (n = 2), and others (n = 8). Various analytical methods were used to quantify the presence of 13 hazardous drugs, primarily cyclophosphamide (n = 16 studies), platinum-based drugs (n = 7), and alpha-fluoro-beta-alanine, a urine metabolite derived from 5-fluorouracil (n = 3). The proportion of workers with positive results ranged from 0% (n = 10 studies) to 100% (n = 4). Considering only those studies that allowed calculation of the rate of workers with at least one positive urine sample (n = 23), the total proportion was 21% (173/809 workers, for all methods and drugs combined). CONCLUSION Twenty-four studies on urine monitoring were conducted in 7 countries between 2010 and 2015. In several studies, no traces of drugs were detected in urine.
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Affiliation(s)
- Céline Poupeau
- est une assistante de recherche, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi une étudiante dans le programme D.Pharm. dans la Faculté des Sciences Pharmaceutiques et Biologiques de Nancy, Université de Nancy 1, Nancy, France
| | - Christel Roland
- est une assistante de recherche, Unité de recherche en pratique pharmaceutique, Centre hospitalier universitaire Sainte-Justine, Montréal, Québec. Elle est aussi une étudiante dans le programme D.Pharm. dans la Faculté des Sciences Pharmaceutiques et Biologiques de Lille, Université Lille 2 Droit et Santé, Lille, France
| | - Jean-François Bussières
- B. Pharm., M. Sc., MBA, FCSHP, est chef, Unité de recherche en pratique pharmaceutique et Départment de pharmacie, Centre hospitalier universitaire Sainte-Justine, et professeur titulaire de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec
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113
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Simon N, Vasseur M, Pinturaud M, Soichot M, Richeval C, Humbert L, Lebecque M, Sidikou O, Barthelemy C, Bonnabry P, Allorge D, Décaudin B, Odou P. Effectiveness of a Closed-System Transfer Device in Reducing Surface Contamination in a New Antineoplastic Drug-Compounding Unit: A Prospective, Controlled, Parallel Study. PLoS One 2016; 11:e0159052. [PMID: 27391697 PMCID: PMC4938267 DOI: 10.1371/journal.pone.0159052] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this randomized, prospective and controlled study was to investigate the ability of a closed-system transfer device (CSTD; BD-Phaseal) to reduce the occupational exposure of two isolators to 10 cytotoxic drugs and compare to standard compounding devices. Methods and Findings The 6-month study started with the opening of a new compounding unit. Two isolators were set up with 2 workstations each, one to compound with standard devices (needles and spikes) and the other using the Phaseal system. Drugs were alternatively compounded in each isolator. Sampling involved wiping three surfaces (gloves, window, worktop), before and after a cleaning process. Exposure to ten antineoplastic drugs (cyclophosphamide, ifosfamide, dacarbazine, 5-FU, methotrexate, gemcitabine, cytarabine, irinotecan, doxorubicine and ganciclovir) was assessed on wipes by LC-MS/MS analysis. Contamination rates were compared using a Chi2 test and drug amounts by a Mann-Whitney test. Significance was defined for p<0.05. Overall contamination was lower in the “Phaseal” isolator than in the “Standard” isolator (12.24% vs. 26.39%; p < 0.0001) although it differed according to drug. Indeed, the contamination rates of gemcitabine were 49.3 and 43.4% (NS) for the Standard and Phaseal isolators, respectively, whereas for ganciclovir, they were 54.2 and 2.8% (p<0.0001). Gemcitabine amounts were 220.6 and 283.6 ng for the Standard and Phaseal isolators (NS), and ganciclovir amounts were 179.9 and 2.4 ng (p<0.0001). Conclusion This study confirms that using a CSTD may significantly decrease the chemical contamination of barrier isolators compared to standard devices for some drugs, although it does not eliminate contamination totally.
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Affiliation(s)
- Nicolas Simon
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
- * E-mail:
| | - Michèle Vasseur
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | | | - Marion Soichot
- Laboratoire de Toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Richeval
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | - Luc Humbert
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | | | | | - Christine Barthelemy
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Delphine Allorge
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | - Bertrand Décaudin
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - Pascal Odou
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
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114
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Callahan A, Ames NJ, Manning ML, Touchton-Leonard K, Yang L, Wallen GR. Factors Influencing Nurses' Use of Hazardous Drug Safe-Handling Precautions. Oncol Nurs Forum 2016; 43:342-9. [PMID: 27105195 PMCID: PMC4876597 DOI: 10.1188/16.onf.43-03ap] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify factors associated with oncology nurses' use of hazardous drug (HD) safe-handling precautions in inpatient clinical research units.
