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Occupational exposure to antineoplastic drugs: what about hospital sanitation personnel?

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Abstract

Objective

Occupational exposure to antineoplastic drugs (ANPs) occurs mainly through dermal contact. Our study was set up to assess the potential exposure of hospital sanitation (HS) personnel, for whom almost no data are available, through contamination of surfaces they regularly touch.

Methods

In the oncology departments of two hospitals around Montreal, surface wipe samples of 120–2000 cm2 were taken at 10 sites cleaned by the HS personnel and five other sites frequently touched by nursing and pharmacy personnel. A few hand wipe samples were collected to explore skin contamination. Wipes were analyzed by ultra-performance liquid chromatography tandem–mass spectrometry for 10 ANPs.

Results

Overall, 60.9% of 212 surface samples presented at least one ANP above the limits of detection (LOD). Cyclophosphamide and gemcitabine were most often detected (52% and 31% of samples respectively), followed by 5–fluorouracil and irinotecan (15% each). Highest concentrations of five ANPs were found in outpatient clinics on toilet floors (5–fluorouracil, 49 ng/cm2; irinotecan, 3.6 ng/cm2), a perfusion pump (cyclophosphamide, 19.6 ng/cm2) and on a cytotoxic waste bin cover (gemcitabine, 4.97 ng/cm2). Floors in patient rooms had highest levels of cytarabine (0.12 ng/cm2) and methotrexate (6.38 ng/cm2). Hand wipes were positive for two of 12 samples taken on HS personnel, seven of 18 samples on nurses, and two of 14 samples on pharmacy personnel.

Conclusions

A notable proportion of surfaces showed measurable levels of ANPs, with highest concentrations found on surfaces cleaned by HS personnel, who would benefit from appropriate preventive training. As potential sources of worker exposure, several hospital surfaces need to be regularly monitored to evaluate environmental contamination and efficacy of cleaning.

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Acknowledgements

The authors wish to thank the hospital center participants, especially the cleaning and sanitation, nursing and pharmacy personnel, and are grateful to the cleaning and sanitation services, oncology pharmacy, oncology clinic and oncology hospital unit heads for facilitating the conduct of the study. The authors are also grateful to Cynthia Tanguay for thoughtful comments on the manuscript.

Funding

This study was supported by the Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), a private non-profit research institute (grant no. 2014–0001). The funding source was not involved in study design, in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit this article for publication.

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Authors and Affiliations

  1. Chemical, Biological, Mechanical and Physical Risk Prevention, Institut de recherche Robert-Sauvé en santé et en sécurité du travail, 505 De Maisonneuve Blvd. West, Montréal, QC, H3A 3C2, Canada

    France Labrèche, Capucine Ouellet & Brigitte Roberge

  2. Service de santé au travail, Direction de santé publique de 1 Estrie, CIUSSE - CHUS de Sherbrooke, Sherbrooke, QC, Canada

    France Labrèche & Ahmed Yennek

  3. Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, QC, Canada

    Nicolas J. Caron

  4. Département de pharmacie, Unité de recherche en pratique pharmaceutique, CHU Sainte-Justine, Montreal, QC, Canada

    Jean-François Bussières

  5. Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada

    Jean-François Bussières

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  1. France Labrèche
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  2. Capucine Ouellet
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  3. Brigitte Roberge
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  4. Nicolas J. Caron
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  6. Jean-François Bussières
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Contributions

FL and BR conceived and designed this study and data collection, NC supervised the analysis of samples, CO, FL and AY analyzed the data, FL drafted the first manuscript, with critical revisions from CO, BB, NC and JFB. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to France Labrèche.

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Conflict of interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. None declared by any of the authors.

Ethics approval

Ethics Committee of the two participating hospitals and Ethics committee for research on Humans from Université de Montreal.

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Labrèche, F., Ouellet, C., Roberge, B. et al. Occupational exposure to antineoplastic drugs: what about hospital sanitation personnel?. Int Arch Occup Environ Health 94, 1877–1888 (2021). https://doi.org/10.1007/s00420-021-01731-w

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