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Betancur S, Leak Bryant A, Conklin J, Walton A. Occupational exposure to chemical substances and health outcomes among hospital environmental services workers: A scoping review of international studies. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:287-309. [PMID: 38451466 PMCID: PMC11172402 DOI: 10.1080/15459624.2024.2311870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Environmental services (EVS) workers are essential to preventing the spread of disease in hospitals. However, their exposure to hazardous chemicals and drugs is understudied. This scoping review will synthesize literature on hazardous chemical exposures and adverse health outcomes among EVS workers to identify research gaps and trends for further investigation. The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure complete and accurate reporting. The scoping review included 25 studies on occupational exposure to chemicals among EVS workers in hospitals. Most studies focused on exposure to cleaning products, which led to dermal, respiratory, and ocular symptoms, oxidative stress, and inflammation. While personal protective equipment (PPE), training, education, and policies have the potential to enhance safety, further research is required to examine the long-term impacts of exposure and the cost-effectiveness of interventions. Future studies should utilize longitudinal approaches and self-reported data collection methods, such as diaries and interviews, to comprehensively assess exposure risks and develop effective interventions and policies. Future research is needed to understand the potential health risks faced by EVS workers from exposure to chemicals in hospitals. Longitudinal studies with objective exposure assessments and larger sample sizes should be conducted. Policies and interventions must be developed and implemented to improve safe work practices and reduce negative health outcomes.
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Affiliation(s)
- Stephanie Betancur
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Jamie Conklin
- The University of North Carolina at Chapel Hill Health Sciences Librarian and Liaison to Nursing, Chapel Hill, North Carolina
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Liu S, Huang Y, Huang H, Hu S, Zhong X, Peng J, Zhang X, Huang X. Influence of occupational exposure to antineoplastic agents on adverse pregnancy outcomes among nurses: A meta-analysis. Nurs Open 2023; 10:5827-5837. [PMID: 37219069 PMCID: PMC10416046 DOI: 10.1002/nop2.1853] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 02/14/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
AIM This study aimed to explore the relationship between nurses' occupational exposure to antineoplastic agents and adverse pregnancy outcomes. DESIGN Meta-analysis. METHODS Data were retrieved from studies published before April 2022 in PubMed, the Cochrane Library, the Web of Science, Embase databases, the China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), China Science and Technology Journal databases (VIP) and Wan Fang databases (WF). Stata MP (Version 17.0) was used to conduct this meta-analysis. RESULTS The current evidence shows that occupational exposure to antineoplastic agents increases nurses' risk of spontaneous abortions, stillbirths, and congenital abnormalities. It is necessary to pay attention to occupational exposures caused by antineoplastic agents, especially for female nurses of reproductive age. Managers should take timely and effective countermeasures to ensure their occupational safety and reduce the risk of adverse pregnancy outcomes.
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Affiliation(s)
- Shuhan Liu
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
| | - Yanshan Huang
- Longgang District Central Hospital of ShenzhenShenzhenChina
- Shantou University Medical CollegeShantouChina
| | - Hong Huang
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
| | - Song Hu
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Xiao Zhong
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Ji Peng
- Longgang District Central Hospital of ShenzhenShenzhenChina
| | - Xiaoming Zhang
- Department of Nursing, Chinese Academy of Medical Sciences‐Peking Union Medical CollegePeking Union Medical College Hospital (Dongdan Campus)BeijingChina
| | - Xiaohong Huang
- Clinical Medical College of ShenzhenGuangzhou University of Chinese MedicineShenzhenChina
- Longgang District Central Hospital of ShenzhenShenzhenChina
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3
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Mason TM. Personal protective equipment for antineoplastic safety. Nursing 2023; 53:42-45. [PMID: 37471366 DOI: 10.1097/01.nurse.0000942856.87753.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT Nurses must protect themselves while handling hazardous drugs or contaminated items. Wearing personal protective equipment (PPE) will reduce contact and prevent any acute or chronic adverse reactions that may occur from unintentional exposure. This article reviews PPE for antineoplastic safety and evidence-based guidelines for their use.
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Affiliation(s)
- Tina M Mason
- Tina Mason is a nurse scientist at the Moffitt Cancer Center
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Vanneste D, Verscheure E, Srinivasan AN, Godderis L, Ghosh M. Systematic review of genotoxicity induced by occupational exposure to antineoplastic drugs. Arch Toxicol 2023; 97:1453-1517. [PMID: 37099053 DOI: 10.1007/s00204-023-03481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/02/2023] [Indexed: 04/27/2023]
Abstract
With increasing numbers of cancer cases, the use of antineoplastic agents is expected to rise. This will be accompanied by an increase in occupational exposure, which can cause unwanted health effects in workers. Our aim was to give an overview of genotoxic and epigenetic effects after occupational exposure to antineoplastic agents and to assess the concentration-effect relation. Four databases were searched for papers investigating genotoxic and/or epigenetic effects of occupational exposure to antineoplastic agents. Out of the 245 retrieved papers, 62 were included in this review. In this systematic literature review, we confirmed that exposure of healthcare workers to antineoplastic agents can lead to genotoxic damage. However, we observed a lack of data on exposure as well as genotoxic and epigenetic effects in workers other than healthcare workers. Furthermore, gaps in the current knowledge regarding the potential epigenetic effects caused by antineoplastic drug exposure and regarding the link between internal antineoplastic drug concentration and genotoxic and epigenetic effects after occupational exposure to antineoplastic agents were identified, offering a first step for future research.
