Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings.
OBJECTIVE
Many antineoplastic drugs are classified as carcinogenic, mutagenic and teratogenic for humans. Therefore, minimization of exposure is required to reduce health risks to employees. The aim of this study was to evaluate working practices and safety measures during drug administration and to assess workplace contamination in outpatient oncology health care settings.


METHODS
Questionnaires about working procedures were sent to 137 day hospitals and private practices. Workplace contamination with 5-fluorouracil, platinum, gemcitabine, cyclophosphamide, ifosfamide, methotrexate, docetaxel and paclitaxel was assessed using wipe samples.


RESULTS
Forty institutions participated in the study, and in 28 departments, wipe samples were taken. Depending on the kind of activity, working procedures often (5-80%) were not confirmed with recommendations for safe handling of antineoplastic drugs. Altogether, 60.9% of the sampling results were above the limit of detection (LOD). Most frequent loads were detected with 5-FU (93.5%) and platinum (88.4%). Contamination was detected on all surfaces and the results ranged between <LOD up to 750,000 pg/cm². There was no correlation between the amount of drugs handled and the extent of surface contamination. However, specific working practices resulting in a lower number of positive wipe samples could be identified (e.g., use of closed infusion systems).


CONCLUSIONS
Workplace contamination with antineoplastic drugs is still present. As patients have to be considered as a potential source of contamination, surface contamination is difficult to avoid. However, our study revealed that it is possible to administer a large number of preparations without causing high workplace contamination.
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany.
Bettina
B
Kopp
Rudolf
R
Schierl
Dennis
D
Nowak
D000554:Ambulatory Care Facilities; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000032:analysis*; D004866:Equipment Contamination / Q000517:prevention & control; D005858:Germany; D006801:Humans; D011795:Surveys and Questionnaires
D000970:Antineoplastic Agents