Meijster T, Fransman W, Veldhof R, Kromhout H
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Ann Occup Hyg. 2006 Oct;50(7):657-64. doi: 10.1093/annhyg/mel023. Epub 2006 May 5.
The objectives were (i) to identify occupational populations outside hospitals working with antineoplastic drugs, (ii) to determine the size of the populations 'at risk', (iii) to identify major determinants and routes of exposure outside hospitals and (iv) to estimate exposure levels and frequencies relative to levels found in hospitals.
The survey consisted of two phases; (i) identification of activities with potential exposure to antineoplastic drugs by literature review, interviews, questionnaires and workplace visits, (ii) exploratory measurements of exposure and surface contamination in selected sectors.
Eight sectors were identified with potential exposure to antineoplastic drugs: pharmaceutical industry, pharmacies, universities, veterinary medicine, nursing homes, home care, laundry facilities, and waste treatment. Four sectors were of primary concern: veterinary medicine, home care, nursing homes and industrial laundries. The populations potentially exposed in these sectors vary considerably (from several tens to thousands of workers), as do their levels of exposure. Exposure measurements collected in the veterinary medicine sector showed that workers are indeed exposed to antineoplastic drugs and, in some cases (on gloves after administration), levels were 15 times higher than levels measured during administration in hospitals. Workers sorting contaminated hospital laundry in industrial laundry facilities were exposed to antineoplastic drugs through inhalation. For the home care and nursing homes sectors the highest exposure levels were found when cleaning toilets and washing treated patients. These two sectors are expected to have the largest exposed population (5,000-10,000 individuals).
This study has resulted in a comprehensive overview of populations with potential exposure to antineoplastic drugs. Exposure levels can potentially be high compared with the hospital environment, because exposure routes are complex and awareness of the hazard (and therefore use of protective measures) is low. The number of individuals outside hospitals in The Netherlands exposed to antineoplastic drugs is estimated to be between 5,000 and 15,000.
目标包括（i）识别医院以外使用抗肿瘤药物的职业人群，（ii）确定“风险”人群的规模，（iii）识别医院以外的主要暴露决定因素和暴露途径，以及（iv）相对于医院中发现的水平估计暴露水平和频率。
该调查包括两个阶段；（i）通过文献综述、访谈、问卷调查和工作场所访问识别有潜在抗肿瘤药物暴露风险的活动，（ii）对选定部门的暴露和表面污染进行探索性测量。
识别出八个有潜在抗肿瘤药物暴露风险的部门：制药行业、药店、大学、兽医学、养老院、家庭护理、洗衣设施和废物处理。四个部门最为令人关注：兽医学、家庭护理、养老院和工业洗衣房。这些部门中潜在暴露的人群差异很大（从几十到数千名工人），他们的暴露水平也是如此。兽医学部门收集的暴露测量结果表明，工人确实接触到了抗肿瘤药物，在某些情况下（给药后在手套上），暴露水平比医院给药期间测量的水平高15倍。在工业洗衣设施中分拣受污染医院衣物的工人通过吸入接触到抗肿瘤药物。对于家庭护理和养老院部门，在清洁厕所和为接受治疗的患者洗澡时发现暴露水平最高。预计这两个部门的暴露人群规模最大（5000 - 10000人）。
本研究全面概述了有潜在抗肿瘤药物暴露风险的人群。与医院环境相比，暴露水平可能较高，因为暴露途径复杂且对危害的认识（以及因此对防护措施的使用）较低。据估计，荷兰医院以外接触抗肿瘤药物的人数在5000至15000人之间。
