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Borghi F, Zellino C, Zago A, De Vito G, Del Vecchio RL, Cattaneo A, Spinazzè A, Cavallo DM. Exposure Assessment and Monitoring of Antiblastic Drugs Preparation in Health Care Settings: A Systematic Review. LA MEDICINA DEL LAVORO 2024; 115:e2024012. [PMID: 38686575 DOI: 10.23749/mdl.v115i2.15609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Several antiblastic drugs (ADs) are classified as carcinogenic, mutagenic, and/or toxic for reproduction. Despite established guidelines and safe handling technologies, ADs contamination of the work environments could occur in healthcare settings, leading to potential exposure of healthcare staff. This systematic review aims to investigate the main techniques and practices for assessing ADs occupational exposure in healthcare settings. The reviewed studies unveil that workplace contamination by ADs appears to be a still-topical problem in healthcare settings. These issues are linked to difficulties in guaranteeing: (i) the adherence to standardized protocols when dealing with ADs, (ii) the effective use of personal protective equipment by operators involved in the administration or management of ADs, (iii) a comprehensive training of the healthcare personnel, and (iv) a thorough health surveillance of exposed workers. A "multi-parametric" approach emerges as a desirable strategy for exposure assessment. In parallel, exposure assessment should coincide with the introduction of novel technologies aimed at minimizing exposure (i.e., risk management). Assessment must consider various departments and health operators susceptible to ADs contamination, with a focus extended beyond worst-case scenarios, also considering activities like surface cleaning and logistical tasks related to ADs management. A comprehensive approach in ADs risk assessment enables the evaluation of distinct substance behaviors and subsequent exposure routes, affording a more holistic understanding of potential risks.
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Affiliation(s)
- Francesca Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Via Pelagio Palagi 9, 40138 Bologna (Ita-ly)
| | - Carolina Zellino
- Department of Science and High Technology, University of Insubria, via Valleggio 11, 22100 Como (Italy)
| | - Arianna Zago
- Department of Science and High Technology, University of Insubria, via Valleggio 11, 22100 Como (Italy)
| | - Giovanni De Vito
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100 Varese (Italy)
| | - Rocco Loris Del Vecchio
- Department of Medicine and Surgery, University of Insubria, Via Guicciardini 9, 21100 Varese (Italy)
| | - Andrea Cattaneo
- Department of Science and High Technology, University of Insubria, via Valleggio 11, 22100 Como (Italy)
| | - Andrea Spinazzè
- Dipartimento di Scienza e Alta Tecnologia Università degli Studi dell'Insubria Via Valleggio, 11 - 22100 Como
| | - Domenico Maria Cavallo
- Department of Science and High Technology, University of Insubria, via Valleggio 11, 22100 Como (Italy)
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Dugheri S, Cappelli G, Squillaci D, Rapi I, Fanfani N, Dori F, Cecchi M, Sordi V, Ghiori A, Mucci N. Evaluation of the risk of occupational exposure to antineoplastic drugs in healthcare sector: part II - the application of the FMECA method to compare manual vs automated preparation. Arh Hig Rada Toksikol 2024; 75:41-50. [PMID: 38548384 PMCID: PMC10978160 DOI: 10.2478/aiht-2024-75-3803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/01/2023] [Accepted: 03/01/2024] [Indexed: 04/01/2024] Open
Abstract
Healthcare workers handling antineoplastic drugs (ADs) in preparation units run the risk of occupational exposure to contaminated surfaces and associated mutagenic, teratogenic, and oncogenic effects of those drugs. To minimise this risk, automated compounding systems, mainly robots, have been replacing manual preparation of intravenous drugs for the last 20 years now, and their number is on the rise. To evaluate contamination risk and the quality of the working environment for healthcare workers preparing ADs, we applied the Failure Mode Effects and Criticality Analysis (FMECA) method to compare the acceptable risk level (ARL), based on the risk priority number (RPN) calculated from five identified failure modes, with the measured risk level (MRL). The model has shown higher risk of exposure with powdered ADs and containers not protected by external plastic shrink film, but we found no clear difference in contamination risk between manual and automated preparation. This approach could be useful to assess and prevent the risk of occupational exposure for healthcare workers coming from residual cytotoxic contamination both for current handling procedures and the newly designed ones. At the same time, contamination monitoring data can be used to keep track of the quality of working conditions by comparing the observed risk profiles with the proposed ARL. Our study has shown that automated preparation may have an upper hand in terms of safety but still leaves room for improvement, at least in our four hospitals.
