title: Antineoplastic drug contamination in the urine of Canadian healthcare workers.
abstract: OBJECTIVE
  The purpose of this study was to quantify the urine concentration of non-metabolized cyclophosphamide (CP), a commonly administered antineoplastic drug, among potentially exposed Canadian healthcare workers and to identify factors associated with the drug concentration levels.
  
  
  METHODS
  Participants were asked to provide two sets of 24-h urine samples (at two different sampling events), and the level of CP was quantified using high-performance liquid chromatography-tandem mass spectrometry. In addition to demographic information, participants were surveyed regarding their frequency of handling of antineoplastic drugs, safe drug handling training, and known contact with CP on their work shift. Descriptive and inferential statistical analyses were performed. A backward stepwise linear mixed effect model was conducted to identify the factors associated with urine concentration levels.
  
  
  RESULTS
  We collected 201 urine samples, and 55 % (n = 111) had levels greater than the LOD of 0.05 ng/mL. The mean urinary CP concentration was 0.156 ng/mL, the geometric mean was 0.067 ng/mL, the geometric standard deviation was 3.18, the 75th percentile was 0.129 ng/mL, and the range was <LOD to 2.37 ng/mL. All eight job categories evaluated had some urinary concentrations in excess of the LOD with unit clerks having the highest average level. Workers who worked in the drug administration unit, but were not responsible for administering the drugs to patients, i.e., volunteers, oncologists, ward aides, and dieticians, had the largest proportion of samples exceeding the LOD. We did not find any correlation between the urinary concentration levels and known contact with CP during the work shift. Two factors were found to be significantly associated with urinary CP concentration: (1) Workers who had a duty to handle antineoplastic drugs had higher concentration levels, and (2) workers who had not received safe drug handling training had higher levels of CP in their urine compared with those who had.
  
  
  CONCLUSIONS
  The presence of non-metabolized CP in urine confirms that, despite the existence of control measures, a broad range of healthcare workers are at risk of exposure to antineoplastic drugs. A review of the effectiveness of interventions to reduce exposure is warranted and should apply to all healthcare workers involved in some capacity with the hospital medication system. This study identified two factors that are related to the urine CP concentration levels which can serve as an impetus for reducing exposure.
authors: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. cyhon@ryerson.ca.|School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada. cyhon@ryerson.ca.
authors: Chun-Yip
authors: CY
authors: Hon
authors: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: Kay
authors: K
authors: Teschke
authors: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
authors: Hui
authors: H
authors: Shen
authors: Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
authors: Paul A
authors: PA
authors: Demers
authors: Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
authors: Scott
authors: S
authors: Venners
mesh_terms: D000970:Antineoplastic Agents / Q000652:urine*; D002170:Canada; D003520:Cyclophosphamide / Q000652:urine*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D016273:Occupational Exposure / Q000032:analysis*; D010564:Personnel, Hospital / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide
keywords: Antineoplastic drugs; Healthcare workers; Hospital medication system; Risk assessment; Urinary concentration
references: Int Arch Occup Environ Health. 2008 Jul;81(7):899-911
references: 18066576
references: J Chromatogr B Analyt Technol Biomed Life Sci. 2010 Oct 1;878(27):2593-605
references: 20478752
references: J Occup Environ Hyg. 2013;10(7):374-83
references: 23668810
references: Saf Health Work. 2015 Jun;6(2):156
references: 26106518
references: J Oncol Pharm Pract. 2011 Dec;17(4):320-32
references: 20823049
references: Ann Occup Hyg. 2014 Jul;58(6):761-70
references: 24644303
references: J Oncol Pharm Pract. 2011 Mar;17(1):20-8
references: 20472603
references: Mutagenesis. 2011 May;26(3):359-69
references: 21112930
references: J Occup Environ Hyg. 2010 Apr;7(4):233-44
references: 20169489
references: J Occup Health. 2005 Jan;47(1):22-48
references: 15703450
references: Clin Pharmacokinet. 2005;44(11):1135-64
references: 16231966
references: Bull Cancer. 2003 Oct;90(10):905-9
references: 14706919
references: Int Arch Occup Environ Health. 2005 Jun;78(5):403-12
references: 15887018
references: Ann Occup Hyg. 2005 Oct;49(7):603-10
references: 15964878
references: Toxicol Lett. 2012 Aug 13;213(1):107-15
references: 21477641
references: Saf Health Work. 2011 Sep;2(3):273-81
references: 22953211
references: Int Arch Occup Environ Health. 2003 Feb;76(1):5-10
references: 12592576
references: Occup Environ Med. 1998 Dec;55(12):795-804
references: 9924440
references: J Oncol Pharm Pract. 2005 Jun;11(2):69-78
references: 16465719
references: J Oncol Pharm Pract. 2011 Mar;17(1):14-9
references: 20179165
references: Arch Environ Health. 1994 May-Jun;49(3):165-9
references: 8185386
references: CA Cancer J Clin. 2006 Nov-Dec;56(6):354-65
references: 17135692
references: Can J Hosp Pharm. 2011 Sep;64(5):327-32
references: 22479084
references: Toxicol Lett. 2011 Nov 10;207(1):42-52
references: 21911042
references: Mutat Res. 1999 Feb 2;439(1):97-104
references: 10029685
references: J Occup Environ Med. 2010 Oct;52(10):1019-27
references: 20881620
references: Online J Knowl Synth Nurs. 2000 Feb 2;7:4
references: 12489036
references: J Occup Environ Med. 2010 Oct;52(10):1028-34
references: 20881619
references: Ann Occup Hyg. 2010 Apr;54(3):257-62
references: 20032004