. DESIGN Descriptive, cross-sectional.
. SETTING The National Institutes of Health Clinical Center in Bethesda, Maryland.
. SAMPLE 115 RNs working on high-volume HD administration units.
. METHODS Survey data were collected online using the Hazardous Drug Handling Questionnaire. Data were analyzed using descriptive statistics and multiple regression analysis.
. MAIN RESEARCH VARIABLES Exposure knowledge, self-efficacy, barriers to personal protective equipment use, perceived risk, conflict of interest, interpersonal influences, workplace safety climate, and total mean HD precaution use.
. FINDINGS Participants demonstrated high exposure knowledge, self-efficacy, perceived risk, interpersonal influences, and workplace safety climate. Participants demonstrated moderate barriers and conflict of interest. Total mean HD precaution use proved highest during HD administration and lowest for handling excreta at 48 hours. Average patients per day significantly influenced total HD precaution. CONCLUSIONS Despite high exposure knowledge, barriers to personal protective equipment use and conflict of interest may contribute to reduced adoption of personal protective practices among oncology nurses.
. IMPLICATIONS FOR NURSING Hospital and unit-specific factors captured by the predictor variables could contribute to institutional HD policy.
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Affiliation(s)
- Amy Callahan
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
| | - Nancy J. Ames
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
| | - Mary Lou Manning
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
| | - Kate Touchton-Leonard
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
| | - Li Yang
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
| | - Gwenyth R. Wallen
- Callahan is a nurse manager in the Sidney Kimmel Cancer Center at the Thomas Jefferson University Hospital in Philadelphia, PA; Ames is a research specialist in the Nursing Department at the National Institutes of Health Clinical Center in Bethesda, MD; Manning is an associate professor in the School of Nursing at Thomas Jefferson University in Philadelphia; and Touchton- Leonard is a research assistant, Yang is a biostatistician, and Wallen is deputy chief nurse, all in the Nursing Department at the National Institutes of Health Clinical Center
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115
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Poupeau C, Tanguay C, Plante C, Gagné S, Caron N, Bussières JF. Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers. J Oncol Pharm Pract 2016; 23:323-332. [DOI: 10.1177/1078155216643860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose There are health risks to workers occupationally exposed to antineoplastic drugs. We hypothesized that implementing a biological monitoring program would be feasible. The goal was to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs. Methods We recruited workers from the hematology–oncology department and control workers in a mother–child university health center. This study was preceded by an information period during which we aimed at enhancing the workers’ awareness and knowledge of the risks of occupational exposure. Participants filled out a journal containing activities performed and personal protective equipment worn. One urine sample was collected at the end of their shift. Samples were analyzed by UPLC/MS-MS for the presence of cyclophosphamide, ifosfamide, methotrexate, and alpha-fluoro-beta-alanine (5-fluorouracile’s main urinary metabolite). Results The participation rate was 85.7% (102/119). No urine sample had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians, and 0/7 doctors). In the 5 days before sampling, 67/92 (72.8%) hematology–oncology participants performed at least one activity with antineoplastic drugs. Nurses wore all of the recommended protection for technical activities (86.2%), but rarely for non-technical activities (14.9%). Pharmacists and pharmacy technicians wore all of the recommended protection for all activities (100.0%). Conclusions This pilot study had a good participation rate. The absence of positive samples was a good indication that the measures in place ensured workers’ safety, even though we found areas where the worker protection can be enhanced.
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Affiliation(s)
- Céline Poupeau
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada
| | - Cynthia Tanguay
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada
| | | | - Sébastien Gagné
- Centre de toxicologie du Québec, Institut national de santé publique du Québec, Canada
| | - Nicolas Caron
- Centre de toxicologie du Québec, Institut national de santé publique du Québec, Canada
| | - Jean-François Bussières
- Pharmacy Department and Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada
- Factulty of pharmacy, Université de Montréal, Canada
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116
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Zhang X, Zheng Q, Lv Y, An M, Zhang Y, Wei Y, Feng W. Evaluation of adverse health risks associated with antineoplastic drug exposure in nurses at two Chinese hospitals: The effects of implementing a pharmacy intravenous admixture service. Am J Ind Med 2016; 59:264-73. [PMID: 26898889 DOI: 10.1002/ajim.22553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the health risks of antineoplastic drugs (ADs) occupational exposure in nurses and to evaluate the effects of implementing a pharmacy intravenous admixture service (PIVAS) in two Chinese hospitals. METHODS The laboratory findings were collected from annual staff physical examination data. Reproductive toxicity and clinical manifestations were self-reported via a questionnaire. RESULTS Hematotoxicity, organ damage, reproductive toxicity, and clinical manifestations associated with AD exposure were markedly higher in oncology nurses than unexposed nurses. Application of PIVAS led to a significant restoration of the blood cell counts and kidney function, and a reduction in adverse reproductive outcomes among oncology nurses. Pronounced symptoms related to AD exposure were alleviated as well. CONCLUSION Oncology nurses who work with AD's experienced more adverse health outcomes than unexposed nurses. The health risks to AD were significantly alleviated by implementing a pharmacy intravenous admixture service.
