title: Occupational exposure to chemotherapy of pharmacy personnel at a single centre.
abstract: BACKGROUND
  Cyclophosphamide is one of the most commonly used chemotherapy drugs worldwide. Data concerning environmental contamination and biological exposure of pharmacy personnel to this and other chemotherapy drugs are limited.
  
  
  OBJECTIVE
  To determine whether pharmacy personnel involved in preparing and checking cyclophosphamide doses were more likely to have detectable levels of this drug in their urine than non-oncology pharmacy personnel with no known contact with the drug, and to compare the degree of surface contamination with cyclophosphamide, methotrexate, and ifosfamide in the oncology pharmacy of a tertiary care pediatric hospital, where chemotherapy doses were prepared, and the main (control) pharmacy in the same institution, where no chemotherapy was prepared.
  
  
  METHODS
  Biological exposure to cyclophosphamide was compared between pharmacy personnel who did and did not handle this drug by determining whether participants had detectable amounts of cyclophosphamide in their urine. Environmental exposure to chemotherapy drugs was assessed by using surface wipes to determine the degree of surface contamination with various chemotherapy agents in the oncology pharmacy and the main (control) pharmacy.
  
  
  RESULTS
  On initial testing, cyclophosphamide was detected in the urine of all pharmacy personnel (n = 7 oncology personnel, n = 5 control personnel). However, it was determined that all control personnel had been exposed to the oncology pharmacy on the day of testing. Repeat testing of these individuals revealed no positive samples among those not exposed to the oncology pharmacy on the day of repeat testing. The sole positive result on retesting of control personnel was for a participant who had been exposed to the oncology pharmacy on the retest day. Surface wipe testing revealed contamination of the oncology pharmacy with cyclophosphamide and methotrexate before and after cleaning, as well as contamination with ifosfamide after cleaning. The main (control) pharmacy showed no evidence of contamination with cyclophosphamide, methotrexate, or ifosfamide.
  
  
  CONCLUSIONS
  The findings suggest that environmental contamination plays a role in biological exposure to cyclophosphamide. Measures to reduce environmental contamination from chemotherapy and biological exposure of pharmacy personnel when handling chemotherapy agents should be identified and implemented as a priority.
authors.affiliation: MBChB, FRACP, MPH, is a Pediatric Hematologist/ Oncologist at the Children's Hospital of Eastern Ontario; an Associate Professor with the Department of Pediatrics, University of Ottawa; and a Clinical Investigator with the Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.
authors.forename: Raveena
authors.initials: R
authors.lastname: Ramphal
authors.affiliation: BSc(Pharm), ACPR, is a Pharmacist with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
authors.forename: Tejinder
authors.initials: T
authors.lastname: Bains
authors.affiliation: BPharm, PharmD, RPh, is a Pharmacist with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Goulet
authors.affiliation: OMM, CD, BPharm, PharmD, FCSHP, is the Director of Pharmacy with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
authors.forename: Régis
authors.initials: R
authors.lastname: Vaillancourt
keywords: biological exposure; chemotherapy; environmental exposure; occupational exposure; pharmacy