Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers

C. Poupeau1, C. Tanguay2, C. Plante3, N.J. Caron4, JF. Bussières5 1 D.Pharm. candidate, Research assistant, Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
2 B.Sc., M.Sc., Coordinator, Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Québec, Canada
3 Inf, conseillère en soins infirmiers, CHU Sainte-Justine, Montréal, Québec, Canada
4 Ph.D, Centre de toxicologie du Québec, Institut national de santé publique du Québec, Québec, Canada
5 B.Pharm., M.Sc., FCSHP, MBA, chef, Département de pharmacie et Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, professeur adjoint de clinique, Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada

Introduction

There are health risks to workers occupationally exposed to antineoplastic drugs.

Objectives

We hypothesized that implementing a biological monitoring program would be feasible. The goal is to present the results of our pilot cross-sectional study of biological monitoring of four antineoplastic drugs.

Methods

We recruited workers from the hematology-oncology department and control workers from other departments in a mother-child university health center. This study was preceded by an information period during which we aimed at enhancing the workers’ awareness and knowledge of the risks of occupational exposure. Participants filled out a journal containing activities performed and personal protective equipment worn. One urine sample was collected at the end of their shift. Samples were analysed by HPLC/MS-MS for the presence of cyclophosphamide, ifosfamide, methotrexate and alpha-fluoro-beta-alanine (5-fluorouracile’s main urinary metabolite).

Results

The participation rate was 85.7% (102/119). No urine sample had detectable concentrations of any of the four drugs evaluated (0/101; 0/74 nurses, 0/11 pharmacists, 0/9 pharmacy technicians and 0/7 doctors). In the five days before sampling, 67/89 (75.3%) hematology-oncology participants performed at least one activity with antineoplastic drugs. Nurses wore all of the recommended protection for technical activities (86.2%), but rarely for non-technical activities (14.9%). Pharmacy technicians and pharmacists wore all of the recommended protection for all activities (100.0%).

Discussion

We implemented a pilot study of biological monitoring of workers with a good participation rate. The absence of positive samples showed the usefulness of maintaining good working practices. We found areas where the worker protection can be enhanced, especially for non-technical activities.

Conclusion

The absence of positive samples is a good indication that the measures that were put in place ensured workers’ safety. Repeating the biological monitoring measures every few years could help confirm that the working practices are continuously followed by workers.

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