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Affiliation(s)
- Stefano Dugheri
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Giovanni Cappelli
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Donato Squillaci
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Ilaria Rapi
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Niccolò Fanfani
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Fabrizio Dori
- AOU Meyer, Health and Safety Service, Florence, Italy
| | - Michele Cecchi
- Careggi University Hospital, Pharmacy AD Preparation Unit, Florence, Italy
| | - Viola Sordi
- Careggi University Hospital, Pharmacy AD Preparation Unit, Florence, Italy
| | - Andrea Ghiori
- Careggi University Hospital, Pharmacy AD Preparation Unit, Florence, Italy
| | - Nicola Mucci
- University of Florence, Department of Experimental and Clinical Medicine, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
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Kåredal M, Özdemir J, Tinnert A, Wetterling M, Hedmer M. Pilot study: External surface contamination of gemcitabine and 5-fluorouracil on drug packaging. J Oncol Pharm Pract 2024; 30:9-14. [PMID: 36916178 DOI: 10.1177/10781552231163544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Antineoplastic drugs (ADs) are commonly used pharmaceuticals for anticancer treatments. It has previously been shown that the external surface of drug vials frequently is contaminated with ADs. More than a decade ago methods to prevent occupational exposure were introduced by using plastic coverage of the glass vials or packing vials in a secondary plastic container. The aim of the pilot study was to determine contamination levels of ADs on different parts of AD packaging of two different commercially available drug vials on the Swedish market and to investigate the occurrence of cross contamination of ADs. METHODS Packagings of gemcitabine (GEM) and 5-fluorouracil (5-FU) were tested by wipe sampling. Five ADs; GEM, 5-FU, cyclophosphamide (CP), ifosfamide and etoposide were quantified using liquid chromatography mass spectrometry. RESULTS AD contaminations were detected in 69% and 60% of the GEM and 5-FU packaging samples. Highest levels, up to approximately 5 µg/sample, were observed on the glass vials. The protective shrink-wrap of 5-FU vials and the plastic container of GEM were contaminated with low levels of 5-FU and GEM, respectively, and furthermore the 5-FU vials with shrink-wrap were cross-contaminated with GEM. Cross-contamination of CP and GEM was detected on 5-FU vials with plastic shrink-wrap removed. CONCLUSIONS External contamination of ADs are still present at primary drug packagings on the Swedish market. Protection of AD vials by plastic shrink-wrap or a secondary plastic container does not remove the external contamination levels completely. The presence of cross contamination of ADs on drug packagings was also observed.
