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Hu J, Zhao F, Liu L, Huang H, Huang X. The meta-analysis of sister chromatid exchange as a biomarker in healthcare workers with occupational exposure to antineoplastic drugs. Medicine (Baltimore) 2023; 102:e34781. [PMID: 37653817 PMCID: PMC10470682 DOI: 10.1097/md.0000000000034781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Sister chromatid exchange (SCE) can be used to identify early occupational health status in health care workers. Our aim is to comprehensively assess the relationship between long-term exposure to antineoplastic drugs (ADs) and SCE in health care workers via meta-analysis. METHODS Five databases were systematically searched for relevant articles published from inception to November 30, 2022. Literature data are expressed as mean difference and 95% confidence intervals (CI) or relative risk and 95% CI. For I2 > 50% trials, random effect model is used for statistical analysis, otherwise fixed effect model is used. This review was registered in the International Prospective Register of Systematic Reviews (identifier CRD42023399914). RESULTS Fourteen studies were included in this study. Results showed the level of SCE in healthcare workers exposed to ADs was significantly higher than in controls. The mean difference of the SCE trial was 0.53 (95% CI: 0.10-0.95, P = .01) under a random-effects model. CONCLUSIONS The findings suggested a significant correlation between occupational exposure to ADs in health care workers and SCE, requiring the attention of health care workers in general.
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Affiliation(s)
- Jinchen Hu
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Feifei Zhao
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Lin Liu
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Hong Huang
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiaohong Huang
- Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen Guangdong & Clinical Medical College of Shenzhen, Guangzhou University of Chinese Medicine, Shenzhen, China
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Huang H, Gu Y, Liu S, Hu S, Zhong X, Huang Y, Peng J, Huang X. The meta-analysis of cytogenetic biomarkers as an assessment of occupational risk for healthcare workers exposed to antineoplastic drugs. Int Arch Occup Environ Health 2023:10.1007/s00420-023-01969-6. [PMID: 37079056 DOI: 10.1007/s00420-023-01969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/07/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE Antineoplastic drugs (ADs) are widely used in clinical practice and have been demonstrated to be effective in treating malignant tumors. However, they carry a risk of cytogenotoxicity for healthcare workers. Studies have reported that genotoxic biomarkers can be applied to assess the occupational health status of healthcare workers at an early stage, but results of different studies are variable. The objectives of the review were examine the association between long-term exposure to ADs and cytogenetic damage to healthcare workers. METHODS We systematically reviewed studies between 2005 and 2021 using PubMed, Embase and Web of Science databases that used cytogenetic biomarkers to assess occupational exposure to ADs in healthcare workers. We used RevMan5.4 to analyze the tail length parameters of the DNA, frequency of the chromosomal aberrations, sister chromatid exchanges and micronuclei. A total of 16 studies were included in our study. The studies evaluate the quality of the literature through the Agency for Healthcare Research and Quality. RESULTS The results revealed that under the random-effects model, the estimated standard deviation was 2.37 (95% confidence interval [CI] 0.92-3.81, P = 0.001) for the tail length parameters of the DNA, 1.48 (95% CI 0.71-2.25, P = 0.0002) for the frequency of chromosomal aberrations, 1.74 (95% CI 0.49-2.99, P = 0.006) for the frequency of sister chromatid exchanges and 1.64 (95% CI 0.83-2.45, P < 0.0001) for the frequency of micronuclei. CONCLUSIONS The results indicate that there is a significant association between occupational exposure to ADs and cytogenetic damage, to which healthcare workers should be alerted.
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Affiliation(s)
- Hong Huang
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, No.6082 Longgang Avenue, Shenzhen, 518116, China
| | - Yeqing Gu
- Institute of Radiation Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Shuhan Liu
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, No.6082 Longgang Avenue, Shenzhen, 518116, China
| | - Song Hu
- Longgang District Central Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China
| | - Xiao Zhong
- Longgang District Central Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China
| | - Yanshan Huang
- Longgang District Central Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China
- Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Ji Peng
- Longgang District Central Hospital of Shenzhen, Shenzhen, 518116, Guangdong, China
| | - Xiaohong Huang
- Department of Nursing, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, China.
- Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
- Longgang District Central Hospital of Shenzhen, No.6082 Longgang Avenue, Longgang District, Shenzhen, Guangdong, China.
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3
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Quartucci C, Rooney JPK, Nowak D, Rakete S. Evaluation of long-term data on surface contamination by antineoplastic drugs in pharmacies. Int Arch Occup Environ Health 2023; 96:675-683. [PMID: 36877242 DOI: 10.1007/s00420-023-01963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The handling of antineoplastic drugs represents an occupational health risk for employees in pharmacies. To minimize exposure and to evaluate cleaning efficacy, wipe sampling was used to analyze antineoplastic drugs on surfaces. In 2009, guidance values were suggested to facilitate the interpretation of results, leading to a decrease in surface contamination. The goal of this follow-up was to evaluate the time trend of surface contamination, to identify critical antineoplastic drugs and sampling locations and to reassess guidance values. METHODS Platinum, 5-fluorouracil, cyclophosphamide, ifosfamide, gemcitabine, methotrexate, docetaxel and paclitaxel were analyzed in more than 17,000 wipe samples from 2000 to 2021. Statistical analysis was performed to describe and interpret the data. RESULTS Surface contaminations were generally relatively low. The median concentration for most antineoplastic drugs was below the limit of detection except for platinum (0.3 pg/cm2). Only platinum and 5-fluorouracil showed decreasing levels over time. Most exceedances of guidance values were observed for platinum (26.9%), cyclophosphamide (18.5%) and gemcitabine (16.6%). The most affected wipe sampling locations were isolators (24.4%), storage areas (17.6%) and laminar flow hoods (16.6%). However, areas with no direct contact to antineoplastic drugs were also frequently contaminated (8.9%). CONCLUSION Overall, the surface contaminations with antineoplastic drugs continue to decrease or were generally at a low level. Therefore, we adjusted guidance values according to the available data. The identification of critical sampling locations may help pharmacies to further improve cleaning procedure and reduce the risk of occupational exposure to antineoplastic drugs.
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Affiliation(s)
- Caroline Quartucci
- Bavarian Health and Food Safety Authority, Institute for Occupational Health and Product Safety, Environmental Health, Munich, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - James P K Rooney
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Stefan Rakete
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
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4
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In vitro genotoxic and antigenotoxic effects of an exopolysaccharide isolated from Lactobacillus salivarius KC27L. Toxicol In Vitro 2022; 86:105507. [DOI: 10.1016/j.tiv.2022.105507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/21/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
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5
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Clark C. The need to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S10. [PMID: 36149419 DOI: 10.12968/bjon.2022.31.17.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in May 2022 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.
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Simegn W, Dagnew B, Dagne H. Health professionals’ practice to care cytotoxic drug handling and associated factors: The case of university of gondar specialized hospital. J Oncol Pharm Pract 2022:10781552221090200. [DOI: 10.1177/10781552221090200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Health care professionals are potential to be in contact with cytotoxic drugs during their daily work activities. The study aimed to assess the practice of health professionals to care for cytotoxic drugs and associated factors in the University of Gondar Specialized Hospital. Methods Cross-sectional study design was employed. EPI Info 7 was used for data entry and then exported into SPSS 20 for statistical analysis. Frequencies and mean with standard deviation were computed. Logistic regression had been performed to find out associated factors. Crude’ and adjusted Odds’ ratio with 95% uncertainty interval was done. Variables with a p < 0.05 were declared as significant factors for practice of cytotoxic drug handling. Results The study used four-hundred and twelve health professionals took part in the study with 97.4% response rate. The mean age of study participants was 29.9 years ranging from 20–60 years and twenty (53.4%) participants were males. One hundred and fifty-five (37.6%) health professionals had good cytotoxic drug handling practice. Attending an average of 4–9 patients per day (AOR = 2.12, 95% CI: 1.05, 4.22), Medium work stress (AOR = 2.01, 95% CI: 1.04, 3.90), availability of cytotoxic drug handling manual (AOR = 2.51: 95% CI: 1.22, 5.12), and good knowledge (AOR = 4.09, 95% CI: 2.35, 7.11) were significantly associated with cytotoxic drug handling practice. Conclusion The practice of cytotoxic drug handling care was low. It demands the engagement of the health sector to avert such inadequate practice and has to focus on delivering knowledge and logistics for the practice of cytotoxic drug handling.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of pharmacy, University of Gondar, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Henok Dagne
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Leso V, Sottani C, Santocono C, Russo F, Grignani E, Iavicoli I. Exposure to Antineoplastic Drugs in Occupational Settings: A Systematic Review of Biological Monitoring Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063737. [PMID: 35329423 PMCID: PMC8952240 DOI: 10.3390/ijerph19063737] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 01/10/2023]
Abstract
The high toxicity of antineoplastic drugs (ADs) makes them dangerous not only for patients, but also for exposed workers. Therefore, the aim of this review was to provide an updated overview of the biological monitoring of occupational AD exposure in order to extrapolate information useful to improve risk assessment and management strategies in workplaces. Several studies demonstrated that remarkable portions of healthcare workers may have traces of these substances or their metabolites in biological fluids, although with some conflicting results. Nurses, directly engaged in AD handling, were the occupational category at higher risk of contamination, although, in some cases, personnel not involved in AD-related tasks also showed quantifiable internal doses. Overall, further research carried out on greater sample sizes appears necessary to gain deeper insight into the variability retrieved in the reported results. This may be important to understand the impact of the extent of ADs use, different handling, procedures, and cleaning practices, spill occurrence, training of the workforce, as well as the adoption of adequate collective and personal protective equipment in affecting the occupational exposure levels. This may support the achievement of the greatest clinical efficiency of such therapies while assuring the health and safety of involved workers.