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Affiliation(s)
- Xiaoxia Zhang
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Qiaowei Zheng
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Yun Lv
- Shaanxi Province Oncology Hospital; Xi'an China
| | - Mengna An
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Yating Zhang
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Youxia Wei
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
| | - Weiyi Feng
- First Affiliated Hospital of Medical College of Xi'an Jiaotong University; Xi'an China
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117
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Cass Y, Connor TH, Tabachnik A. Safe handling of oral antineoplastic medications: Focus on targeted therapeutics in the home setting. J Oncol Pharm Pract 2016; 23:350-378. [PMID: 27009803 DOI: 10.1177/1078155216637217] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction With the growing number of oral targeted therapies being approved for use in cancer therapy, the potential for long-term administration of these drugs to cancer patients is expanding. The use of these drugs in the home setting has the potential to expose family members and caregivers to them either through direct contact with the drugs or indirectly by exposure to the parent compounds and/or their active metabolites in contaminated patients' waste. Methods A systematic literature review was performed and the known adverse health effect of 32 oral targeted therapeutics is summarized. In particular, the carcinogenicity, genotoxicity, and embryo-fetal toxicity, along with the route of excretion were evaluated. Results Carcinogenicity testing has not been performed on most of the oral targeted therapeutics and the genotoxicity data are mixed. However, the majority of these drugs exhibit adverse reproductive effects, some of which are severe. Currently, available data does not permit the possibility of a health hazard from inappropriate handling of drugs and contaminated patients waste to be ignored, especially in a long-term home setting. Further research is needed to understand these issues. Conclusions With the expanding use of targeted therapies in the home setting, family members and caregivers, especially those of reproductive risk age, are, potentially at risk. Overall basic education and related precautions should be taken to protect family members and caregivers from indirect or direct exposure from these drugs. Further investigations and discussion on this subject are warranted.
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Affiliation(s)
| | - Thomas H Connor
- 2 Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
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118
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Böhlandt A, Schierl R. Benefits of Wipe Sampling: Evaluation of Long-Term 5-Fluorouracil and Platinum Monitoring Data. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2016. [DOI: 10.1515/pthp-2016-0010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractObjectives:The aim of this study was to evaluate environmental contamination levels from a large dataset of long-term monitoring data of 5-fluorouracil and platinum-containing drugs in pharmacies, and to investigate the contaminations over 15 years.Methods:Wipe sampling for 5-fluorouracil and platinum (marker for cis-, carbo- and oxaliplatin) was performed on-site from various surfaces in hospital and retail pharmacies with a validated sampling procedure over a period of 15 years. The 5-fluorouracil concentrations were quantified by GCMSMS and platinum concentrations by voltammetry. Statistical evaluation was performed with respect to sampling locations and years, and over the course of time.Results:Overall, 3,584 wipe samples for 5-fluorouracil and 2,955 wipe samples for platinum were analysed and contamination was detected at all surface types in all 151 examined pharmacies with ranges from ND (not detectable) to 1,725,000 pg/cm² and ND to 23,068 pg/cm², respectively. Median concentrations from the different locations ranged between ND and 4.3 pg/cm² (5-fluorouracil) and 0.2 and 1.8 pg/cm² (platinum) with highest loads inside the biological safety cabinets/isolators and storage areas. Evaluation of contamination over the course of 15 years showed a substantial decrease, especially in the years after introduction of guidance values.Conclusions:Long-term evaluation of surface wipe samples for antineoplastic drug contamination with repeated monitoring seems to be a beneficial tool to characterize the actual exposure situation and to assess surface contamination over time. Wipe sampling is a suitable control means to evaluate the work practices and the effectiveness of applied safety and hygiene measures and to identify the potential exposure risk for health care workers.