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Affiliation(s)
- Monica Kåredal
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Jennie Özdemir
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Andreas Tinnert
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Maria Wetterling
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
| | - Maria Hedmer
- Department of Occupational and Environmental Medicine, Region Skåne, Lund, Sweden
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
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Pinet E, Cirtiu CM, Caron N, Bussières JF, Tanguay C. Canadian monitoring program of the surface contamination with 11 antineoplastic drugs in 124 centers. J Oncol Pharm Pract 2024; 30:19-29. [PMID: 37021440 DOI: 10.1177/10781552231167329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers' health. A reproducible Canadian surface monitoring program was established in 2010. The objective was to describe contamination with 11 antineoplastic drugs measured on 12 surfaces among hospitals participating in this annual monitoring program. METHODS Each hospital sampled six standardized sites in oncology pharmacies and six in outpatient clinics. Ultra-performance liquid chromatography coupled with tandem mass spectrometry was used for cyclophosphamide, docetaxel, doxorubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate, paclitaxel, and vinorelbine. Platinum-based drugs were analyzed by inductively coupled plasma mass spectrometry; this excludes inorganic platinum from the environment. Hospitals filled out an online questionnaire about their practices; a Kolmogorov-Smirnov test was used for some practices. RESULTS One hundred and twenty-four Canadian hospitals participated. Cyclophosphamide (405/1445, 28%), gemcitabine (347/1445, 24%), and platinum (71/756, 9%) were the most frequent. The 90th percentile of surface concentration was 0.01 ng/cm² for cyclophosphamide and 0.003 ng/cm² for gemcitabine. Centers that prepared 5000 or more antineoplastic per year had higher concentrations of cyclophosphamide and gemcitabine on their surfaces (p = 0.0001). Almost half maintained a hazardous drugs committee (46/119, 39%), but this did not influence the cyclophosphamide contamination (p = 0.051). Hazardous drugs training was more frequent for oncology pharmacy and nursing staff than for hygiene and sanitation staff. CONCLUSIONS This monitoring program allowed centers to benchmark their contamination with pragmatic contamination thresholds derived from the Canadian 90th percentiles. Regular participation and local hazardous drug committee involvement provide an opportunity to review practices, identify risk areas, and refresh training.
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Affiliation(s)
- Emma Pinet
- Pharmacy Department, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Ciprian Mihai Cirtiu
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Nicolas Caron
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Quebec, Quebec, Canada
| | - Jean-François Bussières
- Pharmacy Department, CHU Sainte-Justine, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Cynthia Tanguay
- Pharmacy Department, CHU Sainte-Justine, Montreal, Quebec, Canada
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E Silva LS, Machado CDSB, Linden R, Antunes MV, da Silva LC, Wayhs CAY, Capp E, Ness SLR. Residual contamination in antineoplastic drug packaging. J Oncol Pharm Pract 2023; 29:1862-1867. [PMID: 36659825 DOI: 10.1177/10781552231151693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The handling of antineoplastic drugs should follow strict supervision and safety rules to minimize the occupational exposure risks to professionals involved. The external surface contamination of drug vials is recognized as a health risk. So, our goal was to determine if there is residual contamination on the vials and containers surface of the antineoplastic drugs doxorubicin (DOX) and cyclophosphamide (CP). METHODS A cross-sectional study was conducted. Samples were collected using a uniform sampling procedure on the inner surfaces of the packages/boxes and the outer surfaces of the vials. The analyzes were executed by high-performance liquid chromatography/mass spectrometry (UHPLC-MS/MS). RESULTS A total of 209 samples were analyzed, 66 of CP and 143 of DOX. CP levels were detected in nine samples (13.63%), three were below the lower limit of quantification (LLQ) and the other six had contamination levels ranging from 1.24 to 28.04 ng/filter. DOX levels were detected in 36 samples (25.17%), two were below the LLQ and the others had levels between 1.32 and 664.84 ng/filter. The majority of samples with residual contamination were in vials (80.0%), however, boxes also showed contamination. CONCLUSIONS The results revealed the presence of residual contamination in the vials and packages of CP and DOX drugs. Although the residues found in each sample are small, special care should be taken in the handling and disposal of the antineoplastic drugs. The use of personal protective equipment is fundamental while handling the vials and packaging of cytotoxic drugs.
