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Vallée A. Green hospitals face to climate change: Between sobriety and resilience. Heliyon 2024; 10:e24769. [PMID: 38298726 PMCID: PMC10828801 DOI: 10.1016/j.heliyon.2024.e24769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/26/2023] [Accepted: 01/14/2024] [Indexed: 02/02/2024] Open
Abstract
Climate change poses a critical challenge to global health, influencing social and environmental determinants such as housing, air and water quality, and food security. This article explores the profound impact of climate change on health, projecting an additional 250,000 annual deaths from various climate-related diseases between 2030 and 2050. Healthcare systems significantly contribute to global carbon emissions. The concept of the "Green Hospital" is introduced as a paradigm shift in healthcare, focusing on optimizing resource efficiency and minimizing environmental impact. This concept encompasses renewable energy integration, natural lighting, sustainable materials, green roofs, and smart building management systems. Several challenges remain major, such as medical waste management, water conservation, chemical use, pollution, and plastic usage in healthcare settings. Moreover, obstacles to green hospital initiatives should be resolved, including system redundancy, regulatory compliance, operational demands, financial constraints, and cultural resistance. Conclusively, an urgent reformation of healthcare systems is needed to align with eco-friendly and sustainable practices, highlighting the necessity to reduce CO2 emissions and manage resources and waste more effectively to meet the evolving health needs of a growing and aging global population.
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Affiliation(s)
- Alexandre Vallée
- Department of Epidemiology and Public Health, Foch Hospital, Suresnes, 92150, France
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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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Rigamonti N, Sebellin J, Pipitone F, Realdon N, Carpanese D, Coppola M. A Method for Risk Assessment Evaluating the Safety, Stability and Efficacy in Clinical Practice of Anticancer Drug Preparations in the Centralized Compounding Unit of the Veneto Institute of Oncology-IRCCS. Pharmaceutics 2023; 15:pharmaceutics15051429. [PMID: 37242671 DOI: 10.3390/pharmaceutics15051429] [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: 02/27/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Preparation of injectable anticancer drugs in hospital pharmacies is a high-risk activity that requires a proper risk assessment (RA) and quality assurance system (QAS) to ensure both a decrease in risk associated with chemotherapy compounding and high quality of the final product, especially in terms of its microbiological stability. METHODS At the centralized compounding unit (UFA) of the Italian Hospital IOV-IRCCS, a quick and deductive method was applied to evaluate the "added value" provided by each prescribed preparation, and its RA was calculated applying a formula that integrates different pharmacological, technological and organizational aspects. According to specific RA range values, the preparations were divided into different risk levels, in order to determine the QAS to be adopted, according to the Italian Ministry of Health guidelines, whose adherence was meticulously evaluated through a specific self-assessment procedure. A review of the scientific literature was carried out to integrate the risk-based predictive extended stability (RBPES) of drugs with data concerning their physiochemical and biological stability. RESULTS Based on the self-assessment comprising all microbiological validations of the working area, personnel and products, the microbiological risk level within the IOV-IRCCS' UFA was defined through the creation of a transcoding matrix, conferring a microbiological stability to preparations and vial leftovers of a maximum of 7 days. The calculated RBPES were successfully integrated with stability data from the literature, leading to the drafting of a stability table of drugs and preparations in use in our UFA. CONCLUSIONS Our methods allowed us to perform an in-depth analysis of the highly specific and technical process of anticancer drug compounding in our UFA, ensuring a certain grade of quality and safety to preparations, especially in terms of microbiological stability. The resulting RBPES table represents an invaluable tool with positive repercussions at organizational and economic levels.