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119
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Janes A, Tanguay C, Caron NJ, Bussières JF. Environmental Contamination with Cyclophosphamide, Ifosfamide, and Methotrexate: A Study of 51 Canadian Centres. Can J Hosp Pharm 2015; 68:279-89. [PMID: 26327701 DOI: 10.4212/cjhp.v68i4.1467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Occupational exposure to hazardous drugs may lead to adverse reproductive effects. There is no safe exposure limit for health care professionals. OBJECTIVES To monitor levels of cyclophosphamide, ifosfamide, and methotrexate contamination in oncology pharmacy and patient care areas in Canadian health care institutions. METHODS The study was conducted in 2014. Hospitals with at least 50 acute care beds were invited to participate. At each participating centre, 12 standardized sites (6 in pharmacy areas and 6 in patient care areas) were sampled. The samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by ultra-performance liquid chromatography tandem mass spectrometry technology. The limits of detection were 0.36 pg/cm(2) for cyclophosphamide, 0.95 pg/cm(2) for ifosfamide, and 0.97 pg/cm(2) for methotrexate. Descriptive statistical analyses were performed to determine the median, 75th percentile, and maximum levels. RESULTS Fifty-one hospitals participated in this descriptive study, and a total of 584 samples were quantified. Overall, 294 (50%) of the samples were positive for cyclophosphamide, 125 (21%) for ifosfamide, and 54 (9%) for methotrexate. The most frequently contaminated sampling sites in pharmacy areas were the front grille inside the hood and the floor in front of the hood and, in patient care areas, the armrest and outpatient clinic counter. The 75th percentiles for surface concentration were 10.8 pg/cm(2) for cyclophosphamide, 1.59 pg/cm(2) for ifosfamide, and below the limit of detection for methotrexate. CONCLUSIONS Relative to 3 other multicentre studies conducted in Quebec over the past few years, the proportion of positive samples remained constant. Nonetheless, the 75th percentile surface concentration of antineoplastic drugs has been decreasing and seems to have reached a plateau. Local (country-specific or region-specific) and attainable goals for surface contamination with hazardous drugs should be set annually, so long as no health-based limit is known.
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Affiliation(s)
- Alexia Janes
- is a Research Assistant in the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec. She is also a DPharm candidate with the Faculté des sciences pharmaceutiques et biologiques de Lille, Lille, France
| | - Cynthia Tanguay
- BSc, MSc, is a Research Assistant in the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, Montréal, Quebec
| | - Nicolas J Caron
- PhD, is a Biochemist with the Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Quebec
| | - Jean-François Bussières
- BPharm, MSc, MBA, FCSHP, is Director of the Pharmacy Practice Research Unit and the Pharmacy Department, Centre hospitalier universitaire Sainte-Justine, and a Clinical Professor, Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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Hon CY, Teschke K, Shen H. Health Care Workers' Knowledge, Perceptions, and Behaviors Regarding Antineoplastic Drugs: Survey From British Columbia, Canada. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:669-677. [PMID: 25897641 DOI: 10.1080/15459624.2015.1029618] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although nurses are knowledgeable regarding the risk of exposure to antineoplastic drugs, they often do not adhere with safe work practices. However, the knowledge, perceptions, and behavior of other health care job categories at risk of exposure has yet to be determined. This study aimed to survey a range of health care workers from British Columbia, Canada about their knowledge, perceptions, and behaviors regarding antineoplastic drugs. A self-administered questionnaire was sent to participants querying the degree of contact with antineoplastics, knowledge of risks associated with antineoplastics, perceptions of personal risk, previous training with respect to antineoplastics, and safe work practices. Subjects were recruited from health care facilities in and around Vancouver. Fisher's exact tests were performed to ascertain whether there were differences in responses between job categories. We received responses from 120 participants representing seven different job categories. Pharmacists, pharmacy technicians, and nurses were more knowledgeable regarding risks than other job categories examined (statistically significant difference). Although 80% of respondents were not afraid of working with or near antineoplastics, there were concerns about the suitability of current control measures and practices employed by co-workers. Only half of respondents felt confident that they could handle all situations where there was a potential for exposure. Only one of the perception questions, self-perceived risk of exposure to antineoplastic drugs, differed significantly between job categories. Not all respondents always wore gloves when directly handling antineoplastic drugs. Further, hand hygiene was not regularly practiced after glove usage or after being in an area where antineoplastic drugs are handled. The majority of responses to questions related to safe work practices differed significantly between job categories. Our results suggest that knowledge regarding risks associated with antineoplastic drugs can be improved, especially among job categories that are not tasked with drug preparation or drug administration. There is also a gap between knowledge and compliance with glove usage and hand hygiene.Training is also recommended to improve health care workers' perceptions of the risks associated with antineoplastic drugs.
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Affiliation(s)
- Chun-Yip Hon
- a School of Occupational and Public Health, Ryerson University , Toronto , Ontario , Canada
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