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Affiliation(s)
- Veruscka Leso
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Cristina Sottani
- Environmental Research Center, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 10, 27100 Pavia, Italy; (C.S.); (E.G.)
| | - Carolina Santocono
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Francesco Russo
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Elena Grignani
- Environmental Research Center, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 10, 27100 Pavia, Italy; (C.S.); (E.G.)
| | - Ivo Iavicoli
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
- Correspondence: ; Tel.: +39-0817462430
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Momeni M, Askarian M, Azad H, Danaei M. Exposure To Cytotoxic Drugs Threatens The Health Of Staff In Oncology Wards. RUSSIAN OPEN MEDICAL JOURNAL 2021. [DOI: 10.15275/rusomj.2021.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background — Cancer is one of the leading causes of death worldwide. Using cytotoxic drugs for cancer treatment is increased. The hazardous effects of occupational exposure to cytotoxic drugs are challenging. Objective — This study aimed to compare the frequency of adverse effects and using personal protective equipment (PPE) between the staff of oncology wards and other hospital wards staff in Iran. Methods — A cross-sectional study with a control group was conducted on female staff members in educational hospitals, selected through convenience sampling. A data collection form was designed for this study. It includes demographic data, acute complications (allergic and neurologic reactions), chronic complications (infertility, menstrual disorders, malignancy, and congenital malformations), and use of PPE. Data analysis was performed using SPSS software through Chi-square and Mann-Whitney tests. Results — The frequencies of chronic complications were not statistically different between the two groups. The frequency of itching (P=0.001), hair loss (P=0.003), itchy eyes (P=0.001), watery eyes (P=0.001), runny nose (P=0.003), headache (P=0.001), vertigo (P=0.007), and nausea (P=0.008) were significantly higher in oncology wards nurses. Among different PPE, only the frequency of using the mask (P= 0.001), and glasses (P=0.027) were significantly higher in the staff of oncology wards. Conclusion — Despite the frequency of acute complications of exposure to cytotoxic drugs, oncology staff does not fully adhere to the standard precautions. Providing effective training and emphasis on implementing accreditation laws can improve the existing situation.
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Affiliation(s)
| | | | - Hossein Azad
- Kerman University of Medical Sciences, Kerman, Iran
| | - Mina Danaei
- Kerman University of Medical Sciences, Kerman, Iran
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Struys I, Lenaerts L, Thienpont B, Amant F. Novel next-generation sequencing-based methodologies to characterize the mutational consequences of (prenatal) chemotherapy exposure in noncancerous tissue. Curr Opin Oncol 2021; 33:476-484. [PMID: 34038918 DOI: 10.1097/cco.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Although chemotherapeutics are considered as genotoxins for decades, their exact mutagenic impact on the genome of cancerous and normal cells of cancer patients was unknown for a long time. However, this knowledge is necessary to understand the long-term side effects of chemotherapy. A particular condition represents pregnant cancer patients being treated with chemotherapy. Since certain chemotherapeutics can cross the placenta, concerns exist about possible mutational effects on the fetus' genome with potential long-term health consequences. RECENT FINDINGS Recent advances of next-generation sequencing (NGS) techniques have opened possibilities to explore the exact mutational footprint of chemotherapies in healthy tissue from treated cancer patients. However, the ultra-low frequency of chemotherapy-induced mutations, introduction of technical artefacts, and inaccessibility of normal tissue has posed important limitations. This review discusses five state-of-the-art approaches that were recently designed to overcome these drawbacks. SUMMARY Results of the latest investigations give valuable insights into the genome-wide genotoxicity profile of frequently applied chemotherapies, with most of these drugs being associated with a signature of random base substitutions and small indels. Though these findings still might be limited to extrapolate to healthy tissue, they pave the way for studies on the origin of long-term chemotherapy-related adverse health effects.
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Affiliation(s)
| | | | | | - Frédéric Amant
- Department of Oncology
- Gynecologic Oncology, Netherlands Cancer Institute
- Gynecologic Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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11
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Pajic J, Rovcanin B, Rakic B. Evaluation of Genetic Damage in Persons Occupationally Exposed to Antineoplastic Drugs in Serbian Hospitals. Ann Work Expo Health 2021; 65:307-318. [PMID: 33886965 DOI: 10.1093/annweh/wxaa100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Although useful in the treatment of malignant cells, antineoplastic drugs (ANPDs) as chemical genotoxic agents, can interfere with normal cell physiology causing genetic damage and unfavourable health effects, especially in occupationally exposed persons. The Cytokinesis-block Micronucleus (CBMN) Cytome assay has been widely used in human biomonitoring studies as a reliable biomarker of chemical genotoxic exposure. OBJECTIVES Our comprehensive research was conducted in order to evaluate micronuclei as a marker for preventive medical screening purposes for persons occupationally exposed to ANPDs. METHODS Using the CBMN Cytome test, peripheral blood lymphocytes of 201 control and 222 exposed subjects were screened for genetic damage. RESULTS Age and gender influenced micronucleus (MN) frequency, but smoking habit did not. The mean micronuclei frequencies and other parameters of the CBMN Cytome test [numbers of binuclear lymphocytes with one (MN1) or two (MN2) micronuclei] were significantly higher in the group of exposed persons. Positive correlation between duration of occupational exposure and MN frequency was revealed. CONCLUSIONS The results of our study performed on a large sample confirmed the capacity of the CBMN Cytome assay to serve as a reliable biomarker of long-term ANPD exposure.
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Affiliation(s)
- Jelena Pajic
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Radiation protection department, Deligradska 29,Belgrade, Serbia
| | - Branislav Rovcanin
- Center for Endocrine Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Koste Todorovica 8, Belgrade, Serbia
| | - Boban Rakic
- Serbian Institute of Occupational Health "Dr Dragomir Karajovic", Radiation protection department, Deligradska 29,Belgrade, Serbia
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12
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Ness SLR, Mascarenhas MÁ, Arbo MD, Tonietto BD, Cestonaro LV, Dos Santos NG, Garcia SC, Ferreira CF, Capp E. Occupational exposure assessment in professionals who manipulate and administer antineoplastic drugs in a university hospital in Southern Brazil. J Oncol Pharm Pract 2021; 27:1205-1213. [PMID: 33736555 DOI: 10.1177/10781552211003638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Our goal was to demonstrate the effects of occupational exposure to antineoplastic drugs on oxidative stress parameters and DNA damage in health professionals who manipulate and administer antineoplastic drugs in a University Hospital in Southern Brazil. METHODS The case-control study with a longitudinal design, involved 64 individuals, 29 of them pharmacists, pharmacy technicians and nurses who were occupationally exposed to antineoplastic drugs and 35 professionals who were not exposed. Gene mutations were determined by micronucleus from salivary fluid; DNA damage by comet assay and oxidative stress parameters in whole blood were also evaluated. RESULTS All workers exposed to antineoplastic drugs used personal protective equipment (PPE). It was demonstrated that the total nonprotein thiol and thiobarbituric acid reactive substances levels showed interaction between group and time, with higher levels one week after handling/administration of antineoplastic drugs in the exposed group (GEE, p ≤ 0.0001 and p = 0,013, respectively). Additionally, there was a group effect on the activities of the catalase and glutathione peroxidase antioxidant enzymes (GEE, p = 0.027 and p ≤ 0.0001, respectively), and workers occupationally exposed to antineoplastic drugs had higher enzyme activities compared to those not exposed. No genotoxic damage was demonstrated through the evaluated parameters. CONCLUSIONS Despite the correct use of PPE, professionals occupationally exposed to antineoplastic drugs were more susceptible to oxidative stress than those not exposed. The evaluation of the studied parameters is especially important for the definition of conducts and practices in the area, always in search of guaranteeing the establishment of a rational policy to protect workers' health.