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Affiliation(s)
- Dorian Vanneste
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Eline Verscheure
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Adhithya Narayanan Srinivasan
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Lode Godderis
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium
| | - Manosij Ghosh
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, ON5 Herestraat 49, Box 952, 3000, Leuven, Belgium.
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5
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The relationship between safety climate and nurses’ safe handling of chemotherapy: A partial least squares structural equation modeling analysis. Eur J Oncol Nurs 2022; 61:102222. [DOI: 10.1016/j.ejon.2022.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022]
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6
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Demircan Yildirim F, Ekmekci I. Design of Analytical Method Validation Protocol Evaluating Environmental Monitoring of AND Contamination on Surfaces Based on Cleaning Validation Procedures: A Multi Component RP-UHPLC Method. J Chromatogr Sci 2022; 60:926-936. [PMID: 35980296 DOI: 10.1093/chromsci/bmac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022]
Abstract
Environmental monitoring of anti-neoplastic drug (AND) residues in workplaces is crucial to limit exposure to workers who handle with them. Although wipe sampling is the most appropriate methodology to evaluate the risk, conflicting results are also reported due to the lack of standardized and validated procedures. In this study, procedures for surface contamination of ANDs in workplaces are presented, with a focus on sampling, sample preparation and instrumentation. The analytical method validation parameters are designed to comply with requirements of The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q7 Good Manufacturing Practice (GMP) for active pharmaceutical ingredients. Additionally, the study provides a simple, specific, rapid and multi-component analytical method to evaluate seven ANDs that are Gefitinib, Imatinib, Dasatinib, Axitinib, Erlotinib, Nilotinib and Sorafenib at very low concentration levels, simultaneously. Quantitative, precise and reproducible results obtained from the study show that environmental monitoring procedure and analytical method validation protocol presented in the study can be used to reduce and monitor occupational exposure risk to ANDs in wokplaces.
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Affiliation(s)
- Fatma Demircan Yildirim
- Istanbul Commerce University, Department of Occupational Health and Safety, Istanbul, 34840, Turkey
| | - Ismail Ekmekci
- Istanbul Commerce University, Faculty of Industrial Engineering, Istanbul, 34840, Turkey
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7
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Eisenberg S. Closed safety system for administration (CSSA): proposal for a new cytotoxic chemotherapy acronym. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S26-S32. [PMID: 35648666 DOI: 10.12968/bjon.2022.31.10.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Exposure to cytotoxic chemotherapy can result in acute and chronic conditions including nausea, headaches, rashes, miscarriages, infertility and genetic aberrations. Surface contamination can occur during drug administration, and can subsequently spread throughout the healthcare environment. Dermal contact with contaminated surfaces can lead to drug absorption. Closed system drug-transfer devices (CSTDs) were initially developed to protect pharmacists during compounding. Components include a vial adapter to prevent pressurisation leakage and a syringe connector for transferring the drug to the intravenous infusion bag. Membrane-based CSTDs require a Luer adapter for drug administration whereas Luer system-based products do not. Most European nurses are familiar with needleless connectors. Unfortunately, these devices do not provide protection from chemotherapy exposure. To decrease confusion, CytoPrevent, a multi-national, primarily European organisation has proposed the term 'closed safety system for administration' (CSSA) for Luer based CSTDs. Along with education, the new term can help promote safety for nurses administering cytotoxic chemotherapy.
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Affiliation(s)
- Seth Eisenberg
- Professional Practice Coordinator, Infusion Services, Seattle Cancer Care Alliance, Seattle, Washington USA
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8
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Lin YS, Gau BS, Liang JC, Chen HC, Shih FY, Lin YC, Lou MF. Development and psychometric testing of the safety climate instrument suitable for nurses handling chemotherapy drugs. J Adv Nurs 2022; 78:1824-1835. [PMID: 35404507 DOI: 10.1111/jan.15257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
AIM To develop and test the psychometric properties of the Taiwanese safety climate instrument suitable for nurses handling chemotherapy drugs. DESIGN This is an instrument development study. METHOD All four stages, including questionnaire design, expert consultation, cognitive testing and psychometric validation, were used in this study. The data were collected between August and December 2018. Nurses with experience in handling chemotherapy drugs (N = 484) at one medical centre and two regional hospitals in Taiwan completed this instrument. Data were randomly split into two groups: one group (N = 237) for exploratory factor analysis and the other (N = 247) for confirmatory factor analysis. RESULTS The instruments' items were based on qualitative research, and the content validity index levels exceeded the acceptable value. An exploratory factor analysis revealed 43 items remaining in six factors, which accounted for 74.4% of variance. The result of the confirmatory factor analysis verified the acceptability of a 43-item model. The composite reliability values, Cronbach's alpha values, convergent validity and discriminant validity for each factor exceeded the acceptable value. CONCLUSION Most climate safety instruments used in the health care sector focus mainly on patient safety outcomes. Furthermore, there is no safety climate instrument for handling chemotherapy drugs, and there is a cultural difference. Through the development and validation process, we have developed a new instrument suitable for nurses handling chemotherapy drugs, which has good psychometric properties. IMPACT This instrument is valuable as its development was based on the concept of a safety climate for health care perceptions and qualitative survey findings. Hospital managers can use this instrument regularly to evaluate nurses' perceptions of the safety climate to determine the strengths and weaknesses of their workplace, thereby assisting organizational managers in proposing concrete actions.
