Abstract
Objective
The aim of this study was to assess internal antineoplastic drugs (ADs) contamination in the nursing staff in French hospital centers, using highly sensitive analytical methods.
Methods
This cross-sectional study included nurses practicing in care departments where at least one of the five ADs studied was handled (5-fluorouracil, cyclophosphamide, doxorubicin, ifosfamide, methotrexate). The nurses study participation lasted 24 h including collection of three urine samples and one self-questionnaire. All urine samples were assayed by ultra-high-performance liquid chromatography–tandem mass spectrometry methods with very low value of the lower limit of quantification (LLOQ).
Results
74 nurses were included, 222 urine samples and 74 self-questionnaires were collected; 1092 urine assays were performed. The percentage of nurses with internal AD contamination was 60.8% and low levels of urinary concentrations were measured. Regarding nurses with internal contamination (n = 45), 42.2% presented internal contamination by methotrexate, 37.8% by cyclophosphamide, 33.3% by ifosfamide, 17.8% by 5-fluorouracil metabolite and 6.7% by doxorubicine. Among the positive assays, 17.9% (n = 26/145) were not explained by exposure data from the self-questionnaire but this could be due to the skin contact of nurses with contaminated work surfaces.
Conclusions
This study reported high percentage of nurses with internal ADs contamination. The low LLOQ values of the used analytical methods, allowed the detection of ADs that would not have been detected with the current published methods: the percentage of contamination would have been 17.6% instead of the 60.8% reported here. Pending toxicological reference values, urine ADs concentrations should be reduced as low as reasonably achievable (ALARA principle).
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Data Availability and material code
The data that support the findings of this study are available on request from the corresponding author.
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Acknowledgements
The authors thank the french Ministry of Health for the support of this work [Grant reference number (PHRC-I n°13-077)]. The authors also thank the occupational physicians of the Bordeaux University Hospital Center and the IUCT-Oncopôle of Toulouse for their involvement in the study and Claire Léger and Isabelle Hennebelle for their implication
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This work represents independent research. It is supported by a grant from the French Ministry of Health [grant reference number (PHRC-I n° 13–077)].
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All authors contributed to the study conception and design. SAT conducted the analyses and wrote the first draft of the manuscript. All other authors contributed to the interpretation of data, critically revised previous versions of the manuscript, and read and approved the final manuscript.
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Following the opinion of the French Regional Ethics Committee for the Protection of Persons (CPP n° 2014/87), this study is considered to be outside the scope of the provisions governing biomedical research and routine care.The study was conducted in accordance with the relevant national legislation for observational studies. The study was obtained the approvals from the National advisory committee on medical research information (CCTIRS) and the French data protection agency (CNIL). This study was registered in the EUPAS registry, as EUPAS19729 (http://www.encepp.eu). This study is registered on the ClinicalTrials.gov website, under the number NCT03137641.
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Villa, A., Molimard, M., Sakr, D. et al. Nurses’ internal contamination by antineoplastic drugs in hospital centers: a cross-sectional descriptive study. Int Arch Occup Environ Health 94, 1839–1850 (2021). https://doi.org/10.1007/s00420-021-01706-x
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DOI: https://doi.org/10.1007/s00420-021-01706-x