Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Human Resources, Occupational Health Services, Ziekenhuis de Gelderse Vallei, Ede, The Netherlands.
J Occup Environ Hyg. 2020 Jul-Aug;17(7-8):343-352. doi: 10.1080/15459624.2020.1776299. Epub 2020 Jul 7.
Many studies into surface contamination of hospital environments have demonstrated that occupational exposure to cytotoxics through the dermal route remains a possible risk. In this study, we assess the actual dermal exposure of the hands of pharmacy technicians and cleaning personnel in a panel of hospitals performing tasks that pose a risk of exposure. We compare the dermal exposure to a tentative limit value for cyclophosphamide. Pharmacy technicians and cleaning personnel were asked for hand rinsing after performance of nine tasks previously identified as posing a risk of occupational exposure. All samples were analyzed for the presence and quantity of eight antineoplastic drugs. By using data on both the frequency of the performance of the tasks and the measured dermal contamination during these tasks, weekly exposure to the marker drug (cyclophosphamide) was calculated. In five Dutch hospitals, 70 hand rinse samples and 8 blanks were collected. These were analyzed and results were used to calculate weekly exposure. The tentative limit value used was 0.74 µg of cyclophosphamide. For cleaning personnel, all results remained below this threshold value. For pharmacy technicians, the compounding itself also remained well below the limit; however, the task involving preparatory work, as well as the checking of compounded drugs, had a 13% chance of exceeding the limit. All of the highest values were found when employees were not wearing gloves on these tasks. Cleaning personnel and pharmacy technicians compounding cytotoxic drugs in our study were sufficiently protected from occupational exposure. In contrast, pharmacy technicians who perform preparatory and finishing tasks (before and after the actual compounding) are not protected enough when they do not wear gloves.
许多针对医院环境表面污染的研究表明，职业性经皮接触细胞毒药物仍然存在潜在风险。在这项研究中，我们评估了在执行存在暴露风险任务的一组医院中，药剂师和清洁人员手部的实际皮肤暴露情况。我们将手部皮肤暴露与环磷酰胺的暂定限值进行了比较。在执行九个先前被认为存在职业暴露风险的任务后，要求药剂师和清洁人员对手部进行冲洗。对所有样本进行了分析，以确定八种抗肿瘤药物的存在和数量。通过对任务执行频率和这些任务中测量的皮肤污染数据进行分析，计算出每周接触标记药物（环磷酰胺）的情况。在五家荷兰医院中，共收集了 70 个手部冲洗样本和 8 个空白样本。对这些样本进行了分析，并根据结果计算出每周的暴露量。暂定的限值为 0.74μg 环磷酰胺。对于清洁人员，所有结果均低于该阈值。对于药剂师，配制本身也远低于该限值；然而，涉及准备工作以及检查配制药物的任务，有 13%的可能超过该限值。当员工在执行这些任务时不戴手套时，所有最高值都被发现。在我们的研究中，配制细胞毒药物的清洁人员和药剂师受到充分的职业暴露保护。相比之下，在实际配制前后（准备和完成阶段）执行预备和收尾任务的药剂师，如果不戴手套，则保护不足。
