Investigation of biological exposure with cytotoxic drugs of hospital pharmacy workers in Germany
Munich University, Munich, Germany
(Director Prof. D. Nowak, M.D.)
Occupational exposure to cytostatic drugs has been recognized as a potential health hazard since the seventies. Hospital and pharmacy personnel preparing and administering therapies may be exposed to cytostatic agents by inhalation, direct skin contact or accidental events. Biological monitoring studies have shown that uptake of cytostatic drugs was detected in several cases.
In Germany we studied urinary excretion of cyclophosphamide, ifosfamide, epi-, doxo-, daunorubicin and platinum from 100 operatives in 14 hospital pharmacies. All of them had vertical laminar air flow safety cabinets, protective clothing and followed standard safety precautions. Sampling was done at the end of a working shift for 24 hours and repeated two times over a 3 years period.
All cytostatic agents that were considered have been detected in urine samples. The amount of positive samples ranged from less than 1 % (epiriubicin) up to 10 % for cyclophosphamide. Maximum concentrations ranged from 0.12 µg/l for doxorubicin up to 1.90 µg/l for cyclophosphamide. Surprisingly, we found drugs in urine samples even from personnel not having handled those drugs themselves during the days before sampling. This could be explained by the result that contamination was not only found on working surfaces but at unexpected locations as well. At such places people don’t have protection by gloves etc. Therefore, it was not surprising that we found no correlation between handled amount of drugs and biological monitoring.
Consequently, we established wipe sample methods to detect contamination of cytostatic drugs. After improving working procedures, repeated measurements showed much lower contamination in several cases. Therefore, environmental monitoring is important to detect the source of contamination and to improve hygienic working conditions.