Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys

Dermal exposure to anti-neoplastic drugs has been suggested as a potentiall y important route of exposure of hospital workers. Three small-scale workpl ace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contamination by spilled urine of pat ients treated with anti-neoplastic drugs and particulate phase anti-neoplas tic drugs in the air of outpatient and nursing clinics. A new visual scorin g technique using a fluorescent tracer was developed. The method showed a v ery low limit of detection (0.02 mul of contamination) and a very high inte r-observer agreement (ICC=0.99). Evaluation of IV systems and connectors sh owed distinct differences between the systems. It was estimated that 0.5-25 0 mug of a drug can become available for contamination during each infusion . Differences in average contamination between nurses mere negligible in th e experimental set-up. Widespread and frequent contamination due to spillag e of contaminated urine was revealed and appeared not to be restricted to t he patient's room. Airborne particulate concentrations went undetected for 80% of the measurements. However, in a few cases concentrations up to 2 ng/ m(3) of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug. Based on these results and a recently proposed conceptual model for dermal exposure a most likely exposure scenario was postulated both for nurses inv olved in administering drugs and nurses caring for treated patients. Estima tion of ail relevant mass transport rates will be a challenge for the near future. (C) 2000 British Occupational Hygiene Society. Published by Elsevie r Science Ltd. All rights reserved.