Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units
C. Kieffer
Pharmacy Resident and PhD Student
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorP. Verhaeghe
Professor of Medicinal Chemistry
Université Paul Sabatier, Faculté de Pharmacie, Laboratoire de Chimie de Coordination, Toulouse
Search for more papers by this authorS. Lagrassa
Head Nurse
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorR. Grégoire
Physician
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorZ. Moussaoui
Quality Specialist
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorC. Casteras-Ducros
Associate Professor of Medicinal Chemistry
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorJ.E. Clark
Assistant Professor
Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
Search for more papers by this authorP. Vanelle
Professor of Organic Chemistry and Hospital Pharmacist
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorCorresponding Author
P. Rathelot
Professor of Medicinal Chemistry and Hospital Pharmacist
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Correspondence address: Pascal Rathelot, Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, UMR CNRS 7273, 27 Boulevard Jean Moulin, CS30064, 13385 Marseille cedex 05, France (e-mail: [email protected]).Search for more papers by this authorC. Kieffer
Pharmacy Resident and PhD Student
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorP. Verhaeghe
Professor of Medicinal Chemistry
Université Paul Sabatier, Faculté de Pharmacie, Laboratoire de Chimie de Coordination, Toulouse
Search for more papers by this authorS. Lagrassa
Head Nurse
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorR. Grégoire
Physician
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorZ. Moussaoui
Quality Specialist
Centre de Coordination en Cancérologie (3C), Hôpital Salvator, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Search for more papers by this authorC. Casteras-Ducros
Associate Professor of Medicinal Chemistry
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorJ.E. Clark
Assistant Professor
Department of Pharmacotherapeutics and Clinical Research, College of Pharmacy, University of South Florida, Tampa, FL, USA
Search for more papers by this authorP. Vanelle
Professor of Organic Chemistry and Hospital Pharmacist
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Search for more papers by this authorCorresponding Author
P. Rathelot
Professor of Medicinal Chemistry and Hospital Pharmacist
Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille
Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, Marseille
Correspondence address: Pascal Rathelot, Aix-Marseille Université, Faculté de Pharmacie, Institut de Chimie Radicalaire, UMR CNRS 7273, 27 Boulevard Jean Moulin, CS30064, 13385 Marseille cedex 05, France (e-mail: [email protected]).Search for more papers by this authorAbstract
This study was specifically focused on para-professional healthcare workers (PHCWs) who handle cytotoxic drugs and contaminated wastes at the Public Teaching Hospitals of Marseille (AP-HM), France. It first aimed at evaluating the knowledge and professional practice of the PHCWs who belong to a personnel category among the less informed and protected in hospitals. In a second time, this study also proposed to raise awareness, educate and train the staff on protective measures to minimise the exposure of the PHCWs to the potential toxicity of anticancer chemotherapy agents (or metabolites) when cleaning and handling both cytotoxic drugs and wastes. Among the 11 oncology units evaluated, 82% completed an assessment survey, 63% of which were PHCWs. Out of nine oncology units assessed, 89% reported limited knowledge of the general risk and of the safe handling of cytotoxic drugs, 89% reported using vinyl gloves which are the less protective ones. Forty-four per cent of the units used wet sweeping techniques for cleaning the floors, and 11% of the units did not have specific procedures for cleaning the equipments used for collecting contaminated excreta. Protective outer apparel was not always worn and chemotherapy wastes were not managed consistently between all units. Standardized procedures and guidelines to prevent occupational exposure were not used by PHCWs. More education and training are needed to improve safety.
Supporting Information
| Filename | Description |
|---|---|
| ecc12249-sup-0001-si.doc64 KB |
Table S1. Questionnaire about the exposition of para-professional healthcare workers to cytotoxic agents, especially when managing excreta. |
| ecc12249-sup-0002-si.jpg102.1 KB |
Figure S1. Recap booklets about recommendations for PHCWs. |
| ecc12249-sup-0003-si.jpg90.8 KB |
Figure S2. Recap booklets about recommendations for adult patients. |
| ecc12249-sup-0004-si.jpg96.9 KB |
Figure S3. Recap booklets about recommendations for infant patients. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
References
- ASHP (2006) Guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy 63, 1172–1193.
10.2146/ajhp050529 Google Scholar
- Boccellino M., Pedata P., Castiglia L., La Porta R., Pieri M., Quagliuolo L., Acampora A., Sannolo N. & Miraglia N. (2010) Doxorubicin can penetrate nitrile gloves and induces apoptosis in keratinocytes cell lines. Toxicology Letters 197, 61–68.
