Healthcare Workers and Chemotherapy Exposure in Oncology Wards

Abstract

Background and Objectives :  Antineoplastic drug has adverse health effects related to risk activities such as handling drug-vial, receiving drug, preparing and transferring drug to ward, administrating drug and contacting secretion of patients who were treated with these drugs. Such medical professional is subjected to these unavoidable risk activities. The aim of this study was to determine Ifosfamide (IF) concentration in urine of risk person and identify factors associated with exposure and type of work.

Methods :  Seventy subjects who worked on handing IF in oncology wards or  antineoplastic drug preparing units at a hospital school of medicine were collected  their urine samples at 1 - 2 hours prior to the end of shift. Self-administered questionnaires and interview were taken immediately after collecting urine and record the pattern of exposure such as location, type of drug, time, dose of drug and time of urine collection. IF was extracted from urine and analysed by gas chromatography / mass spectrometry (GC/MS).

Results :  Twenty subjects were found positive urinary IF (28.6%)  with geometric mean (GM) of  95.1
ng /mL,  range 16.0 – 526.0 ng/mL (limit of detection; LOD = 10 ng/mL).  GM of urinary IF was ranked from highest to lowest  among the pharmacist assistant (526.0 ng/mL), nurse (136.0 ng/mL), nurse assistant (110.9 ng/mL), janitor (92.1 ng/mL),  pharmacist (86.8 ng/mL), clerk (28.9 ng/mL), general officer 28.8 ng/mL and physician (16.0 ng/mL), respectively.   Subjects aged 41 – 60 year were found positive IF at 53.8 percent and negative IF at 45.2 percent (p = 0.04).  Personnels who worked on drug preparing unit were found urinary IF at 4.3 percent (p = 0.02).

Conclusions :  Urinary IF was found in all groups of healthcare workers related to antineoplastic medication. The risk was divided into 3 groups: high risk including pharmacist assistant; intermediate risk including nurse, nurse assistant, janitor and pharmacist; and low risk including clerk, general officer and physician. Factors that correlated to finding of urinary IF were related to drug preparing unit and duration of work especially those who aged 41 – 60 years due to their decrease awareness on personal protective equipment.