Hedmer Maria, Wohlfart Gertrud
Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden.
J Environ Monit. 2012 Jul;14(7):1968-75. doi: 10.1039/c2em10704j. Epub 2012 Jun 12.
The use of antineoplastic drugs in health care steadily increases. Health care workers can be occupationally exposed to antineoplastic drugs classified as carcinogenic or teratogenic. Monitoring of surface contamination is a common way to assess occupational exposure to antineoplastic drugs, since wipe sampling is used as a surrogate measure of dermal exposure. Since no occupational limits for antineoplastic drugs in work environments exist, 'hygienic guidance values' (HGVs) should be used instead. HGVs are practicable, achievable levels, not health based, and can be calculated from exposure data from representative workplaces with good occupational hygiene practices. So far, guidance values for surface monitoring of antineoplastic drugs only exist for pharmacies where antineoplastic drugs are prepared. The objective was to propose HGVs for surface monitoring of cyclophosphamide (CP) and ifosfamide (IF) in Swedish hospitals where antineoplastic drugs are administered to patients. In total, 17 workplaces located at six hospitals in Sweden were surveyed by wipe sampling. Wipe samples were collected, worked up and then analyzed with liquid chromatography tandem mass spectrometry. Surface contamination of CP and IF was found on 80% and 73% of the sampled surfaces, thus indicating that there is potential for health care workers to be exposed to CP and IF via the skin. The median surface load of CP was 3.3 pg cm(-2) (range <0.05-10,800 pg cm(-2)). The corresponding value for IF was 4.2 pg cm(-2) (range <0.13-95,000 pg cm(-2)). The highest surface loads were found on the floors. The proposed HGVs were set at 90th percentile values, and can be applicable to hospital workplaces where patients are treated with CP or IF. Surface monitoring combined with HGVs is a useful tool for health care workers to regularly benchmark their own surface loads which could control and reduce the occupational exposure to CP and IF in hospital workplaces. Thus, the occupational safety of the health care workers will be increased.
医疗保健领域中抗肿瘤药物的使用量在稳步增加。医护人员可能会在职业活动中接触到被归类为致癌或致畸的抗肿瘤药物。由于擦拭采样被用作皮肤接触的替代测量方法，因此监测表面污染是评估医护人员职业接触抗肿瘤药物的常用方法。由于工作环境中不存在抗肿瘤药物的职业接触限值，因此应使用“卫生指导值”（HGVs）取而代之。HGVs是可行的、可实现的水平，并非基于健康标准，可根据具有良好职业卫生实践的代表性工作场所的接触数据进行计算。到目前为止，仅存在针对配制抗肿瘤药物的药房的抗肿瘤药物表面监测指导值。目的是提出瑞典医院中对患者使用抗肿瘤药物时环磷酰胺（CP）和异环磷酰胺（IF）表面监测的HGVs。总共对瑞典六家医院的17个工作场所进行了擦拭采样调查。收集擦拭样本、进行处理，然后用液相色谱串联质谱法进行分析。在80%和73%的采样表面上发现了CP和IF的表面污染，这表明医护人员有可能通过皮肤接触CP和IF。CP的表面负荷中位数为3.3 pg cm(-2)（范围<0.05 - 10,800 pg cm(-2)）。IF的相应值为4.2 pg cm(-2)（范围<0.13 - 95,000 pg cm(-2)）。在地板上发现的表面负荷最高。提议的HGVs设定为第90百分位数，可适用于对患者使用CP或IF进行治疗的医院工作场所。表面监测结合HGVs是医护人员定期将自己的表面负荷作为基准的有用工具，这可以控制和减少医院工作场所中对CP和IF的职业接触。因此，医护人员的职业安全性将得到提高。