- Cass Y. & Musgrave C.F. (1992) Guidelines for the safe handling of excreta contaminated by cytotoxic agents. American Journal of Hospital Pharmacy 49, 1957–1959.
- Castegnaro M., De Méo M., Laget M., Michelon J., Garren L., Sportouch M.H. & Hansel S. (1997) Chemical degradation of wastes of antineoplasic agents 2: six anthracyclines: idarubicin, doxorubicin, epirubicin, pirarubicin, aclarubicin and daunarubicin. International Archives of Occupational and Environmental Health 70, 378–384.
- Castiglia L., Miraglia N., Pieri M., Simonelli A., Basilicata P., Genivese G., Guadani R., Acampora A., Sannolo N. & Scafarto V. (2009) Evaluation of occupational exposure to antiblastic drugs in an Italian hospital oncological department. Journal of Occupational Health 50, 48–56.
- Chrysostomou A., Seshadri R. & Morley A.A. (1984) Mutation frequency in nurses and pharmacists working with cytotoxic drugs. Australian and New Zealand Journal of Medicine 14, 831–834.
- CNIHM (2008) Anticancéreux: utilisation pratique. CNIHM, 6ème edn, n° 5–6, 42–44.
- Connor T.H. & Mc Diarmid A. (2006) Preventing occupational exposures to antineoplasic drugs in health care settings. Cancer Journal for Clinicians 56, 354–365.
- Constantinidis T.C., Vagka E., Dallidou P., Basta P., Drakopoulos V., Kakolyris S. & Chatzaki E. (2011) Occupational health and safety personnel handling chemotherapeutic agents in Greek hospitals. European Journal of Cancer Care 20, 123–131.
- DHOS (2006) French inter-ministry directive n° DHOS/E4/DGS/SD7B/DPPR/2006/58. Recommandations relatives à l'élimination des déchets générés par les traitements anticancéreux. Available at: http://www.sante.gouv.fr/fichiers/bo/2006/06-04/a0040046.htm
- Dranitsaris G., Johnston M., Poirier S., Schueller T., Milliken D., Green E. & Zanke B. (2005) Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature. Journal of Oncology Pharmacy Practice 11, 69–78.
- Dussart C., Favier B., Gilles L., Camal I., Almeras D., Latour J.F. & Grelaud G. (2008) Continuous training program for technicians handling antineoplasic drugs and occupational exposure risk. Bulletin Du Cancer 95, 821–822.
- Fransman W., Vermeulen R. & Kromhout H. (2005) Dermal exposure to cyclophosphamide in hospital during preparation, nursing and cleaning activities. International Archives of Occupational and Environmental Health 78, 403–412.
- Gulten T., Evke E., Ercan I., Evrensel T., Kurt E. & Manavoglu O. (2011) Lack of genotoxicity in medicinal oncology nurses handling antineoplastic drugs: effect of work environment and protective equipment. Work (Reading, Mass.) 39, 485–489.
- Gunnarsdottir H.K., Aspelund T., Karlsson T. & Rafnsson V. (1997) Occupational risk factors for breast cancer among nurses. International Journal of Occupational Medicine and Environmental Health 3, 254–258.
10.1179/oeh.1997.3.4.254 Google Scholar
- Hansel S., Castegnaro M., Sportouch M.H., De Méo M., Malhavet J.C., Laget M. & Duménil G. (1997) Chemical degradation of wastes of antineoplastic agents: cyclophosphamide, ifosfamide and melphalan. International Archives of Occupational and Environmental Health 69, 109–114.
- Hedmer M., Georgiadi A., Rämme Bremberg E., Jönsson B.A. & Eksborg S. (2005) Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden. Annals of Occupational Hygiene 49, 629–637.
- Hon C.Y., Teschke K., Chua P., Venners S. & Nakashima L. (2011) Occupational exposure to antineoplastic drugs: identification of job categories potentially exposed throughout the hospital medication system. Safety and Health at Work 2, 273–281.
- IARC (2013) Agents classified by the IARC Monographs, volumes 1–108. Available at: http://monographs.iarc.fr/ENG/Classification/ClassificationsAlphaOrder.pdf
- Jochimsen P.R. (1992) Handling of cytotoxic drugs by healthcare workers. Drug Safety 7, 374–380.
