Occupational exposures to antineoplastic agents in a hospital hematology-oncology department

Background: Previous studies have documented health risks from occupational exposures to antineoplastic agents. The present study evaluated antineoplastic drug exposures and nurses' use of protective measures in a hospital oncology-hematology department.

Methods: Fourteen wipe samples were taken on various surfaces in patient rooms and common areas where nursing staff spend time. They were quantified for methotrexate, cyclophosphamide, and cytarabine. Fifty nursing staff completed a questionnaire that measured perceptions of chemotherapy exposures, health effects, level of training, and personal protective equipment use.

Results: Seven of the 14 surfaces contained quantifiable levels of either methotrexate or cyclophosphamide. They were detected on the bedside floor, IV pole, bathroom floor, and bathroom toilet. We found that respondents were not adhering to professional guidelines. Less than 50% of respondents reported wearing two pairs of gloves when handling antineoplastic agents. Also, only 86% reported wearing chemotherapy gowns, and 87% reported washing hands after coming into contact with these drugs. Nurses reported experiencing respiratory symptoms immediately after exposure to antineoplastic agents; in addition, 18% reported reproductive difficulties and 18% reported other chronic health issues such as menstrual dysfunction and hair loss.

Conclusion: The results show that antineoplastic agents can persist on many surfaces in patients' rooms. The high levels in bathrooms suggest that patient's excreta can be a significant source of exposure. Our survey results underscore the need for a comprehensive training program for nursing staff so that they can prevent unnecessary exposure to antineoplastic agents.