Ramphal Raveena, Bains Tejinder, Goulet Geneviève, Vaillancourt Régis
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.
BSc(Pharm), ACPR, is a Pharmacist with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Can J Hosp Pharm. 2015 Mar-Apr;68(2):104-12. doi: 10.4212/cjhp.v68i2.1435.
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.
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.
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.
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.
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.
环磷酰胺是全球最常用的化疗药物之一。关于药房工作人员对该药物及其他化疗药物的环境污染和生物暴露的数据有限。
确定参与配制和核对环磷酰胺剂量的药房工作人员尿液中该药物可检测水平是否高于未接触过该药物的非肿瘤药房工作人员，并比较在一家三级护理儿科医院的肿瘤药房（配制化疗剂量）和同一机构的主药房（不配制化疗药物）中环磷酰胺、甲氨蝶呤和异环磷酰胺的表面污染程度。
通过检测参与者尿液中环磷酰胺的可检测量，比较接触和未接触该药物的药房工作人员对环磷酰胺的生物暴露情况。通过表面擦拭来评估化疗药物的环境暴露，以确定肿瘤药房和主药房中各种化疗药物的表面污染程度。
初次检测时，所有药房工作人员（7名肿瘤药房工作人员，5名对照人员）尿液中均检测到环磷酰胺。然而，确定所有对照人员在检测当天都曾接触过肿瘤药房。对这些人员进行复测发现，复测当天未接触肿瘤药房的人员中没有阳性样本。对照人员复测的唯一阳性结果是一名在复测当天接触过肿瘤药房的参与者。表面擦拭检测显示，肿瘤药房在清洁前后均被环磷酰胺和甲氨蝶呤污染，清洁后还被异环磷酰胺污染。主药房（对照药房）未显示有环磷酰胺、甲氨蝶呤或异环磷酰胺污染的迹象。
研究结果表明，环境污染在环磷酰胺的生物暴露中起作用。应确定并优先实施减少化疗环境污染以及药房工作人员在处理化疗药物时生物暴露的措施。
