Occupational exposure to chemotherapy of pharmacy personnel at a single centre

Real-world study of the leakage of two types of infusion bags in multicenter pharmacy intravenous admixture service (PIVAS)

Background: This study sought to analyze the leakage rate, economic loss caused by leakage, leakage reasons, and usage of upright polypropylene infusion bags and non-polyvinyl chloride (PVC) infusion bags, two types of closed intravenous infusion containers used in pharmacy intravenous admixture service (PIVAS), to improve the product quality of drug infusion packaging materials, reduce drug and clinical economic losses, and reduce the safety hazards of medication. Method: A real-world study was used to collect statistics for these infusion containers. The study was conducted in 21 hospitals in China from September to December 2022. Upright polypropylene infusion bags or non-PVC infusion bags in PIVAS of these 21 hospitals were chosen as the research material. Results: In total, 2,349,899 upright polypropylene infusion bags and 3,301,722 non-PVC infusion bags were collected. Eleven cases of upright polypropylene infusion bag leakage occurred (with a the leakage rate of 0.05‱), and 394 cases of non-PVC infusion bag leakage occurred (with a leakage rate of 1.19‱). The leakage rate of non-PVC infusion bags was significantly higher than that of upright polypropylene infusion bags (p < 0.01). The main reason for leakage in upright polypropylene infusion bags was sharp objects such as glass fragments or aluminum caps piercing the bag. The main reason for leakage in non-PVC infusion bags was squeezing, stacking, and uneven arrangement that causes folding of edges. For non-PVC bags, additional reasons for leakage included leakage at the nozzle joint, excessive manual or machine throwing force, and excessive dosage. The economic loss of upright polypropylene infusion bags was 1,116.56 CNY. The economic loss of non-PVC infusion bags was 32,210.86 CNY. Conclusion: Based on real-world study data on the leakage of upright polypropylene infusion bags and non-PVC infusion bags in multicenter PIVAS, it can be concluded that the leakage rates of upright polypropylene infusion bags are significantly lower than those of non-PVC infusion bags in PIVAS, and the economic losses due to upright polypropylene infusion bags are lower than those due to non-PVC infusion bags in PIVAS. Therefore, we can infer that upright polypropylene infusion bags are superior to non-PVC infusion bags.

Exposure to Antineoplastic Drugs in Occupational Settings: A Systematic Review of Biological Monitoring Data

The high toxicity of antineoplastic drugs (ADs) makes them dangerous not only for patients, but also for exposed workers. Therefore, the aim of this review was to provide an updated overview of the biological monitoring of occupational AD exposure in order to extrapolate information useful to improve risk assessment and management strategies in workplaces. Several studies demonstrated that remarkable portions of healthcare workers may have traces of these substances or their metabolites in biological fluids, although with some conflicting results. Nurses, directly engaged in AD handling, were the occupational category at higher risk of contamination, although, in some cases, personnel not involved in AD-related tasks also showed quantifiable internal doses. Overall, further research carried out on greater sample sizes appears necessary to gain deeper insight into the variability retrieved in the reported results. This may be important to understand the impact of the extent of ADs use, different handling, procedures, and cleaning practices, spill occurrence, training of the workforce, as well as the adoption of adequate collective and personal protective equipment in affecting the occupational exposure levels. This may support the achievement of the greatest clinical efficiency of such therapies while assuring the health and safety of involved workers.

Study protocol for the assessment of nurses internal contamination by antineoplastic drugs in hospital centres: a cross-sectional multicentre descriptive study

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.

Photo-oxidative degradation of doxorubicin with siloxane MOFs by exposure to daylight

Doxorubicin (DOX) is a chemotherapeutic agent from anthracycline class, which acts unselectively on all cells; thus, it may have genotoxic and/or mutagenic effects and cause serious environmental problems. Herein, the decomposition of a diluted solution of DOX hydrochloride for injection has been investigated under photo-oxidative conditions, in ambient light and without pH modification, using hydrogen peroxide as oxidizing agent and hydrophobic siloxane-based metal-organic frameworks (MOFs) as heterogeneous catalysts. The kinetics of the photodegradation process was followed by UV-Vis spectroscopy and by ESI-MS. According to UV-Vis data, two pseudo-first-order kinetic steps describe the process, with rate constants in the order of 10^-3-10^-2 min^-1 for the rate-determining one. ESI-MS provided more accurate information, with a rate constant of 2.6 · 10^-2 min^-1 calculated from the variation of DOX ion abundance. Complete decomposition of DOX was achieved after 120 min in the shade and after only 20 min by exposure to sunlight. The analysis of the residual waters by mass spectrometry and 1D and 2D NMR spectroscopy showed complete disappearance of DOX in all cases, excluded any anthracycline species, which are destroyed in the tested conditions, and proved formation of an un-harmful compound-glycerol, while no trace of metal was detected by XRF. Preliminary data also showed decomposition of oxytetracycline in similar conditions. By this study, we bring into attention a less-addressed pollution issue and we propose a mild and effective method for the removal of drug emerging pollutants.

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BACKGROUND

There is increasing evidence that traces of hazardous drugs occur in the urine of health care professionals who are exposed to these drugs.

OBJECTIVE

To review the scientific literature regarding urinary monitoring of health care professionals exposed to antineoplastic drugs through their work.

DATA SOURCES

A search of PubMed using the Medical Subject Headings 'occupational exposure' and 'antineoplastic agents' and of Google Scholar using the terms 'antineoplastic', 'urine', and 'occupational exposure'.

STUDY SELECTION AND DATA EXTRACTION

The analysis covered all articles in English or French pertaining to health care professionals exposed to hazardous drugs in the workplace, published from January 1, 2010, to December 31, 2015. Articles that did not discuss the results of urine tests and those concerning veterinarians, as well as literature reviews, editorials, letters to the editor, and conference abstracts, were excluded.

DATA SYNTHESIS

Twenty-four articles were retained. The studies were conducted in 52 health care institutions in 7 countries. They included 826 workers exposed to hazardous drugs and 175 controls, specifically nurses (n = 16 studies), pharmacists (n = 10), pharmacy technicians (n = 8), physicians (n = 7), health care aides (n = 2), and others (n = 8). Various analytical methods were used to quantify the presence of 13 hazardous drugs, primarily cyclophosphamide (n = 16 studies), platinum-based drugs (n = 7), and alpha-fluoro-beta-alanine, a urine metabolite derived from 5-fluorouracil (n = 3). The proportion of workers with positive results ranged from 0% (n = 10 studies) to 100% (n = 4). Considering only those studies that allowed calculation of the rate of workers with at least one positive urine sample (n = 23), the total proportion was 21% (173/809 workers, for all methods and drugs combined).

CONCLUSION

Twenty-four studies on urine monitoring were conducted in 7 countries between 2010 and 2015. In several studies, no traces of drugs were detected in urine.