Vyas Nitin, Yiannakis Dennis, Turner Andrew, Sewell Graham J
School of Geography, Earth and Environmental Sciences, University of Plymouth, Plymouth, UK.
Oncology Department, Derriford Hospital, Plymouth, UK.
J Oncol Pharm Pract. 2014 Aug;20(4):278-87. doi: 10.1177/1078155213498630. Epub 2013 Aug 22.
Because anti-cancer drugs are non-selective, they affect both cancerous and non-cancerous cells. Being carcinogenic and mutagenic, many anticancer drugs therefore present a major health risk to healthcare staff working with them. This paper reviews the means by which exposure to anti-cancer drugs in the workplace may be monitored, assessed and reduced. Both biological monitoring, using non-selective methods or compound-selective methods, and environmental monitoring have provided information on the nature and degree of exposure in the workplace. Pharmaceutical isolators, used for the compounding of cytotoxic IV infusions and the preparation of injectable drugs, provide a physical barrier between pharmacists and cytotoxic drugs and reduce direct exposure. However, the interior of isolators and the contents thereof (e.g. infusion bags and syringes) are readily contaminated by aerosols and spillages and afford a secondary source of exposure to pharmacists, nurses and cleaning staff. Closed system transfer devices (CSTDs), designed to prohibit the transfer of contaminants into the working environment during drug transfer between the vial and syringe, have been successful in further reducing, but not eliminating surface contamination. Given that the number of patients requiring treatment with chemotherapeutic agents is predicted to increase, further efforts to reduce occupational exposure to anti-cancer drugs, including the refinement and wider use of CTSDs, are recommended.
由于抗癌药物具有非选择性，它们会对癌细胞和非癌细胞都产生影响。许多抗癌药物具有致癌性和致突变性，因此对接触这些药物的医护人员构成了重大健康风险。本文综述了监测、评估和减少工作场所接触抗癌药物的方法。无论是使用非选择性方法或化合物选择性方法的生物监测，还是环境监测，都提供了有关工作场所接触性质和程度的信息。用于配制细胞毒性静脉输液和制备注射用药物的药品隔离器，在药剂师和细胞毒性药物之间提供了物理屏障，减少了直接接触。然而，隔离器内部及其内容物（如输液袋和注射器）很容易被气溶胶和溢出物污染，成为药剂师、护士和清洁人员接触的二次来源。封闭系统转移装置（CSTD）旨在在药瓶和注射器之间转移药物期间防止污染物转移到工作环境中，已成功进一步减少但并未消除表面污染。鉴于预计需要化疗药物治疗的患者数量将会增加，建议进一步努力减少职业接触抗癌药物，包括改进和更广泛地使用CSTD。