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Affiliation(s)
- Ying-Siou Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Bih-Shya Gau
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.,School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jyh-Chong Liang
- Program of Learning Sciences and Institute for Research Excellence in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Hai-Chiao Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Fuh-Yuan Shih
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Chun Lin
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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9
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Nouri A, Seyed Javadi M, Iranijam E, Aghamohammadi M. Improving nurses' performance in the safe handling of antineoplastic agents: a quasi-experimental study. BMC Nurs 2021; 20:247. [PMID: 34879843 PMCID: PMC8656071 DOI: 10.1186/s12912-021-00771-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background The safe and standard handling of antineoplastic drugs can reduce the effects of occupational exposure and promote safe behaviors in nurses. Thus, the present study aimed to determine the effects ofstandard guidelines education on the safe handling of antineoplastic drugs among oncologynurses in Ardabil, Iran. Methods Thequasi-experimental study with a one-group pretest-posttest design was performed among 32 nursesworking in the oncology wards of two educational hospitals in Ardabil city, during 2020. Allthe nurses in the wards who met the inclusion criteria participated in the study. The data were collectedby usinga demographic information form and nurses’knowledge assessment questionnaire regardingthe standard guidelines for working with antineoplastic drugs, and a standard checklist for examiningtheir performance in this regard. Subsequently, they were analyzed by descriptive (mean and standard deviation) and inferential statistics (t-test)and Pearson’s correlation coefficient) in SPSS 22. Results The mean and standard deviation of the knowledge and performance scores of the oncology nurses was59.56±6.41and 18.96±2.54 respectively, which changed to 66±4.82 and 32.03±2.45 respectively three months after training. The results of the t-test represented a statistically significant difference between the level of knowledge and performance before and after the intervention (P=0.001). Conclusions Based on the results, the standard guidelines education improved the nurses’ knowledge and performance on the safe handling of antineoplastic drugs in the chemotherapy wards. Therefore, it is advised to increase the awareness of the oncology nurses in this regard in the planning and policy-making ofhealthcare centers.
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Affiliation(s)
- A Nouri
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Seyed Javadi
- Department of Nursing, Moghan School of Nursing and Midwifery, Ardabil University of Medical Sciences, Moghan, Iran
| | - E Iranijam
- Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - M Aghamohammadi
- Department of Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran.
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10
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Lin YW, Lin CH, Pai LW, Mou CH, Wang JY, Lin MH. Population-Based Study on Cancer Incidence in Pharmacist: A Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312625. [PMID: 34886352 PMCID: PMC8657399 DOI: 10.3390/ijerph182312625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 11/17/2022]
Abstract
Cancer is increasing in rate globally and is leading cause of death among no communicable chronic diseases (NCDs) after cardiovascular disease (CVD). Most of the research focuses on the risk of occupational injury, job stress, mental illness, substance abuse and workplace safety in physicians and nurses. However, fewer studies have investigated the risk of cancer in pharmacists. We compared the matched general population to investigate the risk of cancer in pharmacists in Taiwan. Data were obtained from the Health and Welfare Data Science Center of the Ministry of Health and Welfare in Taiwan. We established a pharmacist group that included 11,568 pharmacists and selected a 4-fold comparison (n = 46,272) for the non-clinics comparison group, frequency being matched by age, gender and Charlson Comorbidity Index (CCI) score. The pharmacists had a lower but non-significant risk of all cancer (Adjusted hazard ratio [aHR] = 0.96; 95% confidence interval [CI] = 0.85–1.07) compared with the general population. Female pharmacists had a higher risk of cancer than male pharmacists ([aHR] = 1.23; 95% CI = 1.06–1.43). Pharmacists had higher risks of breast cancer in females (aHR = 1.68; 95% CI = 1.35–2.08) and of prostate cancer in males (aHR = 2.18; 95% CI = 1.35–2.08) when compared with the general population. Occupational risk factors could play a role, but they were not evaluated. These epidemiological findings require additional studies to clarify cancer risk mechanisms in pharmacists.
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Affiliation(s)
- Ya-Wen Lin
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Department of Public Health, China Medical University, Taichung 406040, Taiwan
| | - Che-Huei Lin
- Department of College Business Administration, National Chiayi University, Chiayi 600355, Taiwan;
- College of Pharmacy and Science, Chia Nan University of Pharmacy & Science, Tainan 71710, Taiwan
| | - Lee-Wen Pai
- Department of Nursing, Central Taiwan University of Science and Technology, Taichung 406053, Taiwan;
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung 40447, Taiwan;
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan
- Correspondence: (J.-Y.W.); (M.-H.L.); Tel.: +886-933-465147 (M.-H.L.); Fax: +886-4-7567218 (M.-H.L.)
| | - Ming-Hung Lin
- College of Pharmacy and Science, Chia Nan University of Pharmacy & Science, Tainan 71710, Taiwan
- Department of Nursing, National Taichung University of Science and Technology, Taichung 40343, Taiwan
- Correspondence: (J.-Y.W.); (M.-H.L.); Tel.: +886-933-465147 (M.-H.L.); Fax: +886-4-7567218 (M.-H.L.)