- Jochimsen P.R., Corder M.P., Lachenbruch P.A. & Spaight M.E. (1988) Preparation and administration of chemotherapy. Hematological consequences for hospital-based nurses. Medical Toxicology and Adverse Drug Experience 3, 59–63.
- Keat C.H., Sooaid N.S., Yun C.Y. & Sriraman M. (2013) Improving safety-related knowledge, attitude and practices of nurses handling cytotoxic anticancer drug: pharmacists' experience in a general hospital, Malaysia. Asian Pacific Journal of Cancer Prevention 14, 69–73.
- Knowles R.S. & Virden J.E. (1980) Handling of injectable antineoplastic agents. British Medical Journal 281, 588–591.
- Kusnetz E. & Condon M. (2003) Acute effects from occupational exposure to antineoplastic drugs in a para-professional health care worker. American Journal of Industrial Medicine 44, 107–109.
- Labuhn K., Valanis B., Schoeny R., Loveday K. & Vollmer W.M. (1998) Nurses and pharmacists exposure to antineoplasic drugs: findings from industrial hygiene scans and urine mutagenicity tests. Cancer Nursing 21, 79–89.
- Laidlaw J.L., Connor T.H., Theiss J.C., Anderson R.W. & Matney T.S. (1984) Permeability of latex and polyvinyl chloride gloves to 20 antineoplasic drugs. American Journal of Hospital Pharmacy 41, 2618–2623.
- Leduc-Souville B., Bertrand E. & Schlatter J. (2013) Risk management of excreta in a cancer unit. Clinical Journal of Oncology Nursing 17, 248–252.
- Lê L.M., Jolivot P.A., Sadou Yaye H., Rieutord A., Bellanger A., Pradeau D., Barbault-Foucher S. & Caudron E. (2013) Effectiveness of cleaning of workplace cytotoxic surface. International Archives of Occupational and Environmental Health 86, 333–341.
- Montheith D.K., Connor T.H., Benvenuto J.A., Fairchild E.J. & Theiss J.C. (1987) Stability and inactivation of mutagenic drugs and their metabolites in the urine of patients administered antineoplasic therapy. Environmental and Molecular Mutagenesis 10, 341–356.
- Reich S.D. (1981) Antineoplastic agents as potential carcinogens: are nurses and pharmacists at risk? Cancer Nursing 4, 500–502.
- Rombaldi F., Cassini C., Salvador M., Saffi J. & Erdtmann B. (2009) Occupational risk assessment of genotoxicity and oxidative stress in workers handling antineoplastic drugs during a working week. Mutagenesis 24, 143–148.
- SA Health (2012) Guidelines for South Australian Health Services: Section 16: Contaminated body waste. Available at: http://www.sahealth.sa.gov.au/wps/wcm/connect/6784bb804b1e35d3902fbde79043faf0/HandlingCytotoxicDrugsGuidelineS16-PHCS-PSS-120514.pdf?MOD=AJPERES&CACHEID=6784bb804b1e35d3902fbde79043faf0&CACHE=NONE
- Skov T., Maarup B., Olsen J. & Rorth M. (1992) Leukemia and reproductive outcome among nurses handling antineoplastic drugs. British Journal of Industrial Medicine 49, 855–861.
- Sottani C., Porro B., Imbriani M. & Minoia C. (2012) Occupational exposure to antineoplastic drugs in four Italian health care settings. Toxicology Letters 213, 107–111.
- Valanis B., Vollmer W., Labuhn K. & Glass A. (1997) Occupational exposure to antineoplasic agents and self-reported infertility among nurses and pharmacist. Journal of Occupational and Environmental Medicine 39, 574–580.
- Vyas N., Yiannakis D., Turner A. & Sewell G.J. (2013) Occupational exposure to anti-cancer drugs: a review of effects of new technology. Journal of Oncology Pharmacy Practice 20, 278–287.
- Wallemacq P.E., Capron A., Vanbinst R., Boekmans E., Gillard J. & Favier B. (2006) Permeability of 13 different gloves to 13 cytotoxic agents under controlled dynamic conditions. American Journal of Health-System Pharmacy 63, 547–556.
- Walton A.M., Mason S., Busshart M., Spruill A.D., Cheek S., Lane A., Sabo K. & Taylor A. (2012) Safe handling: implementing hazardous drug precautions. Clinical Journal of Oncology Nursing 16, 251–254.
- Zanni G. (2013) Safety notice for the use of drugs for intravesical instillations and cost analysis. Urologia 80, 33–36.
