title: Administration of anticancer drugs: exposure in hospital nurses.
abstract: BACKGROUND
  Even though anticancer drugs are prepared in dedicated pharmaceutical units, nurses remain exposed to cytotoxic agents during administration to patients.
  
  
  OBJECTIVE
  The aim of this study was to assess this occupational exposure during the intravenous line-purging procedure at the patient's bedside before administration in oncology departments.
  
  
  METHODS
  This prospective study was conducted over a 4-week period in the hematology and oncology departments at a university hospital. Amounts of doxorubicin and cyclophosphamide on the surface of nurses' gloves were measured after the intravenous line purge of the infusion bag and the connection to the patient. For this purpose, gloves were washed with sterile water, following a validated procedure. Quantification of the 2 drugs into the water was performed using LC-MS/MS.
  
  
  RESULTS
  After 59 chemotherapy administrations, 30.5% of gloves were contaminated. Despite extremely low volumes of contamination (0.08-6.28 µL), amounts collected ranged from 190 to 2500 ng per pair of gloves that tested positive for doxorubicin (median, 1600 ng) and from 130 to 32,600 ng with cyclophosphamide (median, 2700 ng).
  
  
  CONCLUSIONS
  The intravenous line purge preceding antineoplastic infusion bag administration is a potential source of contamination in nurses. Contaminations appear to be invisible but frequent (in >30% of cases). Therefore, intravenous line purging performed under appropriately safe conditions should be mandated in pharmaceutical units dedicated to injectable-drug preparation. This measure should be included as a standard hospital practice as a matter of urgency.
authors.affiliation: University Claude Bernard Lyon, Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France. Electronic address: catherine.rioufol@chu-lyon.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rioufol
authors.affiliation: University Claude Bernard Lyon, Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Ranchon
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Vérane
authors.initials: V
authors.lastname: Schwiertz
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vantard
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Joue
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Gourc
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Noémie
authors.initials: N
authors.lastname: Gauthier
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Clinical Oncology Pharmacy Department, Lyon, France.
authors.forename: Marie Gabrielle
authors.initials: MG
authors.lastname: Guedat
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Department of Haematology-University Claude Bernard, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Salles
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Department of Pneumology, Lyon, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Souquet
authors.affiliation: Centre Léon Bérard, Pharmacy Department, Lyon, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Favier
authors.affiliation: Centre Léon Bérard, Pharmacy Department, Lyon, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Gilles
authors.affiliation: University Claude Bernard Lyon, Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Sud, Department of Oncology, Lyon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Freyer
authors.affiliation: University Claude Bernard Lyon, Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Sud, Department of Oncology, Lyon, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: You
authors.affiliation: University Claude Bernard Lyon, Lyon, France; Hospices Civils de Lyon, Groupement Hospitalier Sud, Department of Oncology, Lyon, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Trillet-Lenoir
authors.affiliation: Hospices Civils de Lyon, Groupement Hospitalier Sud, Chemotherapy Targeting in Oncology Laboratory-University Claude Bernard Lyon, Faculty of Pharmacy, Toxicology Laboratory, Lyon, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Guitton
mesh_terms: D061605:Administration, Intravenous / Q000451:nursing*; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000032:analysis; D003520:Cyclophosphamide / Q000032:analysis; D004317:Doxorubicin / Q000032:analysis; D004866:Equipment Contamination; D005260:Female; D017575:Gloves, Protective; D006785:Hospitals, University; D006801:Humans; D009726:Nurses; D009741:Nursing Staff, Hospital; D016273:Occupational Exposure / Q000032:analysis* / Q000517:prevention & control*; D011446:Prospective Studies; D053719:Tandem Mass Spectrometry
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D003520:Cyclophosphamide
keywords: antineoplastic; intravenous line purge; nurses; occupational exposure