Veille documentaire MTPH

Médecine du travail du personnel hospitalier

Administration of Anticancer Drugs: Exposure in Hospital Nurses

Auteur     Catherine Rioufol
Auteur     Florence Ranchon
Auteur     Vérane Schwiertz
Auteur     Nicolas Vantard
Auteur     Elsa Joue
Auteur     Chloé Gourc
Auteur     Noémie Gauthier
Auteur     Marie Gabrielle Guedat
Auteur     Gilles Salles
Auteur     Pierre-Jean Souquet
Auteur     Bertrand Favier
Auteur     Laurence Gilles
Auteur     Gilles Freyer
Auteur     Benoît You
Auteur     Véronique Trillet-Lenoir
Auteur     Jérôme Guitton
Publication     Clinical therapeutics
Date     Mar 5, 2014
Résumé     BACKGROUND: Even though anticancer drugs are prepared in dedicated pharmaceutical units, nurses remain exposed to cytotoxic agents during administration to patients. OBJECTIVE: The aim of this study was to assess this occupational exposure during the intravenous line-purging procedure at the patient’s bedside before administration in oncology departments. METHODS: This prospective study was conducted over a 4-week period in the hematology and oncology departments at a university hospital. Amounts of doxorubicin and cyclophosphamide on the surface of nurses’ gloves were measured after the intravenous line purge of the infusion bag and the connection to the patient. For this purpose, gloves were washed with sterile water, following a validated procedure. Quantification of the 2 drugs into the water was performed using LC-MS/MS. RESULTS: After 59 chemotherapy administrations, 30.5% of gloves were contaminated. Despite extremely low volumes of contamination (0.08-6.28 µL), amounts collected ranged from 190 to 2500 ng per pair of gloves that tested positive for doxorubicin (median, 1600 ng) and from 130 to 32,600 ng with cyclophosphamide (median, 2700 ng). CONCLUSIONS: The intravenous line purge preceding antineoplastic infusion bag administration is a potential source of contamination in nurses. Contaminations appear to be invisible but frequent (in >30% of cases). Therefore, intravenous line purging performed under appropriately safe conditions should be mandated in pharmaceutical units dedicated to injectable-drug preparation. This measure should be included as a standard hospital practice as a matter of urgency.

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doi:10.1016/j.clinthera.2014.01.016

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