Occupational exposure to cytotoxic drugs in two UK oncology wards

• Published in: Occupational and environmental medicine (London, England) Vol. 59; no. 9; pp. 608 - 612
• Main Authors: Ziegler, E, Mason, H J, Baxter, P J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01-09-2002; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Antimitotic agents; antineoplastic agent; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - analysis; Antineoplastic Agents - urine; Antineoplastics; Biological and medical sciences; biological monitoring; Biomonitoring; Cytotoxicity; Detection limits; Dosage; Drug dosages; Drug toxicity and drugs side effects treatment; Drugs; England; environmental monitoring; Environmental Monitoring - methods; Equipment Contamination; Female; Gloves; Gloves, Protective; Health aspects; Hospitals; Hospitals, District; Humans; Latex; Longitudinal Studies; Male; Medical personnel; Medical sciences; Medication administration; Miscellaneous (drug allergy, mutagens, teratogens...); Monitoring methods; Nurses; Nursing; Nursing Staff, Hospital; Occupational exposure; Occupational Exposure - analysis; Occupational health; Occupational health and safety; Oncology; Oncology Service, Hospital; Original; Patients; Pharmacology. Drug treatments; Pharmacy; Platinum; Protective equipment; Risk assessment; Risk management; Sluices; Support personnel; Teams; Testolactone; Training; Urine; Working conditions; United Kingdom; Europe; England; United Kingdom > UK; British Isles; Antineoplastic agent; Human; Prevention; Glove; Health staff; Hospital ward; Hospital; Working condition; Occupational exposure; Occupational medicine; Biological monitoring; Nurse
• ISSN: 1351-0711; 1470-7926
• DOI: 10.1136/oem.59.9.608

Aims: To investigate the potential exposure to cytotoxic drugs of staff on two oncology wards in a large district, UK hospital under normal working conditions. Methods: Cytotoxic drug exposure was monitored in urine samples, surface wipes, and on disposable gloves by using a number of commonly used marker drugs, namely cyclophosphamide, ifosfamide, methotrexate, and the platino coordinated drugs. Questionnaire data on their work practices, potential exposure, use of protective personal equipment, and relevant training were collected from nursing, domestic, and clerical staff on two oncology wards. Results: The majority of staff were female with a mean age of 31 years. Roughly half of the staff studied were specifically trained nurses with an average of 3.5 years experience of administering cytotoxic drugs. No cytotoxic drug preparation or reconstitution was carried out on the wards. Disposable gloves, plastic armlets and aprons, but not eye protection, were invariably worn where there was potential exposure to cytotoxics. No cytotoxic drug was detected in any of the staff's urine samples. Isolated disposable latex gloves from nurses administering drugs showed some contamination, as did some surfaces within the wards' sluice rooms, but not in the ward areas where the drugs were stored and checked prior to administration. Conclusions: The risk management strategies in place, including use of personal protective equipment, staff training, and other organisational measures, have ensured that internal exposure is lower than the detection limits for the current biological monitoring methods. Levels of contamination appear significantly lower than earlier, non-UK published studies where different risk management strategies were in place and, in particular, ward staff may have been involved in some degree of cytotoxic drug reconstitution.