Symposium Asept In Med

The hidden threats of cytotoxic drugs for healthcare professionals

Cytotoxic drugs used to treat cancer are inherently toxic by reason of their genotoxic, teratogenic, and carcinogenic properties. Healthcare professionals may be exposed to them during their manufacture, preparation, administration, and disposal. Contamination primarily occurs through inhalation of aerosols and skin contact or when handling cytotoxic drugs and patient excreta. It is therefore essential to guarantee the safety of workers by implementing appropriate preventive measures. Over the last few decades, the link between exposure to cytotoxic drugs in the workplace and health risks for healthcare professionals has been clearly established. Today, the challenges persist due to rising cancer rates and the increasing use of cytotoxic drugs outside oncology. The ageing of the population and advances in medicine are leading to an increase in the use of cytotoxic drugs as well.

Despite recognition by national and European and safety agencies that low exposure to these cytotoxic drugs are dangerous, a harmonised approach to their use is still lacking. In 2019, an agreement was reached to ensure that cytotoxic drugs, comply with minimum health and safety requirements for healthcare workers. These requirements are in line with those set out in Council Directive 98/24/EC and Directive 2004/37/EC on Carcinogens and Mutagens. In this context, a new guidance document to promote the safe use of hazardous medicines in the workplace is currently being prepared by the European Commission.

The data presented highlights an overview of exposure in hospital pharmacies, oncology departments and surgical and intensive care units providing intraperitoneal chemotherapy. The main determinants of exposure need to be identified and managed to control cytotoxic risk. To this end, measurements of surface contamination in the working environment have been taken to identify the main sources of exposure and the occupational categories likely to be directly or indirectly exposed. In parallel, the level of impregnation of workers was assessed by analysing cytotoxic compounds of interest in urine at the start and end of their shift. While significant efforts have been made to reduce exposure and keep it as low as possible, our data underlines the need for regular monitoring of exposure in order to maintain a high level of vigilance among workers and prevent any relaxation over time. To make progress in this area, INRS is currently taking part in a European cross-sectional study (Parc- Horizon Europe, 56 partners) in the field of hospital healthcare to assess exposure and risks related to priority chemical substances using biomonitoring of exposure and effect. This study will contribute to the improvement of healthy and safe working conditions.