Antineoplastic drug exposure in an ambulatory setting: a pilot study.
BACKGROUND
Exposure to antineoplastic drugs confers health risks to workers, yet little is known about the exposure after a drug spill, nor has the relationship between exposure and organizational factors such as staffing and work environment been studied.


OBJECTIVE
The aim of this study was to evaluate drug spills prospectively using biological measures and correlate drug spills with organizational factors.


METHODS
Prospective questionnaires with 8-hour timed urine samples were collected from nursing and pharmacy personnel who reported drug spill events in 1 academic health center's infusion center. Urine was collected similarly from workers who did not report a spill. Liquid chromatography tandem mass spectrometry techniques identified detectable drug levels. After the prospective sampling period, workers were surveyed on workloads, practice environment, and safety behaviors.


RESULTS
From 81 eligible individuals, 40 participated in the prospective study and 19 completed retrospective questionnaires. Four spills were reported by 9 personnel, as multiple employees were exposed to drug spills. Four participants who reported a spill showed detectable levels of antineoplastic drugs. Four participants who did not report a spill had detectable levels of docetaxel. Compared with respondents who did not report a spill, collegial relations with physicians were significantly poorer for workers who reported spills.


CONCLUSIONS
The study protocol successfully captured drug spill reports and biological samples. Workers have detectable levels of antineoplastic drugs through both drug spills and environmental contamination.


CONCLUSIONS
Multisite research studies and practice-based quality improvement approaches are needed to improve adherence to personal protective equipment use and safe handling procedures.
Author Affiliations: School of Nursing (Drs Friese and McCullagh) and College of Pharmacy, Pharmacokinetics Core (Dr Zhao), University of Michigan, Ann Arbor; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, East Lansing (Ms McArdle); Department of Medicine, Duke University Medical Center and Duke Cancer Institute Pharmacokinetics/Pharmacodynamics Bioanalytical Core Lab, Durham, North Carolina (Dr Spasojevic); and Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta (Dr Polovich).
Christopher R
CR
Friese
Cristin
C
McArdle
Ting
T
Zhao
Duxin
D
Sun
Ivan
I
Spasojevic
Martha
M
Polovich
Marjorie C
MC
McCullagh
D000328:Adult; D000554:Ambulatory Care Facilities; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017132:Workplace
D000970:Antineoplastic Agents