title: Determination of sevoflurane and isopropyl alcohol in exhaled breath by thermal desorption gas chromatography-mass spectrometry for exposure assessment of hospital staff.
abstract: Volatile anaesthetics and disinfection chemicals pose ubiquitous inhalation and dermal exposure risks in hospital and clinic environments. This work demonstrates specific non-invasive breath biomonitoring methodology for assessing staff exposures to sevoflurane (SEV) anaesthetic, documenting its metabolite hexafluoroisopropanol (HFIP) and measuring exposures to isopropanol (IPA) dermal disinfection fluid. Methods are based on breath sample collection in Nalophan bags, followed by an aliquot transfer to adsorption tube, and subsequent analysis by thermal desorption gas chromatography-mass spectrometry (TD-GC-MS). Ambient levels of IPA were also monitored. These methods could be generalized to other common volatile chemicals found in medical environments. Calibration curves were linear (r(2)=0.999) in the investigated ranges: 0.01-1000 ppbv for SEV, 0.02-1700 ppbv for IPA, and 0.001-0.1 ppbv for HFIP. The instrumental detection limit was 10 pptv for IPA and 5 pptv for SEV, both estimated by extracted ion-TIC chromatograms, whereas the HFIP minimum detectable concentration was 0.5 pptv as estimated in SIM acquisition mode. The methods were applied to hospital staff working in operating rooms and clinics for blood draws. SEV and HFIP were present in all subjects at concentrations in the range of 0.7-18, and 0.002-0.024 ppbv for SEV and HFIP respectively. Correlation between IPA ambient air and breath concentration confirmed the inhalation pathway of exposure (r=0.95, p<0.001) and breath-borne IPA was measured as high as 1500 ppbv. The methodology is easy to implement and valuable for screening exposures to common hospital chemicals. Although the overall exposures documented were generally below levels of health concern in this limited study, outliers were observed that indicate potential for acute exposures.
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ghimenti
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Tabucchi
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy.
authors.forename: Francesca G
authors.initials: FG
authors.lastname: Bellagambi
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Lomonaco
authors.affiliation: Institute of Chemistry of Organometallic Compounds, CNR, Via Moruzzi 1, 56124 Pisa, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Onor
authors.affiliation: Institute of Clinical Physiology, CNR, Via Moruzzi 1, 56124 Pisa, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Trivella
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy.
authors.forename: Roger
authors.initials: R
authors.lastname: Fuoco
authors.affiliation: Department of Chemistry and Industrial Chemistry, University of Pisa, Via Moruzzi, 3, 56124 Pisa, Italy; Institute of Clinical Physiology, CNR, Via Moruzzi 1, 56124 Pisa, Italy. Electronic address: fabio.difrancesco@unipi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Di Francesco
mesh_terms: D019840:2-Propanol / Q000032:analysis* / Q000493:pharmacokinetics; D000328:Adult; D018685:Anesthetics, Inhalation / Q000032:analysis / Q000493:pharmacokinetics; D001944:Breath Tests; D045853:Exhalation; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry / Q000379:methods*; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008738:Methyl Ethers / Q000032:analysis* / Q000493:pharmacokinetics; D016273:Occupational Exposure / Q000032:analysis*; D010564:Personnel, Hospital; D020005:Propanols / Q000032:analysis; D000077149:Sevoflurane; D055815:Young Adult; D006845:Hydrocarbons, Fluorinated
chemical_list: D019840:2-Propanol; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D020005:Propanols; D000077149:Sevoflurane; C001337:hexafluoroisopropanol; D006845:Hydrocarbons, Fluorinated
keywords: Breath analysis; Hospital staff; Isopropyl alcohol; Occupational exposure; Sevoflurane