title: Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study.
abstract: BACKGROUND
  Several studies have shown that exposure to antineoplastic drugs can cause reproductive toxic effects as well as carcinogenic effects. Presence of these drugs in the urine of hospital personnel has been widely studied and some work has been done on exposure by inhalation. So far, assessment of dermal exposure to antineoplastic drugs has not been extensively studied. In this pilot study we assessed potential and actual dermal exposure for several common hospital tasks. Results were used to derive an optimal measurement strategy for a currently ongoing exposure survey.
  
  
  METHODS
  Dermal exposure to cyclophosphamide was determined in three Dutch hospitals during five tasks (preparation, decanting urine, washing the patient, removing bed sheets and cleaning the toilet) using pad samples on 10 body locations. In addition, protective medical gloves (worn during the performance of these activities) were collected to estimate potential exposure of the hands. Subsequently, hands were washed to measure actual exposure of the hands. Bulk samples (i.e. application and body fluids) were collected and possible contact surfaces were monitored to assess the amount of cyclophosphamide potentially available for exposure.
  
  
  RESULTS
  The results show that hospital personnel (i.e. pharmacy technicians and oncology nurses) are dermally exposed to cyclophosphamide during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on other body locations (i.e. forehead and forearms). Gloves used during preparation of cyclophosphamide were more contaminated than gloves used in other tasks, however, actual exposure of the hands (underneath the gloves) was highest during decanting of urine of treated patients. Glove samples correlated significantly with handwash samples (r = 0.57, P = 0.03, n = 15). The level of protection from gloves varied between tasks, being highest for gloves used during preparation (median = 98%) and lowest for gloves used during decanting urine (median = 19%).
  
  
  CONCLUSIONS
  This pilot study demonstrated that dermal exposure to cyclophosphamide is common among hospital personnel. The results showed that hands, forearms and forehead accounted for 87% of the cyclophosphamide total body exposure. Glove samples together with handwash samples enabled estimation of glove efficiency, which appeared to vary strongly between tasks observed.
authors.affiliation: Environmental and Occupational Health Group, Institute for Risk Assessment Sciences, Utrecht University, PO Box 80176, 3508 TD Utrecht, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Fransman
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000032:analysis*; D003520:Cyclophosphamide / Q000032:analysis*; D017575:Gloves, Protective; D006225:Hand; D006235:Hand Disinfection; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D006920:Hygiene; D009426:Netherlands; D016273:Occupational Exposure / Q000032:analysis*; D010865:Pilot Projects; D012867:Skin
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide