title: Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys.
abstract: Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring technique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 microl of contamination) and a very high inter-observer agreement (ICC=0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5-250 microg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental set-up. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/m(3) of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses involved in administering drugs and nurses caring for treated patients. Estimation of all relevant mass transport rates will be a challenge for the near future.
authors.affiliation: Environmental and Occupational Health Group, Utrecht University, P.O. Box 238, 6700 AE, Wageningen, The Netherlands. H.Kromhout@vet.uu.nl
authors.forename: H
authors.initials: H
authors.lastname: Kromhout
authors.forename: F
authors.initials: F
authors.lastname: Hoek
authors.forename: R
authors.initials: R
authors.lastname: Uitterhoeve
authors.forename: R
authors.initials: R
authors.lastname: Huijbers
authors.forename: R F
authors.initials: RF
authors.lastname: Overmars
authors.forename: R
authors.initials: R
authors.lastname: Anzion
authors.forename: R
authors.initials: R
authors.lastname: Vermeulen
mesh_terms: D000395:Air Pollutants, Occupational / Q000032:analysis; D000970:Antineoplastic Agents / Q000032:analysis*; D001557:Benzenesulfonates / Q000032:analysis*; D004784:Environmental Monitoring / Q000295:instrumentation / Q000379:methods*; D005456:Fluorescent Dyes / Q000032:analysis*; D006801:Humans; D008954:Models, Biological; D009741:Nursing Staff, Hospital; D015588:Observer Variation; D016273:Occupational Exposure / Q000032:analysis*; D018570:Risk Assessment / Q000379:methods*; D012869:Skin Absorption; D017132:Workplace
chemical_list: D000395:Air Pollutants, Occupational; D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D005456:Fluorescent Dyes; C011556:Tinopal