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11
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Kato G, Mitome H, Shigematsu S, Utsunomiya A, Shimasaki M, Sasaki Y, Maki T, Yamamoto H, Tanabe T, Funahashi T, Hatae N, Hidaka N, Tanaka M, Akira K. Degradation and inactivation efficacy of ozone water for antineoplastic drugs in hospital settings. J Oncol Pharm Pract 2021; 28:1781-1789. [PMID: 34709082 DOI: 10.1177/10781552211042525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Occupational exposure to antineoplastic drugs in hospital settings is recognized to be hazardous, and as such environmental decontamination including degradation and inactivation of such drugs is recommended. To data, although various agents such as oxidants have been reported to be useful for decontamination, simpler, safer, and more convenient methods are required. In this study, the degradation and inactivation efficacy of ozone water, which has newly been introduced for decontamination of antineoplastic drugs in spills, was investigated for formulations of gemcitabine, irinotecan, and paclitaxel. METHODS Antineoplastic formulations (medicinal ingredient: ∼1.5 μmol) were mixed with 50 mL of ozone water (>4 mg/L). The reactions were monitored by high-performance liquid chromatography, and the degradation mixtures were analyzed by 1H nuclear magnetic resonance spectroscopy in order to obtain the structural information of the degradation products. The formulations of gemcitabine and irinotecan and those degradation mixtures were evaluated for their mutagenicity using the Ames test and cytotoxicity against human cancer cells. RESULTS gemcitabine and irinotecan were found to be readily degraded by the ozone treatment, and their active sites were suggested to be degraded. In contrast, paclitaxel was hard to be decomposed, possibly owing to the consumption of ozone by the polyoxyethylene castor oil added as a pharmaceutical additive of the formulation. No significant mutagenic changes of Salmonella typhimurium strains used for the Ames test were observed for the samples within the concentration ranges examined. The ozone treatment showed obvious increases in cell viability for gemcitabine formulation, and mild increases for irinotecan formulation. CONCLUSIONS Ozone water was shown to be effective as a decomposition agent for the antineoplastic drug formulations examined, although the efficacy depends on the chemical structures of the drugs and the pharmaceutical additives. It was also suggested that ozone treatment has a tendency to decrease the toxicity of the antineoplastic drug formulations. As such, further studies are required in order to clarify the effects and application limitations of ozone water.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Saki Shigematsu
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Aya Utsunomiya
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Miho Shimasaki
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Yuta Sasaki
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Tsuneo Maki
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Hiroshi Yamamoto
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Tomotaka Tanabe
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Tatsuya Funahashi
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Noriyuki Hatae
- Faculty of Pharmaceutical Sciences, 68348Yokohama University of Pharmacy, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, 89456Ehime University Hospital, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, 89456Ehime University Hospital, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
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12
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Labrèche F, Ouellet C, Roberge B, Caron NJ, Yennek A, Bussières JF. Occupational exposure to antineoplastic drugs: what about hospital sanitation personnel? Int Arch Occup Environ Health 2021; 94:1877-1888. [PMID: 34410477 DOI: 10.1007/s00420-021-01731-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/19/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Occupational exposure to antineoplastic drugs (ANPs) occurs mainly through dermal contact. Our study was set up to assess the potential exposure of hospital sanitation (HS) personnel, for whom almost no data are available, through contamination of surfaces they regularly touch. METHODS In the oncology departments of two hospitals around Montreal, surface wipe samples of 120-2000 cm2 were taken at 10 sites cleaned by the HS personnel and five other sites frequently touched by nursing and pharmacy personnel. A few hand wipe samples were collected to explore skin contamination. Wipes were analyzed by ultra-performance liquid chromatography tandem-mass spectrometry for 10 ANPs. RESULTS Overall, 60.9% of 212 surface samples presented at least one ANP above the limits of detection (LOD). Cyclophosphamide and gemcitabine were most often detected (52% and 31% of samples respectively), followed by 5-fluorouracil and irinotecan (15% each). Highest concentrations of five ANPs were found in outpatient clinics on toilet floors (5-fluorouracil, 49 ng/cm2; irinotecan, 3.6 ng/cm2), a perfusion pump (cyclophosphamide, 19.6 ng/cm2) and on a cytotoxic waste bin cover (gemcitabine, 4.97 ng/cm2). Floors in patient rooms had highest levels of cytarabine (0.12 ng/cm2) and methotrexate (6.38 ng/cm2). Hand wipes were positive for two of 12 samples taken on HS personnel, seven of 18 samples on nurses, and two of 14 samples on pharmacy personnel. CONCLUSIONS A notable proportion of surfaces showed measurable levels of ANPs, with highest concentrations found on surfaces cleaned by HS personnel, who would benefit from appropriate preventive training. As potential sources of worker exposure, several hospital surfaces need to be regularly monitored to evaluate environmental contamination and efficacy of cleaning.