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Affiliation(s)
- Sandro Luis R Ness
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Central de Misturas Intravenosas, Serviço de Farmácia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcello Á Mascarenhas
- Programa de Pós-Graduação Strict Sensu em Biociências e Reabilitação, Curso de Farmácia do Centro Universitário Metodista-IPA, Porto Alegre, Brazil
| | - Marcelo D Arbo
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bruna D Tonietto
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Larissa V Cestonaro
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Nícolas G Dos Santos
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Solange Cristina Garcia
- Graduação na Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Laboratório de Toxicologia, Departamento de Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Brazil
| | - Charles F Ferreira
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Grupo de Pesquisa: Climatério, e Menopausa. Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Edison Capp
- Programa de Pós-Graduação em Ciências da Saúde: Ginecologia e Obstetrícia (PPGGO), Hospital de Clínicas de Porto Alegre (HCPA), Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Graduação na Faculdade de Medicina (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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13
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Fernandes E, Fonseca TG, Carriço T, Mestre N, Tavares Á, Bebianno MJ. Cytotoxic responses of the anticancer drug cyclophosphamide in the mussel Mytilus galloprovincialis and comparative sensitivity with human cells lines. CHEMOSPHERE 2020; 261:127678. [PMID: 32717509 DOI: 10.1016/j.chemosphere.2020.127678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The rise of cancer cases worldwide led to an increase in production and consumption of anticancer drugs, that ultimately end up in the marine environment and are accumulated in aquatic organisms. Cyclophosphamide (CP) is a cytotoxic alkylating agent frequently prescribed in cancer treatments. This study assess ecotoxicological effects of CP on mussels Mytilus galloprovincialis, through in vivo and ex vivo approaches and compares the sensitivity of mussel haemocytes with well-established human cell lines (RPE and HeLa). Mussels were exposed in vivo to CP (1000 ng L-1) and several biomarkers analysed in gills and digestive glands namely neurotoxicity (AChE activity), oxidative stress (GPx activity), biotransformation (GST activity), lipid peroxidation (LPO) and apoptosis (caspase activity), whereas genotoxicity was determined in mussels' haemocytes. Cytotoxicity was also assessed in haemocytes (in vivo and ex vivo) and human cell lines (in vitro) exposed to a range of CP concentrations (50, 100, 250, 500 and 1000 ng L-1) over 24 h, via neutral red assay. In in vivo exposure, detoxification of CP did not efficiently occur in the gills while in digestive glands GPx and GST activities were induced, jointly with a decrease in lipid peroxidation, indicating a potential outcome of the protective antioxidant mechanisms, whereas no apoptosis was noted. Moreover, cytotoxicity and DNA damage were detected in haemocytes. The ex vivo exposure haemocytes to CP caused cytotoxicity (from 100 ng L-1), whereas no effects occurred in human cell lines. This suggests that, at relevant environmental concentrations, CP cause subtle and irreversible impacts on M. galloprovincialis.
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Affiliation(s)
- Elna Fernandes
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - Tainá Garcia Fonseca
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - Tânia Carriço
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - Nélia Mestre
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal
| | - Álvaro Tavares
- CBMR, Centre for Biomedical Research, University of Algarve, Campus de Gambelas, 8005-135, Faro, Portugal
| | - Maria João Bebianno
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus de Gambelas, 8000-139, Faro, Portugal.
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Halloush S, Reveles IA, Koeller J. Evaluating Six Commercially Available Closed-System Drug-Transfer Devices Against NIOSH's 2015 Draft Vapor Protocol. Hosp Pharm 2020; 55:391-399. [PMID: 33245720 DOI: 10.1177/0018578719848730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: In 2015, the National Institute for Occupational Safety and Health (NIOSH) published a draft vapor containment protocol to quantitatively evaluate combined liquid, aerosol, and vapor containment performance of commercially available closed-system drug-transfer devices (CSTDs) that claim to be effective for gas/vapor containment within a controlled test environment. Until the release of this proposed protocol, no standard method for evaluating airtightness of CSTDs existed. The aim of this study was to evaluate six commercially available CSTDs utilizing NIOSH draft protocol methodology to evaluate vapor containment under a robust vapor challenge. Methods: In this study, six commercially available CSTDs were tested utilizing draft NIOSH vapor containment protocol methodology to simulate drug compounding and administration using 70% isopropyl alcohol (IPA) as the challenge agent. All device manipulations were carried out in an enclosed test chamber. A Miran sapphIRe gas analyzer was used to detect IPA vapor levels that escaped the device. Study test included the two tasks designated by the NIOSH protocol, with additional steps added to the evaluation. Tasks were repeated 10 times for each device. Results: Only three of the six tested CSTDs (Equashield®, HALO®, and PhaSealTM) had an average IPA vapor release below the quantifiable performance threshold (1.0 ppm) for all tasks performed. This value was selected by NIOSH to represent the performance threshold for successful containment. The remaining three CSTDs had vapor release above 1 ppm at various times during the IPA manipulation process. Conclusion: Equashield®, HALO®, and PhaSealTM devices tested met the 2015 NIOSH protocol quantifiable performance threshold, functioning as a truly closed system. Quantifiable effective data may be useful in product selection.
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Affiliation(s)
- Shiraz Halloush
- The University of Texas at Austin, USA.,UT Health San Antonio, USA
| | | | - Jim Koeller
- The University of Texas at Austin, USA.,UT Health San Antonio, USA
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Walton A, Bush M, Douglas C, Allen D, Polovich M, Spasojevic I. Surface Contamination With Antineoplastic Drugs on Two Inpatient Oncology Units. Oncol Nurs Forum 2020; 47:263-272. [DOI: 10.1188/20.onf.263-272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Aristizabal-Pachon AF, Castillo WO. Genotoxic evaluation of occupational exposure to antineoplastic drugs. Toxicol Res 2019; 36:29-36. [PMID: 31998624 DOI: 10.1007/s43188-019-00003-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/18/2019] [Accepted: 01/29/2019] [Indexed: 12/19/2022] Open
Abstract
During the last years, several reports have provided evidence about adverse health effects on personal involved in Antineoplastic Drugs (ANPD) handling. ANPD has the ability to bind DNA, thus produce genotoxic damage. In this way, XRCC1 and XRCC3 proteins are necessary for efficient DNA repair and polymorphisms in this genes can be associated with an individual response to ANPD exposure. Therefore, the aim of this study was to evaluate genetic damage of occupational exposure to antineoplastic drugs and the possible effect of XRCC1 and XRCC3 polymorphisms in oncology employees from Bogotá, Colombia. Peripheral blood samples were obtained from 80 individuals, among exposed workers and healthy controls. The comet assay and Cytokinesis-block micronucleus cytome assay was performed to determinate genetic damage. From every sample DNA was isolated and genotyping for XRCC1 (Arg194Trp, Arg280His and Arg399Gln) and XRCC3 (Thr241Met) SNPs by PCR-RFLP. The exposed group showed a significant increase of comet assay results and micronucleus frequency, compared with unexposed group. It was observed a gender, exposure time and workplace effect on comet assay results. Our results showed no significant associations of comet assay results and micronucleus frequency with either genotype, allele, nor haplotype of XRCC1 and XRCC3 SNPs. The results suggest that occupational exposure to ANPD may lead to genotoxic damage and even be a risk to human health. To our knowledge, this is the first study to assess the genotoxic damage of occupational exposure to APND in South America.
