Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic.
Masaryk Memorial Cancer Institute, Žlutý kopec 7, 65653, Brno, Czech Republic.
Int Arch Occup Environ Health. 2021 Oct;94(7):1687-1702. doi: 10.1007/s00420-021-01671-5. Epub 2021 Mar 18.
Antineoplastic drugs (ADs) pose risks to healthcare staff. Surface disinfectants are used in hospitals to prevent microbial contamination but the efficiency of disinfectants to degrade ADs is not known. We studied nine disinfectants on ten ADs in the standardized laboratory and realistic in situ hospital conditions.
A survey in 43 hospitals prioritized nine most commonly used disinfections based on different ingredients. These were tested on inert stainless steel and in situ on contaminated hospital flooring. The effects against ten ADs were studied by LC-MS/MS (Cyclophosphamide CP; Ifosfamide IF; Capecitabine CAP; Sunitinib SUN; Methotrexate MET; Doxorubicin DOX; Irinotecan IRI; Paclitaxel PX; 5-Fluorouracil FU) and ICP-MS (Pt as a marker of platinum-based ADs).
Monitoring of the floor contamination in 26 hospitals showed that the most contaminated are the outpatient clinics that suffer from a large turnover of staff and patients and have limited preventive measures. The most frequent ADs were Pt, PX, FU and CP with maxima exceeding the recommended 1 ng/cm limit by up to 140 times. IRI, FU, MET, DOX and SUN were efficiently removed by hydrolysis in clean water and present thus lower occupational risk. Disinfectants based on hydrogen peroxide were efficient against PX and FU (> 70% degradation) but less against other ADs, such as carcinogenic CP or IF, IRI and CAP. The most efficient were the active chlorine and peracetic acid-based products, which however release irritating toxic vapors. The innovative in situ testing of ADs previously accumulated in hospital flooring showed highly problematic removal of carcinogenic CP and showed that alcohol-based disinfectants may mobilize persistent ADs contamination from deeper floor layers.
Agents based on hydrogen peroxide, peracetic acid, quaternary ammonium salts, glutaraldehyde, glucoprotamine or detergents can be recommended for daily use for both disinfection and AD decontamination. However, they have variable efficiencies and should be supplemented by periodic use of strong chlorine-based disinfectants efficient also against the carcinogenic and persistent CP.
抗肿瘤药物（ADs）对医护人员构成风险。医院使用表面消毒剂来防止微生物污染，但消毒剂降解 ADs 的效率尚不清楚。我们在标准化实验室和现实医院环境中对十种 ADs 研究了九种消毒剂。
对 43 家医院进行调查，根据不同成分对九种最常用消毒剂进行优先级排序。在惰性不锈钢和现场污染医院地板上对这些消毒剂进行测试。通过 LC-MS/MS（环磷酰胺 CP；异环磷酰胺 IF；卡培他滨 CAP；舒尼替尼 SUN；甲氨蝶呤 MET；阿霉素 DOX；伊立替康 IRI；紫杉醇 PX；5-氟尿嘧啶 FU）和 ICP-MS（铂作为铂类 ADs 的标志物）研究了它们对十种 ADs 的影响。
对 26 家医院地板污染的监测显示，污染最严重的是门诊，这些门诊人员流动大、患者多，且预防措施有限。最常见的 ADs 是 Pt、PX、FU 和 CP，最大值超过推荐的 1ng/cm 限值高达 140 倍。在清洁水中水解时，IRI、FU、MET、DOX 和 SUN 可有效去除，因此职业风险较低。基于过氧化氢的消毒剂对 PX 和 FU（>70%降解）有效，但对其他 ADs 如致癌性 CP 或 IF、IRI 和 CAP 效果较差。最有效的是含活性氯和过氧乙酸的产品，但这些产品会释放出刺激性有毒蒸气。创新性地对先前在医院地板上积累的 ADs 进行现场测试显示，致癌性 CP 的去除非常困难，并表明酒精基消毒剂可能会从更深的地板层中动员持久性 ADs 污染。
基于过氧化氢、过氧乙酸、季铵盐、戊二醛、葡糖胺或清洁剂的制剂可推荐用于日常消毒和 AD 去污。然而，它们的效率存在差异，应定期使用强氯基消毒剂补充，该消毒剂也能有效对抗致癌性和持久性 CP。