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Affiliation(s)
- Luciana Stein E Silva
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cibele da Silva Barbosa Machado
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Linden
- Analytical Toxicology Laboratory, Feevale University, Novo Hamburgo, RS, Brazil
| | | | - Laura Cé da Silva
- Analytical Toxicology Laboratory, Feevale University, Novo Hamburgo, RS, Brazil
- Graduate Program in Toxicology and Toxicological Analysis, Feevale University, Novo Hamburgo, RS, Brazil
| | - Carlos Alberto Yasin Wayhs
- Center for Intravenous Drug Preparation, Department of Pharmacy, Hospital de Clínicas Porto Alegre, Porto Alegre, RS, Brazil
| | - Edison Capp
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandro Luís Ribeiro Ness
- Center for Intravenous Drug Preparation, Department of Pharmacy, Hospital de Clínicas Porto Alegre, Porto Alegre, RS, Brazil
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Delafoy C, Benoist H, Patin A, Vasseur M, Guillouet S, Eveno C, Guilloit JM, Odou P, Simon N, Saint-Lorant G. Knowledge and practices about safe handling regarding the risk of exposure to antineoplastic drugs for caregivers in compounding units and in operating rooms performing HIPEC/PIPAC. J Oncol Pharm Pract 2023; 29:1628-1636. [PMID: 36514878 DOI: 10.1177/10781552221144303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Ever since the late 1970s, occupational exposure associated with the handling of antineoplastic drugs (ADs) in the healthcare environment has been highlighted and demonstrated. Contamination was detected in both operating rooms (OR) and compounding units (CU), where healthcare workers handle and are exposed to ADs in different ways. In the OR, the risk of exposure is higher and the staff receives less training in handling ADs than in the CU. This study aimed to assess and compare knowledge and practices about the safe handling of ADs by caregivers working in these two locations, namely the CU and OR. METHODS Two questionnaires (one each for the OR and CU) were created by two investigator pharmacists and were completed during a personal interview of 20 min. The questions were related to the following topics: training, knowledge about occupational exposure and questions related to protective practices. A scoring system was implemented to assess the knowledge and practices of each participant. RESULTS In total, 38 caregivers working in the OR and 39 in the CU were included in our study. Significantly more CU staff had specific initial training (p < 0.001) and ongoing training (p < 0.001) in handling ADs. Concerning the knowledge score, OR caregivers had a significantly lower median score for contamination routes (p < 0.001), contamination surfaces (p < 0.001), existing procedures (p < 0.001) and total knowledge (p < 0.001) than CU caregivers. Concerning protective handling practices of ADs, the two locations had nonsignificantly different median scores (p = 0.892). CONCLUSION This study suggests that there is still room for improvement in terms of knowledge and protection practices when handling ADs. An appropriate and tailored training program should be developed and provided to all caregivers who handle or come in contact with ADs.Clinical trial registrationStudy CONTACT, ref. 19-504.
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Affiliation(s)
- Clémence Delafoy
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
| | - Hubert Benoist
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
| | - Alex Patin
- Department of Pharmacy, CHU Caen, Caen, France
| | - Michèle Vasseur
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Sonia Guillouet
- UNICAEN, CHU de Caen Normandie, Néphrologie, Direction des Soins, Normandie University, Caen, France
| | - Clarisse Eveno
- Department of Digestive Surgery, CHU Lille, Lille, France
| | - Jean-Marc Guilloit
- Department of Surgery, Comprehensive Cancer Center F. Baclesse, Caen, France
| | - Pascal Odou
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Nicolas Simon
- ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, CHU Lille, University of Lille, Lille, France
- Institut of Pharmacy, CHU Lille, Lille, France
| | - Guillaume Saint-Lorant
- Department of Pharmacy, CHU Caen, Caen, France
- UNICAEN, UNIROUEN, ABTE, Centre de Lutte Contre le Cancer F. Baclesse, Normandie University, Caen, France
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Cerutti A, Ledoux T, Vantard N, Cerfon MA, Kimbidima R, Larbre V, Herledan C, Lattard C, Baudouin A, Caffin AG, Schwiertz V, Ranchon F, Rioufol C. Comparing different robots available in the European market for the preparation of injectable chemotherapy and recommendations to users. J Oncol Pharm Pract 2023; 29:1599-1612. [PMID: 36999226 DOI: 10.1177/10781552221143786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Recent advances in technology have made it possible to develop robots for preparing injectable anticancer drugs. This study aims to compare characteristics between robots available in the European market in 2022 and to help future pharmacy users in their choices. METHODS Three sources of data were used: (1) a review of published articles in the MEDLINE database from November 2017 to end of June 2021 on chemotherapy-compounding robots used in hospital; (2) all manufacturers' documentation, and (3) demonstrations of robot operations in real hospital conditions and discussions with users and manufacturers. Robot characteristics included number of robots installed, general technical characteristics, type of injectable chemotherapy produced and compatible materials, productivity data, preparation control methods, residual manual tasks, chemical and microbiological risk management, cleaning method, software, and implementation time. RESULTS Seven robots commercialized were studied. Several technical characteristics have to be taken into account in selecting the robot whose match the specific needs of a particular hospital, and which often require rethinking the current production workflow as well as the organization of the pharmacy unit. In addition to increasing productivity, the robots improve the quality of production thanks to better traceability, reproducibility, and precision of sampling. They also improve user protection against chemical risk, musculoskeletal disorders, and needle wounds. Nevertheless, when robotization is being planned, there are still numerous residual manual tasks to keep in mind. CONCLUSION Robotization of the production of injectable anticancer drugs is booming within anticancer chemotherapy preparation pharmacy units. Feedback from this experience needs to be further shared with the pharmacy community regarding this significant investment.