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Affiliation(s)
- Andres Felipe Aristizabal-Pachon
- 1Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Carrera 7 # 43-82, Bogota, D.C. Colombia
| | - Willian Orlando Castillo
- 2Department of Biology, Faculty of Natural Sciences, Exact and Education, University of Cauca, Popayán, Colombia
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17
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Power LA, Coyne JW. ASHP Guidelines on Handling Hazardous Drugs. Am J Health Syst Pharm 2018; 75:1996-2031. [DOI: 10.2146/ajhp180564] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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18
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Medical Surveillance Programs for Workers Exposed to Hazardous Medications: A Survey of Current Practices in Health Care Institutions. J Occup Environ Med 2018; 61:120-125. [PMID: 30475315 DOI: 10.1097/jom.0000000000001494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess current medical surveillance monitoring practices for health care workers who prepare, handle, or administer hazardous medications. METHODS A cross-sectional survey was distributed to members of the American College of Occupational and Environmental Medicine and the National Comprehensive Cancer Network. RESULTS Forty-six of the 91 survey respondents indicated that their institution had a hazardous medication surveillance program. We identified the most frequent laboratory (complete blood count) and physical (skin) examination components. A health history was frequently used. Statistical analysis did not suggest an association between institutions with greater resources and presence of a surveillance program. CONCLUSIONS A consensus standard for medical monitoring was not reported by the respondents. We recommend using a standardized surveillance questionnaire and applying uniform laboratory testing across institutions, in addition to establishing a national repository for surveillance data.
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19
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Ndaw S, Hanser O, Kenepekian V, Vidal M, Melczer M, Remy A, Robert A, Bakrin N. Occupational exposure to platinum drugs during intraperitoneal chemotherapy. Biomonitoring and surface contamination. Toxicol Lett 2018; 298:171-176. [PMID: 29852276 DOI: 10.1016/j.toxlet.2018.05.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/25/2018] [Accepted: 05/23/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hyperthermic intraperitoneal chemotherapy (HIPEC) has been introduced over the last decade for the treatment of peritoneal carcinomatosis. In this procedure, heated cytotoxic drugs are administered directly into the abdominal cavity, ensuring cancer cells to be exposed while reducing systemic toxicity. More recently, pressurized intraperitoneal aerosol chemotherapy (PIPAC), where the chemotherapeutic drug is injected into the peritoneal cavity as an aerosol under pressure, has been proposed to patients in palliative situation, as a new approach. The amount of drug used is up to 10 fold lower than in HIPEC. The use of cytotoxic drugs poses an occupational risk for the operating room personnel. This study investigated the potential exposure of the medical staff by biomonitoring and surface contamination measurements, during a HIPEC procedure and a PIPAC procedure. METHOD Wipe samples were collected from various locations in operating rooms including gloves, hands, devices and floor. Urines samples were collected from 10 volunteers of the medical staff and from a control group. The platinum analysis was performed by inductively coupled plasma mass spectrometry. RESULTS Significant contaminations were observed on the floor, gloves, shoes and devices. However, urinary platinum was below the limit of quantification (<10 ng/L) for more than 50% of samples from the healthcare workers performing HIPEC and PIPAC. Concentrations did not differ significantly from those reported for the control group. CONCLUSION There appears to be little risk of exposure to platinum drugs during HIPEC and PIPAC providing the adequate safety measures are implemented.
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Affiliation(s)
- S Ndaw
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France.
| | - O Hanser
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - V Kenepekian
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - M Vidal
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - M Melczer
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - A Remy
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - A Robert
- Institut National de Recherche et de Sécurité INRS, Toxicology and Biomonitoring Department, Vandoeuvre, France
| | - N Bakrin
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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20
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Çayir A, Coskun M, Coskun M, Cobanoglu H. DNA damage and circulating cell free DNA in greenhouse workers exposed to pesticides. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2018; 59:161-169. [PMID: 29130594 DOI: 10.1002/em.22148] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 05/28/2017] [Accepted: 09/27/2017] [Indexed: 06/07/2023]
Abstract
Pesticides widely used in agriculture and other applications have been linked to cancer and other diseases through several potential mechanisms. The goals of this study were to assess DNA damage in lymphocytes by the cytokinesis-block micronucleus assay (CBMN), and to measure circulating cell free DNA (ccf-DNA) in the blood of pesticide-exposed greenhouse workers and matched controls living in the same area. CBMN was applied to peripheral blood lymphocyte samples taken at different times (spring and autumn) for each individual. We measured plasma ccf-DNA levels using a Qubit® fluorometer. The results indicated that the MNL, BNMN, and NBUDs frequencies of pesticide-exposed individuals were significantly higher than non-exposed individuals. Apart from MNL, BNMN and CBPI, a season-related effect was found for the NPB and NBUD frequencies. With MNL and BNMN as the dependent variables, multiple regression analysis showed that age and gender affected MN formation. The ccf-DNA level in the pesticide-exposed group was significantly higher than the control group. There was no seasonal variation regarding the free DNA amount. Ccf-DNA in males was found to be higher than females. The MNL, BNMN, NPB, and CBPI did not correlate with the ccf-DNA amount. It can be concluded that pesticide exposure can modulate DNA integrity via different mechanisms. Also, elevated levels of ccf-DNA could be recommended as a biomarker of pesticide exposure. Environ. Mol. Mutagen. 59:161-169, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Akin Çayir
- Health Services Vocational College, Çanakkale Onsekiz Mart University, 17100, Çanakkale, Turkey
| | - Mahmut Coskun
- Faculty of Medicine, Department of Medical Biology, Çanakkale Onsekiz Mart University, Terzioglu Campus, 17100, Çanakkale, Turkey
| | - Munevver Coskun
- Health Services Vocational College, Çanakkale Onsekiz Mart University, 17100, Çanakkale, Turkey
| | - Hayal Cobanoglu
- Health Services Vocational College, Çanakkale Onsekiz Mart University, 17100, Çanakkale, Turkey
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21
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Medical Surveillance for Hazardous Drugs: A Qualitative Assessment of Current Practices. J Occup Environ Med 2017; 60:521-527. [PMID: 29200189 DOI: 10.1097/jom.0000000000001238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The National Institute for Occupational Safety and Health recommends that institutions establish a medical surveillance program for workers who handle hazardous drugs. Our aim was to investigate current practices with occupational medicine practice (OMP) national leaders. METHODS A series of qualitative telephone interviews were conducted with 11 OMP national leaders from medical centers in 10 states. Interviews were recorded, transcribed, and coded using a directed content analysis. Codes were organized into themes. RESULTS All respondents were board-certified physicians in medical center OMP. Interviews up to 45 minutes found three themes: policy interpretation, benefits and barriers to surveillance, and potential respondent-generated solutions. Three of 10 medical centers provided medical surveillance. CONCLUSIONS Medical surveillance for hazardous drugs is infrequent, and consensus is lacking regarding standard practices. Further work is needed to minimize risk to health care workers.
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22
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Simons A, Toland S. Perceived adverse effects from handling systemic anti-cancer therapy agents. ACTA ACUST UNITED AC 2017; 26:S38-S44. [PMID: 28880622 DOI: 10.12968/bjon.2017.26.16.s38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article explores the immediate adverse effects experienced by nurses during the administration of systemic anti-cancer therapy (SACT), specifically cytotoxic chemotherapy, and whether closed systems are being used to minimise exposure risk. Many SACT agents are known to be carcinogenic, teratogenic and mutagenic and this has led to concerns relating to the increased number of healthcare workers potentially exposed to these agents. An anonymous online survey was designed, made up of four questions, to elicit whether adverse effects were experienced by nurses during preparation, administration or following administration of chemotherapy. A total of 46% of respondents stated that they experienced some form of adverse effect either during preparation, administration or following administration of SACT. More formal research is required in this area to explore the relationship between exposure to SACT and perceived adverse effects in healthcare workers administering SACT.
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Affiliation(s)
- Alison Simons
- Senior Lecturer, Birmingham City University, Edgbaston
| | - Samantha Toland
- Senior Lecturer, Birmingham City University, Lead Chemotherapy Nurse, Worcestershire Acute Hospitals Trust
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Roussel C, Witt KL, Shaw PB, Connor TH. Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2017; 781:207-217. [PMID: 31416576 DOI: 10.1016/j.mrrev.2017.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 12/15/2022]
Abstract
Many antineoplastic drugs used to treat cancer, particularly alkylating agents and topoisomerase inhibitors, are known to induce genetic damage in patients. Elevated levels of chromosomal aberrations, micronuclei, and DNA damage have been documented in cancer patients. Elevations in these same biomarkers of genetic damage have been reported in numerous studies of healthcare workers, such as nurses and pharmacists, who routinely handle these drugs, but results vary across studies. To obtain an overall assessment of the exposure effect, we performed a meta-analysis on data obtained from peer-reviewed publications reporting chromosomal aberration levels in healthcare workers exposed to antineoplastic drugs. A literature search identified 39 studies reporting on occupational exposure to antineoplastic drugs and measurement of chromosomal aberrations in healthcare workers. After applying strict inclusion criteria for data quality and presentation, data from 17 studies included in 16 publications underwent meta-analysis using Hedges' bias-corrected g and a random-effects model. Results showed the level of chromosomal aberrations in healthcare workers exposed to antineoplastic drugs was significantly higher than in controls. The standardized mean differences (difference of means divided by within sd) from all studies were pooled, yielding a value 1.006 (unitless) with p<0.001. Thus, in addition to the documented genotoxic effects of antineoplastic drugs in cancer patients, this meta-analysis confirmed a significant association between occupational exposure to antineoplastics during the course of a normal work day and increases in chromosomal aberrations in healthcare workers. Based on the studies reviewed, we were unable to accurately assess whether appropriate use of protective measures might reduce the incidence of genetic damage in healthcare workers. However, given the potential for increased cancer risk linked to increases in chromosomal aberrations, the results of this study support the need to limit occupational exposure of healthcare workers to antineoplastic drugs as much as possible.
