Le monitoring biologique dans les hôpitaux

Occupational exposure to cytostatic drugs has been recognized as a potential health hazard since the seventies. Hospital and pharmacy personnel may be exposed to cytostatic agents by inhalation, direct skin contact or accidental events. Since 40 years, several biological monitoring studies have confirmed the uptake of cytostatic drugs in blood and urine samples. Evaluation of these studies shows that there has been a very good progress in analytical methods during the last decades. Now, it is possible to describe strengths and weaknesses of biological monitoring.

Strengths

• direct proof for uptake of cytostatic drugs (e.g. after accidents)
  sensitive techniques available for CP, IF, FU, Epi, Pt
• "education effect" for staff
• database for definition of limit values

Weaknesses

• timing of sampling difficult (most drugs are eliminated within hours)
• sensitive analytical methods limited to few substances only
• no information about source or reason of drug-uptake
• challenging communication of positive results to personnel
• interpretation in terms of personal risk is not possible

In conclusion, biological monitoring is an extreme powerful tool in case of quantifying potential uptakes of cytostatic drugs under special circumstances (spillages, accidents, new techniques). As a routine method for risk assessment at workplaces it can not be recommended at present. But this would change notably if threshold limit values for safe handling of cytostatic dugs could be established in future.