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Affiliation(s)
- France Labrèche
- Chemical, Biological, Mechanical and Physical Risk Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, 505 De Maisonneuve Blvd. West, Montréal, QC, H3A 3C2, Canada. .,Service de santé au travail, Direction de santé publique de 1 Estrie, CIUSSE - CHUS de Sherbrooke, Sherbrooke, QC, Canada.
| | - Capucine Ouellet
- Chemical, Biological, Mechanical and Physical Risk Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, 505 De Maisonneuve Blvd. West, Montréal, QC, H3A 3C2, Canada
| | - Brigitte Roberge
- Chemical, Biological, Mechanical and Physical Risk Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, 505 De Maisonneuve Blvd. West, Montréal, QC, H3A 3C2, Canada
| | - Nicolas J Caron
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Ahmed Yennek
- Service de santé au travail, Direction de santé publique de 1 Estrie, CIUSSE - CHUS de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-François Bussières
- Département de pharmacie, Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, Montreal, QC, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
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13
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Jeronimo M, Arnold S, Astrakianakis G, Lyden G, Stewart Q, Petersen A, Chambers C, Malard Johnson D, Zimdars E, Kaup H, Davies HW. Spatial and Temporal Variability in Antineoplastic Drug Surface Contamination in Cancer Care Centers in Alberta and Minnesota. Ann Work Expo Health 2021; 65:760-774. [PMID: 33889938 DOI: 10.1093/annweh/wxab013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
The health risks of exposure to antineoplastic drugs (ADs) are well established, and healthcare professionals can be exposed while caring for cancer patients receiving AD therapy. Studies conducted worldwide over the past two decades indicate continuing widespread surface contamination by ADs. No occupational exposure limits have been established for ADs, but concerns over exposures have led to the development of guidelines, such as United States Pharmacopeia (USP) General Chapter <800> Hazardous Drugs-Handling in Healthcare. While recommending regular surveillance for surface contamination by ADs these guidelines do not provide guidance on sampling strategies. Better characterization of spatial and temporal variability of multidrug contamination would help to inform such strategies. We conducted surface-wipe monitoring of nine cancer care centers in Alberta, Canada and Minnesota, USA, with each center sampled eight times over a 12-month period. Twenty surfaces from within pharmacy and drug administration areas were sampled, and 11 drugs were analyzed from each wipe sample. Exposure data were highly left-censored which restricted data analysis; we examined prevalence of samples above limit of detection (LOD), and used the 90th percentile of the exposure distribution as a measure of level of contamination. We collected 1984 wipe samples over a total of 75 sampling days resulting in 21 824 observations. Forty-five percent of wipe samples detected at least one drug above the LOD, but only three of the drugs had more than 10% of observations above the LOD: gemcitabine (GEM) (24%), cyclophosphamide (CP) (16%), and paclitaxel (13%). Of 741 wipe samples with at least one drug above LOD, 60% had a single drug above LOD, 19% had two drugs, and 21% had three drugs or more; the maximum number of drugs found above LOD on one wipe was 8. Surfaces in the compounding area of the pharmacy and in the patient area showed the highest prevalence of samples above the LOD, including the compounding work surface, drug fridge handle, clean room cart, passthrough tray, and hazardous drug room temperature storage, the IV pump keypad, patient washroom toilet handle, patient washroom door handle, nurses' storage shelf/tray, and patient side table. Over the course of the study, both 90th percentiles and prevalence above LOD varied without clear temporal patterns, although some centers appeared to show decreasing levels with time. Within centers, the degree of variability was high, with some centers showing changes of two to three orders of magnitude in the 90th percentile of drug concentrations month to month. A clear difference was observed between the six centers located in Alberta and the three in Minnesota, with Minnesota centers having substantially higher percentages of samples above the LOD for CP and GEM. Other factors that were associated with significant variability in exposures were drug compounding volume, size of center, number of patients seen, and age of the center. We hope that demonstrating variability associated with drug, surface, clinic-factors, and time will aid in a better understanding of the nature of AD contamination, and inform improved sampling strategies.
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Affiliation(s)
- Matthew Jeronimo
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Susan Arnold
- Division of Environmental Health Sciences School of Public Health, University of Minnesota SE Minneapolis, MN, USA
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Grace Lyden
- Division of Biostatistics, School of Public Health, University of Minnesota SE Minneapolis, MN, USA
| | - Quinn Stewart
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ashley Petersen
- Division of Biostatistics, School of Public Health, University of Minnesota SE Minneapolis, MN, USA
| | - Carole Chambers
- Alberta Health Services, Tom Baker Cancer Clinic Pharmacy NW Calgary, Alberta, Canada
| | | | | | - Hannah Kaup
- Division of Environmental Health Sciences School of Public Health, University of Minnesota SE Minneapolis, MN, USA
| | - Hugh W Davies
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Oratz T, Ogletree R, Gettis M, Cherven B. Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste. Clin J Oncol Nurs 2021; 25:272-281. [PMID: 34019028 DOI: 10.1188/21.cjon.272-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Safe handling practices for patient waste have focused on patients receiving IV chemotherapy, but these practices do not address safe handling for patients receiving oral chemotherapy. OBJECTIVES The aim of this article is to evaluate evidence and formulate best practice recommendations for handling and disposing waste from patients receiving oral chemotherapy. METHODS A literature search established a framework for the project. For healthcare providers and staff, procedures were established to access biohazard supplies and to follow safe handling of patient waste post-oral chemotherapy administration. Supply cost utilization was evaluated pre- and postimplementation. Staff perceptions were assessed six months after project implementation. FINDINGS The cost of supplies per patient day increased minimally. Staff self-reported use of biohazard precautions when handling patients' waste increased. The majority of staff reported that they had access to supplies and were knowledgeable regarding safe handling procedures six months after this practice change.