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Affiliation(s)
- Christine Roussel
- Doylestown Hospital, 595 West State Street, Doylestown, PA, 18901, United States.
| | - Kristine L Witt
- Biomolecular Screening Branch, National Institute of Environmental Health Sciences/Division of the National Toxicology Program, Research Triangle Park, NC, 27709, United States.
| | - Peter B Shaw
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
| | - Thomas H Connor
- Division of Applied Research and Technology, National Institute for Occupational Safety and Health, 1090 Tusculum Avenue, Cincinnati, OH, 45226, United States.
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24
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Broto M, Galve R, Marco MP. Bioanalytical methods for cytostatic therapeutic drug monitoring and occupational exposure assessment. Trends Analyt Chem 2017. [DOI: 10.1016/j.trac.2017.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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25
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Crul M, Simons-Sanders K. Carry-over of antineoplastic drug contamination in Dutch hospital pharmacies. J Oncol Pharm Pract 2017; 24:483-489. [DOI: 10.1177/1078155217704990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background To prevent occupational exposure of hospital staff to cytostatics, a mandatory national guideline describing a set of safety measures was issued in the Netherlands in 2004. The guideline includes, among other directives, obligatory annual wipe testing to assess the efficacy of the local cleaning protocol. Full implementation of this guideline was executed in all Dutch hospital pharmacies over the next couple of years. Objective We aimed to investigate the effect of the national guideline on contamination levels, and specifically on the phenomenon of carry-over of traces of antineoplastic drugs through contact with surfaces, since this is a potential route of exposure. Methods From a database including wipe sample results of 9 hospitals over 10 years, we extracted all sampled locations in the compounding areas as well as in adjacent or bypass rooms and locks. We considered only the locations outside safety cabinets or isolators, to examine the containment of contamination and to address possible routes of how a contamination can migrate through the preparation and distribution areas. The dataset consisted of 2647 wipe samples. Results In adjacent rooms, 18 out of 275 wipe samples were contaminated (6%). Inside the compounding room, the extracted locations away from the safety workbench showed a positive percentage for contamination of 13% (39 out of 297). When stratifying the data to sample year, it was shown that contaminations outside the preparation room were no longer detectable after 2008. Conclusion With this study, we show that implementation of a set of guidelines on safety measures can prevent spreading of cytostatic traces from the compounding area in hospital pharmacies.
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Affiliation(s)
- M Crul
- Department of Clinical Pharmacy, OLVG, Amsterdam, The Netherlands
| | - K Simons-Sanders
- Department of Hospital Pharmacy Midden Brabant, TweeSteden Hospital, Tilburg, The Netherlands
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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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Kibby T. A review of surface wipe sampling compared to biologic monitoring for occupational exposure to antineoplastic drugs. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:159-174. [PMID: 27676216 DOI: 10.1080/15459624.2016.1237026] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The potential for adverse health effects from occupational exposure to antineoplastic drugs (AD) is well known. Control measures recommended by the NIOSH Alert [3] include medical and biologic monitoring, and environmental monitoring where available. At present no guidelines or published best practices exist to guide EHS managers on how to carry out this biologic or environmental monitoring. Studies investigating surface wipe sampling for AD have been numerous in the past decade, but very limited research exists to correlate surface contamination with actual absorption by pharmacists and nurses. This article reviews the studies with concurrent surface wipe sampling and urine monitoring for the same AD, and tests their correlation. Methodologic limitations are reviewed. Twenty-one studies were identified that concurrently measured surface contamination by AD by wipe sampling and AD absorption by urine monitoring. Two studies directly evaluated the AD by wipe sampling and urine levels and neither found a statistically significant correlation. Six studies reported a decrease in both surface and urine levels following interventions to reduce contamination or exposure. Only one study directly evaluated the personal protective equipment and handling techniques employed by the studied workers, which can be viewed as a major confounder of absorption. While no statistically significant correlation was found between wipe sampling and urine monitoring for AD, decreases in urine and wipe levels following interventions to reduce exposure were noted. Limitations in the data and recommendations for future research are reviewed.
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Affiliation(s)
- Thomas Kibby
- a Department of Emergency Medicine , Toxicology Section, Washington University School of Medicine , St. Louis , Missouri
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28
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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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29
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Assessment of the genotoxicity of the tyrosine kinase inhibitor imatinib mesylate in cultured fish and human cells. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2017; 814:14-21. [DOI: 10.1016/j.mrgentox.2016.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/17/2016] [Accepted: 12/19/2016] [Indexed: 11/19/2022]
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Fonseca TG, Morais MB, Rocha T, Abessa DMS, Aureliano M, Bebianno MJ. Ecotoxicological assessment of the anticancer drug cisplatin in the polychaete Nereis diversicolor. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 575:162-172. [PMID: 27744150 DOI: 10.1016/j.scitotenv.2016.09.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 02/07/2023]
Abstract
Anticancer drugs are designed to inhibit tumor cell proliferation by interacting with DNA and altering cellular growth factors. When released into the waterbodies of municipal and hospital effluents these pharmaceutical compounds may pose a risk to non-target aquatic organisms, due to their mode of action (cytotoxic, genotoxic, mutagenic and teratogenic). The present study aimed to assess the ecotoxicological potential of the alkylating agent cisplatin (CisPt) to the polychaete Nereis diversicolor, at a range of relevant environmental concentrations (i.e. 0.1, 10 and 100ngPtL-1). Behavioural impairment (burrowing kinetic impairment), ion pump effects (SR Ca2+-ATPase), neurotoxicity (AChE activity), oxidative stress (SOD, CAT and GPXs activities), metal exposure (metallothionein-like proteins - MTLP), biotransformation (GST), oxidative damage (LPO) and genotoxicity (DNA damage), were selected as endpoints to evaluate the sublethal responses of the ragworms after 14-days of exposure in a water-sediment system. Significant burrowing impairment occurred in worms exposed to the highest CisPt concentration (100ngPtL-1) along with neurotoxic effects. The activity of antioxidant enzymes (SOD, CAT) and second phase biotransformation enzyme (GST) was inhibited but such effects were compensated by MTLP induction. Furthermore, LPO levels also increased. Results showed that the mode of action of cisplatin may pose a risk to this aquatic species even at the range of ngL-1.
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Affiliation(s)
- T G Fonseca
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal; NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia. Aquática, São Paulo State University - UNESP, Campus Experimental do Litoral Paulista, Praça Infante Dom Henrique, s/n, 11330-900, São Vicente, SP, Brazil
| | - M B Morais
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - T Rocha
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal
| | - D M S Abessa
- NEPEA, Núcleo de Estudos em Poluição e Ecotoxicologia. Aquática, São Paulo State University - UNESP, Campus Experimental do Litoral Paulista, Praça Infante Dom Henrique, s/n, 11330-900, São Vicente, SP, Brazil
| | - M Aureliano
- CCMar, Centre of Marine Sciences, University of Algarve, Campus de Gambelas, 8005-135 Faro, Portugal
| | - M J Bebianno
- CIMA, Centre for Marine and Environmental Research, University of Algarve, Campus Gambelas, 8005-135 Faro, Portugal.
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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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Álvarez-Barrera L, Rodríguez-Mercado JJ, López-Chaparro M, Altamirano-Lozano MA. Genotoxicity of Casiopeina III-Ea in mouse bone marrow cells. Drug Chem Toxicol 2016; 40:333-338. [PMID: 27784184 DOI: 10.1080/01480545.2016.1229787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Casiopeina III-Ea® (Cas III-Ea®) is a chelated copper complex with antineoplastic activity that is capable of reducing tumor size and inducing antiproliferative and apoptotic effects. However, little is known about its in vivo genotoxic effects. Therefore, this study evaluated two cytogenetic and two proliferative parameters 24 h after the administration of Casiopeina III-Ea® to male CD-1 mice. Three doses of Cas III-Ea® were administered by intraperitoneal injections of 1.69, 3.39 and 6.76 mg/kg (corresponding to 1/8, 1/4 and 1/2 of LD50, respectively). A reduction in the mitotic index (MI) and an increased numbers of cells with structural chromosomal aberrations (SCA) were detected. Additionally, a low but significant increase in the frequency of sister chromatid exchange (SCE) was observed at the highest dose. Changes in the DNA replication index (RI) were not observed. These results indicate that Casiopeina III-Ea® shows cytotoxic and clastogenic activity in bone marrow cells from treated mice.
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Affiliation(s)
- Lucila Álvarez-Barrera
- a Facultad de Estudios Superiores Zaragoza UNAM, Unidad de Investigación en Genética y Toxicología Ambiental (UIGTA), Laboratorio L5-PA, Unidad Multidisciplinaria de Investigación Experimental (UMIEZ) , Ciudad de México , México
| | - Juan J Rodríguez-Mercado
- a Facultad de Estudios Superiores Zaragoza UNAM, Unidad de Investigación en Genética y Toxicología Ambiental (UIGTA), Laboratorio L5-PA, Unidad Multidisciplinaria de Investigación Experimental (UMIEZ) , Ciudad de México , México
| | - Michel López-Chaparro
- a Facultad de Estudios Superiores Zaragoza UNAM, Unidad de Investigación en Genética y Toxicología Ambiental (UIGTA), Laboratorio L5-PA, Unidad Multidisciplinaria de Investigación Experimental (UMIEZ) , Ciudad de México , México
| | - Mario A Altamirano-Lozano
- a Facultad de Estudios Superiores Zaragoza UNAM, Unidad de Investigación en Genética y Toxicología Ambiental (UIGTA), Laboratorio L5-PA, Unidad Multidisciplinaria de Investigación Experimental (UMIEZ) , Ciudad de México , México
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Dutta S, Bahadur M. Cytogenetic analysis of micronuclei and cell death parameters in epithelial cells of pesticide exposed tea garden workers. Toxicol Mech Methods 2016; 26:627-634. [DOI: 10.1080/15376516.2016.1230917] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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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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Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: A systematic review of the literature and meta-analysis. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2016; 770:35-45. [DOI: 10.1016/j.mrrev.2016.05.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 12/23/2022]
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Zhang J, Bao J, Wang R, Geng Z, Chen Y, Liu X, Xie Y, Jiang L, Deng Y, Liu G, Xu R, Miao L. A multicenter study of biological effects assessment of pharmacy workers occupationally exposed to antineoplastic drugs in Pharmacy Intravenous Admixture Services. JOURNAL OF HAZARDOUS MATERIALS 2016; 315:86-92. [PMID: 27179702 DOI: 10.1016/j.jhazmat.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 05/11/2023]
Abstract
This multi-centered study was designed to evaluate the biological effects of exposure to antineoplastic drugs (ADs) at PIVAS (Pharmacy Intravenous Admixture Service) across ten Chinese hospitals. 8-hydroxy-2-deoxyguanosine (8-OHdG) was used as a biomarker of DNA oxidative damage and lymphocyte apoptosis assays using peripheral lymphocyte cells were used to detect primary DNA damage. The mutagenicity activity was estimated with the Ames fluctuation test. 158 exposed and 143 unexposed workers participated in this study. The urinary 8-OHdG/Cr concentrations of the exposed group was 22.05±17.89ng/mg Cr, which was significantly higher than controls of 17.36±13.50ng/mg Cr (P<0.05). The rate of early lymphocyte apoptosis was slightly increased in exposed group than that of the control group (P=0.087). The mutagenic activity was significantly higher in the exposed group relative to the control group (P<0.05). Moreover, while no statistically significant difference was observed, higher concentrations of 8-OHdG/Cr in urine and an early lymphocyte apoptosis rate were found in exposed group II as compared to exposed group I. In addition, a significant correlation between early lymphocyte apoptosis and exposure time to ADs was also observed (P<0.05). In conclusion, our study identified elevated biomarkers in PIVAS workers exposed to ADs. However whether these findings could lead to increased incidence of genotoxic responses remains to be further investigated.
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Affiliation(s)
- Jingjing Zhang
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China
| | - Jianan Bao
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China
| | - Renying Wang
- Sun Yan-Sen University Cancer Center, Guangzhou 510060, PR China
| | - Zhou Geng
- The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, PR China
| | - Yao Chen
- First People's Hospital of Yunnan Province, Kunming 650034, Yunnan, PR China
| | - Xinchun Liu
- Qilu Hospital of Shandong University, Jinan 250002, Shandong, PR China
| | - Yongzhong Xie
- Huangshan City People's Hospital, Huangshan 245000, Anhui, PR China
| | - Ling Jiang
- Anhui Provincial Hospital, Hefei 230001, Anhui, PR China
| | - Yufei Deng
- Wuxi No.2 People's Hospital, Wuxi 214002, Jiangsu, PR China
| | - Gaolin Liu
- Shanghai General Hospital, Shanghai 200080, PR China
| | - Rong Xu
- Shanghai Sixth People's Hospital, Shanghai 200233, PR China
| | - Liyan Miao
- The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu, PR China.
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Zare Sakhvidi MJ, Hajaghazadeh M, Mostaghaci M, Mehrparvar AH, Zare Sakhvidi F, Naghshineh E. Applicability of the comet assay in evaluation of DNA damage in healthcare providers' working with antineoplastic drugs: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:52-67. [PMID: 27110842 DOI: 10.1080/10773525.2015.1123380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unintended occupational exposure to antineoplastic drugs (ANDs) may occur in medical personnel. Some ANDs are known human carcinogens and exposure can be monitored by genotoxic biomarkers. OBJECTIVE To evaluate the obstacles to obtaining conclusive results from a comet assay test to determine DNA damage among AND exposed healthcare workers. METHODS We systematically reviewed studies that used alkaline comet assay to determine the magnitude and significance of DNA damage among health care workers with potential AND exposure. Fifteen studies were eligible for review and 14 studies were used in the meta-analysis. RESULTS Under random effect assumption, the estimated standardized mean difference (SMD) in the DNA damage of health care workers was 1.93 (95% CI: 1.15-2.71, p < 0.0001). The resulting SMD was reduced to 1.756 (95% CI: 0.992-2.52, p < 0.0001) when the analysis only included nurses. In subgroup analyses based on gender and smoking, heterogeneity was observed. Only for studies reporting comet moment, I2 test results, as a measure of heterogeneity, dropped to zero. Heterogeneity analysis showed that date of study publication was a possible source of heterogeneity (B = -0.14; p < 0.0001). CONCLUSIONS A mixture of personal parameters, comet assay methodological variables, and exposure characteristics may be responsible for heterogenic data from comet assay studies and interfere with obtaining conclusive results. Lack of quantitative environmental exposure measures and variation in comet assay protocols across studies are important obstacles in generalization of results.
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Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- a Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Mohammad Hajaghazadeh
- b Faculty of Health, Department of Occupational Health , Urmia University of Medical Sciences , Urmia , Iran
| | - Mehrdad Mostaghaci
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Amir Houshang Mehrparvar
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Fariba Zare Sakhvidi
- d Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Elham Naghshineh
- e Faculty of Medicine, Department of Obstetrics/Gynecology, Isfahan University of Medical Sciences , Isfahan , Iran
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Systematic Review of Control Measures to Reduce Hazardous Drug Exposure for Health Care Workers. J Nurs Care Qual 2016; 31:183-90. [DOI: 10.1097/ncq.0000000000000155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Martínez-Valenzuela C, Rodríguez-Quintana AR, Meza E, Waliszewski SM, Amador-Muñóz O, Mora-Romero A, Calderón-Segura ME, Félix-Gastélum R, Rodríguez-Romero I, Caba M. Cytogenetic biomonitoring of occupationally exposed workers to ashes from burning of sugar cane in Ahome, Sinaloa, México. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2015; 40:397-401. [PMID: 26245813 DOI: 10.1016/j.etap.2015.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/13/2015] [Indexed: 05/24/2023]
Abstract
Burning the sugar cane field before harvesting has a negative impact on both air and human health, however this issue had not been explored in Mexico. The objective of this work was to determine the chromosomal damage in workers from sugar cane burning fields in Sinaloa, México. To this purpose, we analyzed 1000 cells of buccal exfoliated epithelia from 60 exposed workers and 60 non-exposed controls to determine micronucleus frequencies and other nuclear abnormalities. The results indicated significant higher values of micronucleus and nuclear abnormalities such as binucleate cells, pyknosis, karyolysis, chromatin condensation and nuclear buds frequencies in the exposed subjects compared to those that were not exposed. Our data indicates that sugar cane burning, that generates polycyclic aromatic hydrocarbons, represents a genotoxic risk for workers in this important sugar cane producing area in Mexico.
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Affiliation(s)
- Carmen Martínez-Valenzuela
- Instituto de Investigación en Ambiente y Salud, Universidad de Occidente, Boulevard Macario Gaxiola y Carretera Internacional, Los Mochis, SIN, Mexico
| | - Ana Rosa Rodríguez-Quintana
- Instituto de Investigación en Ambiente y Salud, Universidad de Occidente, Boulevard Macario Gaxiola y Carretera Internacional, Los Mochis, SIN, Mexico
| | - Enrique Meza
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, VER, Mexico
| | - Stefan M Waliszewski
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, VER, Mexico
| | - Omar Amador-Muñóz
- Centro de Ciencias de la Atmósfera, UNAM, Circuito Exterior Ciudad Universitaria, Coyoacán 04510, México, DF, Mexico
| | - Arlene Mora-Romero
- Instituto de Investigación en Ambiente y Salud, Universidad de Occidente, Boulevard Macario Gaxiola y Carretera Internacional, Los Mochis, SIN, Mexico
| | - María Elena Calderón-Segura
- Centro de Ciencias de la Atmósfera, UNAM, Circuito Exterior Ciudad Universitaria, Coyoacán 04510, México, DF, Mexico
| | - Rubén Félix-Gastélum
- Instituto de Investigación en Ambiente y Salud, Universidad de Occidente, Boulevard Macario Gaxiola y Carretera Internacional, Los Mochis, SIN, Mexico
| | - Isabel Rodríguez-Romero
- Instituto de Investigación en Ambiente y Salud, Universidad de Occidente, Boulevard Macario Gaxiola y Carretera Internacional, Los Mochis, SIN, Mexico
| | - Mario Caba
- Centro de Investigaciones Biomédicas, Universidad Veracruzana, Xalapa, VER, Mexico.
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Abstract
BACKGROUND The north-west coast of Spain was heavily contaminated by the Prestige oil spill, in 2002. Individuals who participated in the clean-up tasks showed increased chromosome damage two years after exposure. Long-term clinical implications of chromosome damage are still unknown. OBJECTIVE To realize a follow-up genotoxic study to detect whether the chromosome damage persisted six years after exposure to the oil. DESIGN Follow-up study. SETTING Fishermen cooperatives in coastal villages. PARTICIPANTS Local fishermen who were highly exposed (n = 52) and non-exposed (n = 23) to oil seven years after the spill. MEASUREMENTS Chromosome damage in circulating lymphocytes. RESULTS Chromosome damage in exposed individuals persists six years after oil exposure, with a similar incidence than those previously detected four years before. A surprising increase in chromosome damage in non-exposed individual was found six years after Prestige spill vs. those detected two years after the exposure. LIMITATIONS The sample size and the possibility of some kind of selection bias should be considered. Genotoxic results cannot be extrapolated to the approximately 300,000 individuals who participated occasionally in clean-up tasks. CONCLUSION The persistence of chromosome damage detected in exposed individuals six years after oil exposure seems to indicate that the cells of the bone marrow are affected. A surprising increase in chromosome damage in non-exposed individuals detected in the follow-up study suggests an indirect exposition of these individuals to some oil compounds or to other toxic agents during the last four years. More long-term studies are needed to confirm the presence of chromosome damage in exposed and non-exposed fishermen due to the association between increased chromosomal damage and increased risk of cancer. Understanding and detecting chromosome damage is important for detecting cancer in its early stages. The present work is the first follow-up cytogenetic study carried out in lymphocytes to determine genotoxic damage evolution between two and six years after oil exposure in same individuals.
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Anastasi M, Rudaz S, Queruau Lamerie T, Odou P, Bonnabry P, Fleury-Souverain S. Efficacy of Two Cleaning Solutions for the Decontamination of 10 Antineoplastic Agents in the Biosafety Cabinets of a Hospital Pharmacy. ANNALS OF OCCUPATIONAL HYGIENE 2015; 59:895-908. [PMID: 25979920 DOI: 10.1093/annhyg/mev031] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 03/05/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to evaluate two cleaning solutions for the chemical decontamination of antineoplastic agents on the surfaces of two biosafety cabinets routinely used for chemotherapy preparation in a hospital pharmacy. METHODS For almost 1 year (49 weeks), two different solutions were used for the weekly cleaning of two biosafety cabinets in a hospital pharmacy's centralized cytotoxic preparation unit. The solutions evaluated were a commercial solution of isopropyl alcohol (IPA) and water (70:30, vol:vol), and a detergent solution constituted by 10(-2)M of sodium dodecyl sulfate (SDS) with 20% IPA. Seven areas in each biosafety cabinet were wiped 14 times throughout the year, before and after the weekly cleaning process, according to a validated procedure. Samples were analyzed using a validated method of high-performance liquid chromatography coupled to mass spectrometry. The decontamination efficacy of these two solutions was tested for 10 antineoplastic agents: cytarabine, gemcitabine, methotrexate, etoposide phosphate, irinotecan, cyclophosphamide, ifosfamide, doxorubicin, epirubicin, and vincristine. RESULTS Overall decontamination efficacies observed were 82±6% and 49±11% for SDS solution and IPA, respectively. Higher contamination levels were distributed on areas frequently touched by the pharmacy technicians-such as sleeves and airlock handles-than on scale plates, gravimetric control hardware, and work benches. Detected contaminations of cyclophosphamide, ifosfamide, gemcitabine, and cytarabine were higher than those of the others agents. SDS solution was almost 20% more efficient than IPA on eight of the antineoplastic agents. CONCLUSION Both cleaning solutions were able to reduce contamination levels in the biosafety cabinets. The efficacy of the solution containing an anionic detergent agent (SDS) was shown to be generally higher than that of IPA and, after the SDS cleaning procedure, biosafety cabinets demonstrated acceptable contamination levels.
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Affiliation(s)
- Marco Anastasi
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Serge Rudaz
- 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Thomas Queruau Lamerie
- 3.Department of Pharmacy, Dunkerque Hospital, 130, avenue Louis Herbeaux, BP 6 367, 59385 Dunkerque, France
| | - Pascal Odou
- 3.Department of Pharmacy, Dunkerque Hospital, 130, avenue Louis Herbeaux, BP 6 367, 59385 Dunkerque, France 4.Biopharmacy, Galenic and Hospital Pharmacy Department (EA 4481, IFR114), UFR Pharmacie, Université Lille Nord de France, 1 Rue Lefèvre, 59000 Lille, France
| | - Pascal Bonnabry
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Antineoplastic drug contamination in the urine of Canadian healthcare workers. Int Arch Occup Environ Health 2015; 88:933-41. [DOI: 10.1007/s00420-015-1026-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/20/2015] [Indexed: 11/27/2022]
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Boiano JM, Steege AL, Sweeney MH. Adherence to Precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:588-602. [PMID: 25897702 DOI: 10.1080/15459624.2015.1029610] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Precautionary guidelines detailing standards of practice and equipment to eliminate or minimize exposure to antineoplastic drugs during handling activities have been available for nearly three decades. To evaluate practices for compounding antineoplastic drugs, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted among members of professional practice organizations representing primarily oncology nurses, pharmacists, and pharmacy technicians. This national survey is the first in over 20 years to examine self-reported use of engineering, administrative, and work practice controls and PPE by pharmacy practitioners for minimizing exposure to antineoplastic drugs. The survey was completed by 241 nurses and 183 pharmacy practitioners who compounded antineoplastic drugs in the seven days prior to the survey. They reported: not always wearing two pairs of chemotherapy gloves (85%, 47%, respectively) or even a single pair (8%, 10%); not always using closed system drug-transfer devices (75%, 53%); not always wearing recommended gown (38%, 20%); I.V. lines sometimes/always primed with antineoplastic drug (19%, 30%); and not always using either a biological safety cabinet or isolator (9%, 15%). They also reported lack of: hazard awareness training (9%, 13%); safe handling procedures (20%, 11%); and medical surveillance programs (61%, 45%). Both employers and healthcare workers share responsibility for adhering to precautionary guidelines and other best practices. Employers can ensure that: workers are trained regularly; facility safe-handling procedures reflecting national guidelines are in place and support for their implementation is understood; engineering controls and PPE are available and workers know how to use them; and medical surveillance, exposure monitoring, and other administrative controls are in place. Workers can seek out training, understand and follow facility procedures, be role models for junior staff, ask questions, and report any safety concerns.
