DETERMINATION OF PLATINUM IN WORKROOM AIR AND IN BLOOD AND URINE FROMNURSING STAFF ATTENDING PATIENTS RECEIVING CISPLATIN CHEMOTHERAPY

Objectives: The use of anti-neoplastic drugs is increasing and nursing staff are evidently concerned about the risk of hazardous exposure. G eneral methods are available for measuring exposure to carcinogens. Th ese methods, however, lack specificity. One group of antineoplastic dr ugs, based on cisplatin derivatives, contain platinum, which can be an alysed at low concentrations with the use of adsorptive voltammetry. T he aim of this study was to employ this technique for assessment of oc cupational exposure by selective determination of platinum in workroom air and in blood and urine samples from medical staff nursing cancer patients. Methods: The voltammetric method for determination of platin um has been further developed for analysis of blood, urine and air sam ples. The effects of different materials in crucibles and different ac ids for sample pre-treatment, and of the ashing temperature programme were investigated for optimum conditions for analysis of blood, urine and filter samples. Occupational exposure to cisplatin derivatives was also investigated among medical staff. Air sampling in the workroom, as well as analysis of blood and urine samples from the exposed subjec ts, was carried out during the process of drug preparation and adminis tration and when attending treated patients. Results: After developmen t of the experimental method by the introduction of synthetic quartz c rucibles and the optimization of acid composition, and of the temperat ure programme for sample pre-treatment, the recovery has been improved and the method has proved to be adequate for determination of platinu m (Pt) in blood, urine and air-filter samples. Increased Pt blood leve ls were found in both graduate (2.2 +/- 1.7 ng ml(-1)) and staff nurse s (3.8 +/- 4.0 ng ml(-1)), but not in pharmacists (0.47 +/- 0.31 ng ml (-1)), in comparison with unexposed subjects (1.2 +/- 0.69 ng ml(-1)). The variation was, however, high with CV > 50% for all groups. From t he median values it can be seen that a few subjects with high values h ad a large impact on the mean values. The mean Pt level in urine sampl es was 126 +/- 92 ng l(-1), which was found to be close to the pooled reference urine (110 ng l(-1)). No increased Pt air levels were found in any of the measurements. Moreover, the results showed difference in mean Pt blood level between staff at the investigated hospitals. The staff at hospital A had 1.2 +/- 0.53 ng ml(-1), at hospital B 3.8 +/- 4.3 ng ml(-1) and at hospital C 2.0 +/- 2.1 ng ml(-1). Conclusions: Th e method has proved to be adequate for determination of platinum in bl ood, urine and air-filter samples. No increased airborne Pt levels wer e found. However, increased Pt blood levels were found. Staff nurses h ad a higher mean level than graduate nurses, which indicates that poss ible exposure occurs while attending treated patients rather than duri ng the preparation and administration of drugs. There was a noticeable variations in the mean blood level for the investigated groups as a w hole. This variation might reflect an actual difference in the exposur e situation, but more probably depends on differences in skill and exp erience between the subjects. Routines and facilities for handling ant i-neoplastic drugs vary between the clinics and this also probably has an impact on exposure.