title: Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities.
abstract: OBJECTIVE
  To determine levels of potential and actual dermal exposure to cyclophosphamide (CP) during performance of oncology-related tasks in hospitals and to investigate the relationship with potential sources and surface contamination levels of CP.
  
  
  METHODS
  Dermal exposure to CP was determined for tasks with potential exposure to CP: preparation of CP, decanting of patients' urine, washing of the patient, removal of bed sheets of treated patients and cleaning of patients' toilets on oncology wards. Exposure was assessed by the collection of nitrile and latex protective medical gloves (potential exposure), washing of hands (actual exposure), from cotton pads attached to (un)covered forearms (potential or actual exposure) and a wipe sample of the forehead (actual exposure). Bulk samples (i.e. application fluids and patients' excreta) and possible contact surfaces were monitored to assess the amount of CP available for dermal exposure.
  
  
  RESULTS
  Pharmacy technicians, oncology nurses and cleaning personnel showed actual and potential dermal exposure to CP during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on the forehead and forearms. Although all nurses used gloves during handling of patients' urine and sometimes during the other nursing tasks, skin underneath gloves was repeatedly contaminated. Results of tests on bulk and surface contamination samples confirmed that patients intravenously treated with CP excrete the unmetabolised drug, which could subsequently lead to dermal exposure of hospital personnel. A clear relationship was found between dermal exposure levels and direct sources of exposure for all tasks, except for handling patients' urine.
  
  
  CONCLUSIONS
  We demonstrated for the first time that actual dermal exposure to CP is common among oncology nurses working with patients treated with this anti-neoplastic drug. Pharmacy technicians and cleaning personnel, on the other hand, are potentially exposed to CP, and protection provided by gloves seemed to be sufficient.
authors.affiliation: Environmental and Occupational Health Division, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 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; D003520:Cyclophosphamide; D006801:Humans; D016273:Occupational Exposure / Q000032:analysis*; D016522:Oncology Service, Hospital; D010564:Personnel, Hospital; D012869:Skin Absorption
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide