title: Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system.
abstract: We previously reported that antineoplastic drug contamination is found on various work surfaces situated throughout the hospital medication system (process flow of drug within a facility from initial delivery to waste disposal). The presence of drug residual on surfaces suggests that healthcare workers involved in some capacity with the system may be exposed through dermal contact. The purpose of this paper was to determine the dermal contamination levels of healthcare employees working throughout a hospital and to identify factors that may influence dermal contamination. We selected participants from six hospitals and wiped the front and back of workers' hands. Wipe samples were analyzed for cyclophosphamide (CP), a commonly used antineoplastic drug, using high-performance liquid chromatography-tandem mass spectrometry. Participants were asked about their frequency of handling antineoplastic drugs, known contact with CP on their work shift, gender, job title, and safe drug handling training. In addition, participants were surveyed regarding their glove usage and hand washing practices prior to wipe sample collection. We collected a total of 225 wipe samples. Only 20% (N = 44) were above the limit of detection (LOD) of 0.36ng per wipe. The average concentration was 0.36ng per wipe, the geometric mean < LOD, the geometric standard deviation 1.98, and the range < LOD to 22.8ng per wipe. Hospital employees were classified into eight different job categories and all categories had some dermal contamination levels in excess of the LOD. The job category with the highest proportion of samples greater than the LOD were those workers in the drug administration unit who were not responsible for drug administration (volunteer, oncologist, ward aide, dietician). Of note, the highest recorded concentration was from a worker who had no known contact with CP on their work shift. Our results suggest that a broader range of healthcare workers than previously believed, including those that do not directly handle or administer the drugs (e.g. unit clerks, ward aides, dieticians, and shipper/receivers), are at risk of exposure to antineoplastic drugs. A review of control measures to minimize antineoplastic drug exposure that encompasses a wide array of healthcare workers involved with the hospital medication system is recommended.
authors.affiliation: 1.School of Occupational and Public Health, Ryerson University, POD247C, 350 Victoria Street, Toronto, M5B 2K3, Canada 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada cyhon@ryerson.ca.
authors.forename: Chun-Yip
authors.initials: CY
authors.lastname: Hon
authors.affiliation: 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada.
authors.forename: Kay
authors.initials: K
authors.lastname: Teschke
authors.affiliation: 2.School of Population and Public Health, University of British Columbia, 3rd Floor, 2206 East Mall, Vancouver V6T 1Z3, Canada 3.Occupational Cancer Research Centre, Cancer Care Ontario, 505 University Avenue, 17th Floor, Toronto, Ontario M5G 1X3, Canada 4.Dalla Lana School of Public Health, University of Toronto, 563 Spadina Crescent, Toronto, Ontario M5S 2J7, Canada.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Demers
authors.affiliation: 5.Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby BC V5A 1S6, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Venners
mesh_terms: D000970:Antineoplastic Agents / Q000032:analysis*; D003520:Cyclophosphamide / Q000032:analysis; D004340:Drug Contamination; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D006225:Hand; D006801:Humans; D008297:Male; D008510:Medication Systems, Hospital; D016273:Occupational Exposure / Q000032:analysis*; D010564:Personnel, Hospital; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide
keywords: antineoplastic drugs; cyclophosphamide; dermal contamination; healthcare workers; hospital medication system