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15
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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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16
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Factors influencing precautions against antineoplastic drug exposure among nurses and nurse assistants in Thailand. Int Arch Occup Environ Health 2021; 94:813-822. [PMID: 33427994 DOI: 10.1007/s00420-020-01649-9] [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: 06/18/2020] [Accepted: 12/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Antineoplastic drugs (AD) are important chemical risks for healthcare workers. Precautions against AD exposure include the use of appropriate personal protective equipment (PPE). Evaluation of PPE usage during patient care processes has not been reported in Thailand. We aimed to evaluate the level of PPE usage and factors predicting PPE usage among nurses and nurse assistants in Thailand. METHODS A cross-sectional survey was conducted in a university hospital and two general hospitals. The questionnaires covered demographic characteristics, self-reported use of PPE and 7 predictive factors. Mixed-effects modeling was used to determine the association between standardized score of predictive factors and PPE usage score. RESULTS The response rate was 78.6% and 884 participants were left for analysis after data cleaning. Among nurses (n = 499), higher PPE usage score was associated with self-efficacy (β = 0.28, 95% CI 0.21, 0.34), workplace safety climate (β = 0.27, 95% CI 0.20, 0.34), and conflict of interest (β = - 0.07, 95% CI - 0.14, - 0.01). Among nurse assistants (n = 385), higher PPE usage score was associated with self-efficacy (β = 0.27, 95% CI 0.18, 0.36), interpersonal influence (β = 0.14, 95% CI 0.04, 0.24), workplace safety climate (β = 10.29, 95% CI 0.19, 0.38), and conflict of interest (β = - 0.14, 95% CI - 0.24, - 0.03). CONCLUSIONS Several factors were associated with PPE usage among nurses and nurse assistants. Improved PPE usage against AD can be promoted through interventions that modify those factors.
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17
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Ferrario L, Schettini F, Garagiola E, Cecchi A, Lugoboni L, Serra P, Porazzi E, Foglia E. Advanced Medical Devices for Preparation and Administration of Chemotherapeutic Agents: Results from a Multi-Dimensional Evaluation. Clinicoecon Outcomes Res 2020; 12:711-722. [PMID: 33293839 PMCID: PMC7718866 DOI: 10.2147/ceor.s267283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate the incremental benefits concerning the implementation of closed-system medical devices for the preparation and administration of chemotherapy agents (integrated or not with traceable workflow), within an Italian clinical practice, in which the use of such technologies is not standardized. Methodology Four Scenarios, implying different levels of technologies introduction, were analyzed, based on the presence and/or absence of closed systems and traceable workflow, in the preparation and in the administration phase. A literature review was conducted, in order to retrieve efficacy and safety measures. Economic and organizational benefits, assuming a hospitals perspective, were assessed by means of health-economics tools, considering 27,660 (±695.86) drugs on average prepared, on an annual basis, by 12 hospitals involved. The typology of medical devices and other devices/equipment used, the human resources involved, and the time spent for the preparation and administration phases were collected. Results Literature stated that the introduction of advanced technologies (CSTDs in the preparation phase, closed-system in the administration phase, both integrated by a traceable workflow) could: i) decrease surface contamination (12.24% vs 26.39%, P<0.001) and ii) improve the capability to identify dosage errors (7% vs 0.096%, P<0.05). The above technologies presented the best trade-off between cost sustained and efficacy gained. Despite marginal investments (ranging from +1% to +6%) being required for their acquisition, an organizational saving equal to more than 1,000 working hours emerged, which could be spent on other hospital activities. Conclusion The implementation of closed systems, integrated with a traceable workflow grounding on gravimetric control, may be considered a valid technological alternative within the investigated setting. The marginal incremental costs could be absorbed already in the first year after their introduction, in particular, because of the potential time saving in using closed systems in both the preparation and administration phases, demonstrating the sustainability and feasibility of such advanced technologies.
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Affiliation(s)
- Lucrezia Ferrario
- Carlo Cattaneo - LIUC University and LIUC Business School, Castellanza, Italy
| | - Fabrizio Schettini
- Carlo Cattaneo - LIUC University and LIUC Business School, Castellanza, Italy
| | | | - Adriana Cecchi
- ARCS - Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | | | | | - Emanuele Porazzi
- Carlo Cattaneo - LIUC University and LIUC Business School, Castellanza, Italy
| | - Emanuela Foglia
- Carlo Cattaneo - LIUC University and LIUC Business School, Castellanza, Italy
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18
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Palamini M, Hilliquin D, Delisle JF, Chouinard A, Bussières JF. Surface Contamination by Antineoplastic Drugs in Two Oncology Inpatient Units. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2020. [DOI: 10.1515/pthp-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundHazardous drugs pose risks to health care workers. To reduce the risk of occupational exposure for all workers, several protective and monitoring measures have been recommended and implemented over the past two decades. This study was undertaken to describe traces contamination with ten antineoplastic drugs in the oncology care unit of two university hospitals.MethodsIn this descriptive interrupted time series study, data was collected in two hospitals (a pediatric hospital and an adult hospital) in two consecutive years (12 December 2017 and 27 March 2018, defined as Period 1; 17 April 2019 and 12 June 2019, defined as Period 2). In both Period 1 and Period 2, 36 sites were sampled in each inpatient care unit to explore the contamination of surfaces with hazardous drugs.ResultsA total of 144 samples from the oncology care unit of the two hospitals were obtained for measurement. Overall, 40 % (58/144) of the sampling sites were positive for at least one hazardous drug. In the pediatric centre, 50 % (18/36) and 36 % (13/36) of the sites sampled in Period 1 and Period 2, respectively, were positive for at least one hazardous drug, whereas in the adult hospital, the percentage of sites that were positive for at least one hazardous drug was 19 % (7/36) in Period 1 and 56 % (20/36) in Period 2.ConclusionThe surfaces of inpatient care units sampled in this study were contaminated with antineoplastic drugs, and contamination was present throughout the care units (including structures, furniture, medical equipment, and office equipment). Hospitals’ environmental surveillance programs should encompass inpatient care units.
