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
Volume       36
Numéro       3
Pages       401-407
Publication       Clinical Therapeutics
ISSN       1879-114X
Date       Mar 1, 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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