title: Pressurized intraperitoneal aerosol chemotherapy (PIPAC): occupational health and safety aspects.
abstract: BACKGROUND
  Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach for treating peritoneal carcinomatosis. First encouraging results have been obtained in human patients. However, delivering chemotherapy as an aerosol might result in an increased risk of exposure to health care workers, as compared with other administration routes.
  
  
  METHODS
  PIPAC was applied in two human patients using chemotherapeutic drugs (doxorubicin and cisplatin), and air contamination levels were measured under real clinical conditions. Air was collected on a cellulose nitrate filter with a flow of 22.5 m(3)/h. To exclude any risk for health care workers, both procedures were remote controlled. Toxicological research of cisplatin was performed according to NIOSH 7300 protocol. Sampling and analysis were performed by an independent certification organization.
  
  
  RESULTS
  The following safety measures were implemented: closed abdomen, laminar airflow, controlled aerosol waste, and protection curtain. No cisplatin was detected in the air (detection limit < 0.000009 mg/m(3)) at the working positions of the surgeon and the anesthesiologist under real PIPAC conditions.
  
  
  CONCLUSIONS
  For the drugs tested, PIPAC is in compliance with European Community working safety law and regulations. Workplace contamination remains below the tolerance margin. The safety measures and conditions as defined above are sufficient. Further protecting devices, such as particulate (air purifying) masks, are not necessary. PIPAC can be used safely in the clinical setting if the conditions specified above are met. However, a toxicological workplace analysis must be performed to confirm that the procedure as implemented complies with local regulations.
authors.affiliation: Department of Pathology, Ruhr University Bochum, Bochum, Germany.
authors.forename: Wiebke
authors.initials: W
authors.lastname: Solass
authors.forename: Urs
authors.initials: U
authors.lastname: Giger-Pabst
authors.forename: Jürgen
authors.initials: J
authors.lastname: Zieren
authors.forename: Marc A
authors.initials: MA
authors.lastname: Reymond
mesh_terms: D000336:Aerosols / Q000009:adverse effects*; D000395:Air Pollutants, Occupational / Q000032:analysis*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D019570:Inhalation Exposure / Q000032:analysis*; D016273:Occupational Exposure / Q000032:analysis*; D016272:Occupational Health; D010534:Peritoneal Neoplasms / Q000188:drug therapy*; D011312:Pressure; D014481:United States
chemical_list: D000336:Aerosols; D000395:Air Pollutants, Occupational; D004317:Doxorubicin; D002945:Cisplatin