title: Guidance values for surface monitoring of antineoplastic drugs in German pharmacies.
abstract: OBJECTIVE
  Antineoplastic drugs are widely used in anticancer therapy due to their cytotoxic activity but many of them are classified as carcinogenic, mutagenic, or teratogenic to humans. In order to evaluate personal exposure, surface monitoring has been successfully applied for several years. In this study, we present a statistical description of our data set from 102 German pharmacies and propose 'threshold guidance values (TGVs)' to facilitate interpretation of monitoring results.
  
  
  METHODS
  Our database included 1008 results for platinum (PT) and 1237 for 5-fluorouracil (FU) collected in 102 pharmacies in Germany. Wipe sampling on site was performed with one validated procedure. PT concentrations were measured by voltammetry and FU by gas chromatography/mass spectrometry. Data were stratified into 10 locations and statistically evaluated.
  
  
  RESULTS
  Contamination was detected on all surfaces in the pharmacies with high levels on storage shelves and floors. The median values for the different locations ranged from 0.20 to 1.70 pg cm(-2) (mean: 0.57 pg cm(-2)) for PT and from 2.50 to 10.00 pg cm(-2) (mean: 5.34 pg cm(-2)) for FU. The mean 75th percentiles were 3.92 pg cm(-2) (PT) and 28.90 pg cm(-2) (FU). The TGV 1 value was set at the median value and results below demonstrate good working practices. Contaminations above the TGV 2, which was assigned at the 75th percentile, show a clear need for optimizing the handling procedures.
  
  
  CONCLUSIONS
  The introduction of TGVs helps to reduce occupational exposure and allows pharmacy personnel to benchmark their own contamination levels. This provides a basis for improvement in occupational safety precautions and for regular contamination controls.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, D-80336 Muenchen, Germany. Rudolf.Schierl@med.uni-muenchen.de
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schierl
authors.forename: Antje
authors.initials: A
authors.lastname: Böhlandt
authors.forename: Dennis
authors.initials: D
authors.lastname: Nowak
mesh_terms: D000970:Antineoplastic Agents / Q000032:analysis*; D003666:Decontamination / Q000379:methods*; D004784:Environmental Monitoring / Q000379:methods; D005472:Fluorouracil / Q000032:analysis*; D005858:Germany; D006801:Humans; D016273:Occupational Exposure / Q000032:analysis*; D010594:Pharmacies; D017671:Platinum Compounds / Q000032:analysis*; D017410:Practice Guidelines as Topic; D012016:Reference Values; D017132:Workplace
chemical_list: D000970:Antineoplastic Agents; D017671:Platinum Compounds; D005472:Fluorouracil