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Affiliation(s)
- James M Boiano
- a Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health Centers for Disease Control and Prevention , Cincinnati , Ohio
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Murashov V, Howard J. Risks to health care workers from nano-enabled medical products. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:D75-D85. [PMID: 25950806 DOI: 10.1080/15459624.2015.1006641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Nanotechnology is rapidly expanding into the health care industry. However, occupational safety and health risks of nano-enabled medical products have not been thoroughly assessed. This manuscript highlights occupational risk mitigation practices for nano-enabled medical products throughout their life cycle for all major workplace settings including (1) medical research laboratories, (2) pharmaceutical manufacturing facilities, (3) clinical dispensing pharmacies, (4) health care delivery facilities, (5) home health care, (6) health care support, and (7) medical waste management. It further identifies critical research needs for ensuring worker protection in the health care industry.
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Affiliation(s)
- Vladimir Murashov
- a Department of Health and Human Services, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention , Washington , DC
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Lu Y, Matsuse R, Sobue T. Rejoining kinetics of bleomycin-induced DNA single-strand breaks in agarose-bound human blood cells. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2015; 778:6-11. [DOI: 10.1016/j.mrgentox.2014.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 12/11/2014] [Accepted: 12/22/2014] [Indexed: 12/12/2022]
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Milic M, Frustaci A, Del Bufalo A, Sánchez-Alarcón J, Valencia-Quintana R, Russo P, Bonassi S. DNA damage in non-communicable diseases: A clinical and epidemiological perspective. Mutat Res 2014; 776:118-27. [PMID: 26255943 DOI: 10.1016/j.mrfmmm.2014.11.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/28/2014] [Accepted: 11/30/2014] [Indexed: 02/02/2023]
Abstract
Non-communicable diseases (NCDs) are a leading cause of death and disability, representing 63% of the total death number worldwide. A characteristic phenotype of these diseases is the accelerated aging, which is the result of phenomena such as accumulated DNA damage, telomere capping loss and subcellular irreversible/nonrepaired oxidative damage. DNA damage, mostly oxidative, plays a key role in the development of most common NCDs. The present review will gather some of the most relevant knowledge concerning the presence of DNA damage in NCDs focusing on cardiovascular diseases, diabetes, chronic obstructive pulmonary disease, and neurodegenerative disorders, and discussing a selection of papers from the most informative literature. The challenge of comorbidity and the potential offered by new systems approaches for introducing these biomarkers into the clinical decision process will be discussed. Systems Medicine platforms represent the most suitable approach to personalized medicine, enabling to identify new patterns in the pathogenesis, diagnosis and prognosis of chronic diseases.
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Affiliation(s)
- Mirta Milic
- IRCCS San Raffaele Pisana, Area of Clinical and Molecular Epidemiology, 00166 Rome, Italy; Institute for Medical Research and Occupational Health, Mutagenesis Unit, 10 000 Zagreb, Croatia
| | - Alessandra Frustaci
- IRCCS San Raffaele Pisana, Area of Clinical and Molecular Epidemiology, 00166 Rome, Italy
| | - Alessandra Del Bufalo
- IRCCS San Raffaele Pisana, Area of Clinical and Molecular Epidemiology, 00166 Rome, Italy
| | - Juana Sánchez-Alarcón
- Universidad Autónoma de Tlaxcala, Facultad de Agrobiología, Evaluación de Riesgos Ambientales, 90062 Tlaxcala, Mexico
| | - Rafael Valencia-Quintana
- Universidad Autónoma de Tlaxcala, Facultad de Agrobiología, Evaluación de Riesgos Ambientales, 90062 Tlaxcala, Mexico
| | - Patrizia Russo
- IRCCS San Raffaele Pisana, Area of Clinical and Molecular Epidemiology, 00166 Rome, Italy
| | - Stefano Bonassi
- IRCCS San Raffaele Pisana, Area of Clinical and Molecular Epidemiology, 00166 Rome, Italy.
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Gerić M, Gajski G, Garaj-Vrhovac V. γ-H2AX as a biomarker for DNA double-strand breaks in ecotoxicology. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2014; 105:13-21. [PMID: 24780228 DOI: 10.1016/j.ecoenv.2014.03.035] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 06/03/2023]
Abstract
The visualisation of DNA damage response proteins enables the indirect measurement of DNA damage. Soon after the occurrence of a DNA double-strand break (DSB), the formation of γ-H2AX histone variants is to be expected. This review is focused on the potential use of the γ-H2AX foci assay in assessing the genotoxicity of environmental contaminants including cytostatic pharmaceuticals, since standard methods may not be sensitive enough to detect the damaging effect of low environmental concentrations of such drugs. These compounds are constantly released into the environment, potentially representing a threat to water quality, aquatic organisms, and, ultimately, human health. Our review of the literature revealed that this method could be used in the biomonitoring and risk assessment of aquatic systems affected by wastewater from the production, usage, and disposal of cytostatic pharmaceuticals.
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Affiliation(s)
- Marko Gerić
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb, Croatia
| | - Goran Gajski
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb, Croatia
| | - Vera Garaj-Vrhovac
- Institute for Medical Research and Occupational Health, Ksaverska cesta 2, 10000 Zagreb, Croatia.
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Hon CY, Barzan C, Astrakianakis G. Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe. Saf Health Work 2014; 5:169-74. [PMID: 25516807 PMCID: PMC4266773 DOI: 10.1016/j.shaw.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 01/20/2023] Open
Abstract
We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.
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Affiliation(s)
- Chun-Yip Hon
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada ; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cris Barzan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada ; Prevention Division, WorkSafeBC, Vancouver, British Columbia, Canada
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Hon CY, Teschke K, Demers PA, Venners S. Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system. ACTA ACUST UNITED AC 2014; 58:761-70. [PMID: 24644303 DOI: 10.1093/annhyg/meu019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We previously reported that antineoplastic drug contamination is found on various work surfaces situated throughout the hospital medication system (process flow of drug within a facility from initial delivery to waste disposal). The presence of drug residual on surfaces suggests that healthcare workers involved in some capacity with the system may be exposed through dermal contact. The purpose of this paper was to determine the dermal contamination levels of healthcare employees working throughout a hospital and to identify factors that may influence dermal contamination. We selected participants from six hospitals and wiped the front and back of workers' hands. Wipe samples were analyzed for cyclophosphamide (CP), a commonly used antineoplastic drug, using high-performance liquid chromatography-tandem mass spectrometry. Participants were asked about their frequency of handling antineoplastic drugs, known contact with CP on their work shift, gender, job title, and safe drug handling training. In addition, participants were surveyed regarding their glove usage and hand washing practices prior to wipe sample collection. We collected a total of 225 wipe samples. Only 20% (N = 44) were above the limit of detection (LOD) of 0.36ng per wipe. The average concentration was 0.36ng per wipe, the geometric mean < LOD, the geometric standard deviation 1.98, and the range < LOD to 22.8ng per wipe. Hospital employees were classified into eight different job categories and all categories had some dermal contamination levels in excess of the LOD. The job category with the highest proportion of samples greater than the LOD were those workers in the drug administration unit who were not responsible for drug administration (volunteer, oncologist, ward aide, dietician). Of note, the highest recorded concentration was from a worker who had no known contact with CP on their work shift. Our results suggest that a broader range of healthcare workers than previously believed, including those that do not directly handle or administer the drugs (e.g. unit clerks, ward aides, dieticians, and shipper/receivers), are at risk of exposure to antineoplastic drugs. A review of control measures to minimize antineoplastic drug exposure that encompasses a wide array of healthcare workers involved with the hospital medication system is recommended.
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Affiliation(s)
- Chun-Yip Hon
- 1.School of Occupational and Public Health, Ryerson University, POD247C, 350 Victoria Street, Toronto, M5B 2K3, Canada 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada
| | - Kay Teschke
- 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada
| | - Paul A Demers
- 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada 3.Occupational Cancer Research Centre, Cancer Care Ontario, 505 University Avenue, 17th Floor, Toronto, Ontario M5G 1X3, Canada 4.Dalla Lana School of Public Health, University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada
| | - Scott Venners
- 5.Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby BC V5A 1S6, Canada
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