Exposure of healthcare workers to cytotoxic drugs

S. N’Daw, D. Flavien, M. Philippe, H. Ogier, R. Alain
Institut National de Recherche et de Sécurité (INRS), Département Polluants et santé, rue du Morvan, CS 60027, 54519 VANDOEUVRE LES NANCY Cedex, France.


Cytotoxic drugs used in the treatment of cancers have an intrinsic toxicity, because of their genotoxic, teratogenic and carcinogenic properties. Healthcare workers can be exposed during the manufacturing, the preparation, the administration and the elimination of these drugs. Contamination results mainly from dermal contact or inhalation of aerosols, when handling the cytotoxic and excreta of patients. It is therefore necessary to ensure the safety of workers by implementing appropriate preventive measures.
However, studies published since the 2000s still report exposure of healthcare workers and frequent contamination of work surfaces in hospitals. Hospital managements should promote programs to evaluate exposures, assess the effectiveness of the protective measures and establish priorities for prevention.
This presentation reviews the main exposure data collected in France over the last ten years by the INRS. Workers exposures were assessed by biomonitoring and by the measurement of surfaces contamination. Biomonitoring, based on the determination of cytotoxic agents or their metabolites in urine, takes into account all the absorption routes (respiratory, cutaneous and oral). Therefore, it reports on the effectiveness of the working methods and preventive measures. Surface sampling is useful to raise awareness of workers with respect to good handling practices and to the major sources of contamination and to evaluate the effectiveness of cleaning procedures.
The data presented provide an update on exposures in hospital pharmacies, oncology departments and also in surgical departments for intraperitoneal chemotherapy.
Exposures concern all professional categories in the hospitals. Measure of the contamination of surfaces in the working environment provided information on the main sources of exposure. All means must therefore be implemented to reduce exposures and keep them as low as possible. Above all, it is necessary to identify all the professional categories likely to be exposed directly or indirectly, in order to propose appropriate preventive measures. The main determinants of exposure must be identified and taken into account in the control of cytotoxic risk. Finally, the data presented highlight the need for regular monitoring of exposures to maintain an optimal level of vigilance of workers to avoid drift over time.

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