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Affiliation(s)
- Ariane Cerutti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Thomas Ledoux
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Marie-Anne Cerfon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Reine Kimbidima
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Chloe Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Claire Lattard
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Anne Gaelle Caffin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Unité de Pharmacie Clinique Oncologique, Pierre-Bénite, France
- Université Lyon 1- EA 3738, CICLY Centre pour l'Innovation en Cancérologie de Lyon, Lyon, Oullins cedex F-69921, France
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Dugheri S, Squillaci D, Cappelli G, Saccomando V, Fanfani N, Ceccarelli J, Mucci N, Arcangeli G. Evaluation of the risk of occupational exposure to antineoplastic drugs in healthcare sector: part I - medical gloves. Arh Hig Rada Toksikol 2023; 74:187-197. [PMID: 37791676 PMCID: PMC10549893 DOI: 10.2478/aiht-2023-74-3734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/01/2023] [Accepted: 07/01/2023] [Indexed: 10/05/2023] Open
Abstract
Antineoplastic drugs (ADs) are essential tools in cancer treatment, but their cytotoxicity poses a risk to workers involved in their handling. In a hospital environment fundamental strategies for minimising exposure involve proper use of safety cabinets and closed-circuit transfer devices, along with personnel training and increased awareness of risks. However, medical gloves remain the first line of defence. In this respect the evaluation of glove materials and best choices can improve hospital safety management and prevent potential hazards and long-term consequences. The aim of this study was to assess contamination of gloves in samples taken from AD administration and preparation units of nine Italian hospitals and to raise awareness of the importance of evaluating chemico-physical properties of gloves. Our findings show that 33 % of the analysed gloves were positive for at least one AD, with contaminations ranging from 0.6 to 20,729 pg/ cm2. We proposed the alert glove values (AGVs) for each AD as a limit value for contamination assessment and good practice evaluation. Our findings also point to multiple AD contamination (43 % of positive findings in preparation units), calculated as total AGV (AGV-T), and confirm that gloves should be replaced after 30 min of AD handling, based on cumulative permeation and area under the curve (AUC), to maintain safety and limit dermal exposure.
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Affiliation(s)
- Stefano Dugheri
- University Hospital Careggi, Industrial Hygiene and Toxicology Laboratory, Florence, Italy
| | - Donato Squillaci
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Giovanni Cappelli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Valentina Saccomando
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Niccolò Fanfani
- University of Florence, Mario Serio Department of Experimental and Clinical Biomedical Sciences, Florence, Italy
| | - Jacopo Ceccarelli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Nicola Mucci
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
| | - Giulio Arcangeli
- University of Florence, Department of Experimental and Clinical Medicine, Florence, Italy
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Kirsanov KI, Sycheva LP, Lesovaya EA, Zhidkova EM, Vlasova OA, Osipova AV, Lylova ES, Grigorieva DD, Kulakova EM, Solenova LG, Belitsky GA, Mikhaylova IN, Yakubovskaya MG. Buccal Micronucleus Cytome Assay for the Evaluation of Cytogenetic Status of Healthcare Professionals Contacting with Anti-Cancer Drugs. RUSS J GENET+ 2022. [DOI: 10.1134/s1022795422050052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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