Surface contamination in homes of home-care patients

R. Schierl, Y. Sverdel Institute for Occupational, Social and Environmental Medicine,
University Munich (LMU), Germany (rschierl@med.lmu.de)

Many antineoplastic drugs are classified as carcinogenic, mutagenic and teratogenic for humans. Cancer chemotherapy treatment is increasingly administered in outpatient centres and patients can stay at home during their therapy. Therefore, exposure risk shifts from hospitals to homes, which has been shown recently (Yuki et al. 2002). The aim of this study was to assess surface contamination in homes of cancer patients and to evaluate the potential exposure of their family members by wipe and urine sampling during home-care period.

Altogether, 13 chemotherapy patients receiving 5-fluorouracil, cyclophosphamide and/or platinum compounds participated together with 11 adult family members. At two time points after last administration of drugs (mean 5 days, range 2-15 days) 265 wipe samples were taken at their homes at surfaces which are frequently used (e.g.; toilet rooms, bath rooms and kitchen). Additionally, 32 urine samples of patients and 30 urine samples of family members were analysed at three subsequent days after drug administration.

In total, 100% of 157 platinum samples (median 0.37 pg/cm²), 65% of 52 CP samples (median 0.46 pg/cm²) and 23% of 56 FU samples (median 0.0 pg/cm²) were contaminated with highest loads at toilet seats and lids and on the floor around the toilets. Highest surface contaminations were 42.5 pg/cm² (platinum), 98 pg/cm² (5-fluorouracil) and 283 pg/cm² (cyclophosphamide). As expected, very high drug concentrations were found in all urine samples of the patients. But no drug residues were detected in any urine sample of the family members, which implies no significant uptake of drugs from contaminated spots.

In summary, significant surface contamination by antineoplastic drugs was found at homes of chemotherapy patients, especially at surfaces where spillage of urine or vomit could occur. Thus, cleaning of frequently surfaces should be performed regularly in order to minimize the risk of incorporation for persons living together with the patients.

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