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Affiliation(s)
- Marie Palamini
- Pharmacy Practice Research Unit, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montreal, QuebecH3T 1C5, Canada
| | - Delphine Hilliquin
- Pharmacy Practice Research Unit, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montreal, QuebecH3T 1C5, Canada
| | - Jean-François Delisle
- Pharmacy Practice Research Unit, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montreal, QuebecH3T 1C5, Canada
| | | | - Jean-François Bussières
- Pharmacy Practice Research Unit, CHU Sainte-Justine, 3175, chemin de la Côte Sainte-Catherine, Montreal, QuebecH3T 1C5, Canada
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19
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Park C. Reproductive toxic agents in work environments and related cases in Korea. Yeungnam Univ J Med 2020; 37:22-31. [PMID: 31914717 PMCID: PMC6986961 DOI: 10.12701/yujm.2019.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 11/04/2022] Open
Abstract
There has been a growing concern and subsequent interest surrounding numerous reproductive toxic agents found in various working and non-working environments. Meanwhile, there have been many efforts in medical fields such as toxicology and epidemiology applying experimental studies to elucidate reproductive toxic agents' characterization and health effects. However, there remains insufficient research data and inadequate evidence in humans. Adverse reproductive outcomes vary from transient, moderate health effects to severely detrimental consequences, such as permanent infertility or childhood cancer of one's offspring. Furthermore, upon exposure to toxic agents, the latent period before reproductive health effects are observed is relatively short compared to other occupational diseases (e.g., occupational cancer); instant action is required once exposure to reproductive toxic agents is detected. Therefore, it is very important for workers and healthcare professionals to know about the reproductive toxic agents they are likely to be exposed to. In this review, we discuss the general epidemiology of reproductive health in Korea, and the information regarding these reproductive toxic agents.
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Affiliation(s)
- Chulyong Park
- Department of Occupational and Environmental Medicine, Kang Mijung's Internal Medicine Clinic, Daegu, Korea
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20
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Villa A, Molimard M, Bignon E, Martinez B, Rouyer M, Mathoulin-Pelissier S, Baldi I, Verdun-Esquer C, Canal-Raffin M. Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study. BMJ Open 2019; 9:e033040. [PMID: 31712349 PMCID: PMC6858204 DOI: 10.1136/bmjopen-2019-033040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/18/2019] [Accepted: 10/07/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Antineoplastic drugs (AD) are potentially carcinogenic and/or reprotoxic molecules. Healthcare professionals are increasingly exposed to these drugs and can be potentially contaminated by them. Internal contamination of professionals is a key concern for occupational physicians in the assessment and management of occupational risks in healthcare settings. Objectives of this study are to report AD internal contamination rate in nursing staff and to identify factors associated with internal contamination. METHODS AND ANALYSIS This trial will be conducted in two French hospital centres: University Hospital of Bordeaux and IUCT-Oncopole of Toulouse. The target population is nurses practicing in one of the fifteen selected care departments where at least one of the five studied AD is handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The trial will be conducted with the following steps: (1) development of analytical methods to quantify AD urine biomarkers, (2) study of the workplace and organization around AD in each care department (transport and handling, professional practices, personal and collective protection equipments available) (3) development of a self-questionnaire detailing professional activities during the day of inclusion, (4) nurses inclusion (urine samples and self-questionnaire collection), (5) urine assays, (6) data analysis. ETHICS AND DISSEMINATION The study protocol has been approved by the French Advisory Committee on the Treatment of Information in Health Research (CCTIRS) and by the French Data Protection Authority (CNIL). Following the opinion of the Regional Committee for the Protection of Persons, this study is outside the scope of the provisions governing biomedical research and routine care (n°2014/87). The results will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03137641.
