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Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings

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Abstract

Purpose

Many antineoplastic drugs are classified as carcinogenic, mutagenic and teratogenic for humans. Therefore, minimization of exposure is required to reduce health risks to employees. The aim of this study was to evaluate working practices and safety measures during drug administration and to assess workplace contamination in outpatient oncology health care settings.

Methods

Questionnaires about working procedures were sent to 137 day hospitals and private practices. Workplace contamination with 5-fluorouracil, platinum, gemcitabine, cyclophosphamide, ifosfamide, methotrexate, docetaxel and paclitaxel was assessed using wipe samples.

Results

Forty institutions participated in the study, and in 28 departments, wipe samples were taken. Depending on the kind of activity, working procedures often (5–80%) were not confirmed with recommendations for safe handling of antineoplastic drugs. Altogether, 60.9% of the sampling results were above the limit of detection (LOD). Most frequent loads were detected with 5-FU (93.5%) and platinum (88.4%). Contamination was detected on all surfaces and the results ranged between <LOD up to 750,000 pg/cm². There was no correlation between the amount of drugs handled and the extent of surface contamination. However, specific working practices resulting in a lower number of positive wipe samples could be identified (e.g., use of closed infusion systems).

Conclusion

Workplace contamination with antineoplastic drugs is still present. As patients have to be considered as a potential source of contamination, surface contamination is difficult to avoid. However, our study revealed that it is possible to administer a large number of preparations without causing high workplace contamination.

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Acknowledgments

We like to thank all participating day hospitals and private practices. We thank Elke Fischer and Stefan Gröbmair for excellent laboratory analyses. This study was financially supported by the German Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), Hamburg, Germany. Data presented here are part of the doctoral thesis of BK.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336, Munich, Germany

    Bettina Kopp, Rudolf Schierl & Dennis Nowak

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  1. Bettina Kopp
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  2. Rudolf Schierl
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  3. Dennis Nowak
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Correspondence to Rudolf Schierl.

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Kopp, B., Schierl, R. & Nowak, D. Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health 86, 47–55 (2013). https://doi.org/10.1007/s00420-012-0742-z

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  • DOI: https://doi.org/10.1007/s00420-012-0742-z

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