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Affiliation(s)
- Nicoletta Rigamonti
- Pharmacy Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Comprehensive Cancer Centre, 35128 Padua, Italy
| | - Jessica Sebellin
- Pharmacy Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Comprehensive Cancer Centre, 35128 Padua, Italy
| | - Francesca Pipitone
- Pharmacy Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Comprehensive Cancer Centre, 35128 Padua, Italy
| | - Nicola Realdon
- Pharmaceutical and Pharmacological Sciences Department, University of Padua, 35122 Padua, Italy
| | - Debora Carpanese
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Comprehensive Cancer Centre, 35128 Padua, Italy
| | - Marina Coppola
- Pharmacy Unit, Veneto Institute of Oncology (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Comprehensive Cancer Centre, 35128 Padua, Italy
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Charlier B, Coglianese A, De Rosa F, Cozzolino A, Boccia G, Borrelli A, Capunzo M, Genovese G, De Caro F, Filippelli A, Dal Piaz F, Izzo V. A LC-MS/MS based methodology for the environmental monitoring of healthcare settings contaminated with antineoplastic agents. J Public Health Res 2023; 12:22799036231160629. [PMID: 36923326 PMCID: PMC10009035 DOI: 10.1177/22799036231160629] [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: 12/14/2022] [Accepted: 02/13/2023] [Indexed: 03/13/2023] Open
Abstract
Background Adverse health events associated with the exposure of healthcare workers to antineoplastic drugs are well documented in literature and are often related to the chemical contamination of work surfaces. It is therefore crucial for healthcare professionals to validate the efficiency of safety procedures by periodic biological and environmental monitoring activities where the main methodological limitations are related to the complexity, in terms of chemical-physical features and chemical-biological stability, of the drugs analyzed. Materials and methods Here we describe the evaluation and application of a UHPLC-MS/MS based protocol for the environmental monitoring of hospital working areas potentially contaminated with methotrexate, iphosphamide, cyclophosphamide, doxorubicin, irinotecan, and paclitaxel. This methodology was used to evaluate working areas devoted to the preparation of chemotherapeutics and combination regimens at the University Hospital "San Giovanni di Dio e Ruggi d'Aragona" in Salerno (Italy). Results Our analyses allowed to uncover critical aspects in both working protocols and workspace organization, which highlighted, among others, cyclophosphamide and iphosphamide contamination. Suitable adjustments adopted after our environmental monitoring campaign significantly reduced the exposure risk for healthcare workers employed in the unit analyzed. Conclusion The use of sensitive analytical approaches such as LC-MS/MS coupled to an accurate wiping procedure in routine environmental monitoring allows to effectively improve chemical safety for exposed workers.
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Affiliation(s)
- Bruno Charlier
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy.,Graduate School in Clinical Pharmacology and Toxicology, University of Salerno, Baronissi, Campania, Italy
| | - Albino Coglianese
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,Graduate School in Clinical Pathology and Clinical Biochemistry, University of Salerno, Baronissi, Campania, Italy
| | - Federica De Rosa
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,Graduate School in Clinical Pharmacology and Toxicology, University of Salerno, Baronissi, Campania, Italy
| | - Armando Cozzolino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,Graduate School in Clinical Pharmacology and Toxicology, University of Salerno, Baronissi, Campania, Italy
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Anna Borrelli
- Medical School and Hospital "Secondo Policlinico," University Federico II of Naples, Italy
| | - Mario Capunzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Giovanni Genovese
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Francesco De Caro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Amelia Filippelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Fabrizio Dal Piaz
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
| | - Viviana Izzo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana," University of Salerno, Baronissi, Campania, Italy.,University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno (SA), Italy
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Pironti C, Ricciardi M, Motta O, Venier M, Faggiano A, Cucciniello R, Proto A. Sulphurous air pollutants and exposure events of workers in thermal-mineral springs: a case study of Contursi Terme (Salerno, Italy). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:3112-3120. [PMID: 35945319 PMCID: PMC9892073 DOI: 10.1007/s11356-022-22432-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
Thermo-mineral springs are widely spread over the volcanic areas of Salerno, a city in southern Italy. Although the water of thermal structures provides beneficial effects on human health, the air is characterized by the presence of potentially toxic compounds, such as hydrogen sulphide (H2S) and sulphur dioxide (SO2). Exposure to sulphurous compounds may have detrimental effects on human health, with asthma being the most common. In this study, air concentrations of H2S and SO2 in the thermal springs of Contursi Terme (Salerno, Italy) were monitored for 4 months (using both active and passive sampling), along with the chemical and microclimatic characterization of thermal water, to assess workers' exposure to these pollutants. An in-depth characterization of indoor air at the springs is paramount to establish emission control limits for occupational exposure and to take protective measures. The air concentration of SO2 varied from 0.11 ± 0.02 to 0.91 ± 0.02 mg/m3, following a seasonal pattern (higher values in winter and lower in spring). Conversely, indoor H2S concentrations did not vary significantly with time, but outdoor levels (from 0.40 ± 0.03 to 1.90 ± 0.03 mg/m3) were always higher than indoor ones (from 0.11 ± 0.03 to 0.56 ± 0.03 mg/m3). Not negligible air concentrations of these pollutants were detected in this thermal spring workplace, so further investigations are needed to ensure workers' safety.
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Affiliation(s)
- Concetta Pironti
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy
| | - Maria Ricciardi
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy
| | - Oriana Motta
- Department of Medicine Surgery and Dentistry, University of Salerno, via S. Allende, 84081, Baronissi, SA, Italy.
| | - Marta Venier
- O'Neill School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
| | - Antonio Faggiano
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Raffaele Cucciniello
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
| | - Antonio Proto
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084, Fisciano, SA, Italy
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