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Affiliation(s)
- Antoine Villa
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Consultation de Pathologie Professionnelle et de I'environnement, CHU Timone, AP-HM, Marseille, France
- Univ. of Bordeaux, Bordeaux, France
| | - Mathieu Molimard
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
| | - Emmanuelle Bignon
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Béatrice Martinez
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Magali Rouyer
- Bordeaux PharmacoEpi (BPE, CIC 1401), Université de Bordeaux, Talence, France
| | - Simone Mathoulin-Pelissier
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
| | - Isabelle Baldi
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Catherine Verdun-Esquer
- GH Pellegrin, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, France
| | - Mireille Canal-Raffin
- Inserm U1219, Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
- Univ. of Bordeaux, Bordeaux, France
- Laboratoire de Pharmacologie Clinique et Toxicologie, CHU de Bordeaux, Bordeaux, France
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Alhaji MM, Lai A, Naing L, Tuah NA. Self-Reported Skin Disorders Among Health Care Workers. Workplace Health Saf 2019; 67:294-301. [DOI: 10.1177/2165079918795958] [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
This study aimed to estimate the point prevalence and 1-year period prevalence of skin disorder symptoms (SDS) among health care workers (HCWs) and to explore the possible risk factors. A random sample of 400 HCWs from 13 government health centers in Brunei Darussalam self-administered an adapted Nordic Occupational Skin Questionnaire (NOSQ-2002/SHORT). The point and 1-year prevalence of SDS were 12% and 19%, respectively. Having a history of SDS before the current job, exposure to SDS-exacerbating materials at the workplace, and having clinical roles were correlated for both prevalence estimates. Frequent handwashing and moderate use of latex gloves were associated with higher risk of SDS at 1-year. Female HCWs were more likely to report SDS. In multivariate analyses, only contact with SDS-exacerbating materials at the workplace, prejob SDS, and moderate glove usage were significant predictors of SDS.
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Affiliation(s)
| | - Alice Lai
- Universiti Brunei Darussalam
- Ministry of Health, Brunei Darussalam
| | | | - Nik Ani Tuah
- Universiti Brunei Darussalam
- Imperial College London
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Koller M, Böhlandt A, Haberl C, Nowak D, Schierl R. Environmental and biological monitoring on an oncology ward during a complete working week. Toxicol Lett 2018; 298:158-163. [DOI: 10.1016/j.toxlet.2018.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
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Vasseur M, Simon N, Picher C, Richeval C, Soichot M, Humbert L, Barthélémy C, Fleury-Souverain S, Bonnabry P, Décaudin B, Allorge D, Odou P. A decontamination process adding a tensioactive agent and isopropanol to a closed-system drug transfer device for better control of isolator contamination. A prospective, parallel study. PLoS One 2018; 13:e0201335. [PMID: 30089139 PMCID: PMC6082556 DOI: 10.1371/journal.pone.0201335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/13/2018] [Indexed: 11/29/2022] Open
Abstract
Background Despite the use of closed system drug transfer devices (CSTD), residual contamination from antineoplastic drugs is still detected inside isolators. The aim of this study was to compare the decontamination level obtained using a CSTD + standard cleaning procedure with a CSTD + standard cleaning procedure + specific decontamination procedure. Methods and findings A comparative and prospective study was carried out in a newly opened compounding unit. Compounding was performed with a CSTD (BD-Phaseal, Becton-Dickinson). In the Control isolator (C), the cleaning process was completed daily with a standard biocide solution (AnioxysprayTM, Anios, France). In the Intervention isolator (I), weekly decontamination with a homemade admixture of sodium dodecyl sulfate 10−2 M/70% isopropanol (80/20, v/v) was added. Monitoring was performed via a validated LC-MS/MS method. Eight drugs (cyclophosphamide, cytarabine, dacarbazine, fluorouracile, gemcitabine, ifosfamide, irinotecan and methotrexate) were monitored daily over 14 consecutive weeks on three sites inside the isolators: gloves, workbench and window. Results are presented as the odds-ratio (OR) of contamination and as overall decontamination efficiency (EffQ, %). The proportion of EffQ ≥ 90% was assessed by a Fisher’s exact test (p<0.05). Overall contamination rates (CR, %) were significantly different from one isolator to the other (CRC = 25.3% vs. CRI = 10.4%; OR = 0.341; p<0.0001). Overall EffQ values (median; 1st and 3rd quartiles) were higher in the intervention isolator (I: 78.3% [34.6%;92.6%] vs. C: 59.5% [-5.5%;72.6%]; p = 0.0015) as well as the proportion of days with an EffQ ≥ 90% (I: 42.9% vs. C: 7.1%; p = 0.077) but very variable depending on drugs. Conclusion Adding a decontamination protocol with a tensioactive agent to a CSTD leads to better control of chemical contamination inside isolators. Improving decontamination by increasing decontamination frequency or modifying the protocol will be further studied.
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Affiliation(s)
- Michèle Vasseur
- Univ. Lille, EA 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Nicolas Simon
- Univ. Lille, EA 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
- * E-mail:
| | - Chloé Picher
- Univ. Lille, EA 4483 –IMPECS–IMPact de l’Environnement Chimique sur la Santé humaine, Lille, France
- CHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, Lille, France
| | - Camille Richeval
- Univ. Lille, EA 4483 –IMPECS–IMPact de l’Environnement Chimique sur la Santé humaine, Lille, France
- CHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, Lille, France
| | - Marion Soichot
- Laboratoire de Toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luc Humbert
- Univ. Lille, EA 4483 –IMPECS–IMPact de l’Environnement Chimique sur la Santé humaine, Lille, France
- CHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, Lille, France
| | - Christine Barthélémy
- Univ. Lille, EA 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Bertrand Décaudin
- Univ. Lille, EA 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Delphine Allorge
- Univ. Lille, EA 4483 –IMPECS–IMPact de l’Environnement Chimique sur la Santé humaine, Lille, France
- CHU Lille, Pôle de Biologie-Pathologie-Génétique, Unité Fonctionnelle de Toxicologie, Lille, France
| | - Pascal Odou
- Univ. Lille, EA 7365—GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
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