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 potentially important route of exposure of hospital workers. Three small-scale workplace surveys were carried out in several hospitals focusing on contamination by leakage from IV infusion systems; contami-nation by spilled urine of patients treated with anti-neoplastic drugs and particulate phase anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring tech-nique using a fluorescent tracer was developed. The method showed a very low limit of detection (0.02 ml of contamination) and a very high inter-observer agreement (ICC=0.99). Evaluation of IV systems and connectors showed distinct differences between the systems. It was estimated that 0.5–250 mg of a drug can become available for contamination during each infusion. Differences in average contamination between nurses were negligible in the experimental set-up. Widespread and frequent contamination due to spillage of contaminated urine was revealed and appeared not to be restricted to the patient’s room. Airborne particu-late concentrations went undetected for 80 % of the measurements. However, in a few cases concentrations up to 2 ng/m3 of cyclophosphamide were measured predominantly in a room of a patient treated with this anti-neoplastic drug