Abstract
Health professionals, especially nurses are exposed to antineoplastic drugs used in the treatment ofthe cancer. As the antineoplastics are known to becarcinogenic, teratogenic and mutagenic to humans, the occupational exposure is important. Thiscross-sectional study, carried out in 2002-2003, wasrealised in order to evaluate the exposure by the“Cytotoxic Contact Index” CCI , the research ofcytotoxics excreted in urines General UnknownScreening Method GUS , complaints and blood analysis. CCI revealed that 44.1% of the nurses were moderatly, 41% were highly exposed. The analysis of the urines with GUS method didn’t show anycontamination. Headache, hair loss and weaknesswere the most reported complaints. The blood analysis revealed elevated monocytes 51.7% andlower hemoglobin 23.3% values. The measureswhich should be taken according CCI for 85% ofthe nurses were the use of a vertical laminar airflow VLAF hood but only 50% of the nurses usedproper cabins. Only 38.2% of the nurses were usinggloves, working suit, goggles/surgical mask. Although the contamination wasn’t shown by GUS method which could be due the limitation of the method, the results emphasize the necessity of improving personal protection of nurses occupationallyexposed to cytostatic drugs and support the importance of biological monitoring
References
- ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs. Am J Hosp Pharm, 1990: 47, 1033-49.
- IARC Monographs on the evaluation of the carcinogenic risk of chemicals to man. 1976:Vol 10 (daunomycin).
- IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans: some antineoplastic and immunosuppressive agents. 1981:V 26,370-84.
- OSHA Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs. Am J Hosp Pharm,1986: 43, 1193-1204.
- Ensslin Angela S, Huber R, Pethran Angelika, et al. Biological monitoring of hospital pharmacy personel occupationally exposed to cytostatic drugs: urinary excretion and cytogenetic studies. Int Arch Occup Environ Health, 1997.70, 205-8.
- Pethran A, Schierl R, Hauff K, et al. Uptake of antineoplastic agents in pharmacy personel. Part I: monitoring of urinary concentrations. Int Arch Occup Environ Health, 2002: 76, 5-10.
- Sessink PJM, Boer KA, Scheefhals APH, et al. Occupational exposure to antineoplastic agents at several departments in a hospital. Environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. Int Arch Occup Environ Health, 1992: 64, 105-12.
- Sessink PJM, Van de Kerkhof MCA, Anzion RBM, et al. Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route? 1994:Arch Environ Health, 49, 165-9.
- Sessink PJM, Verplanke AJW, Herber RFM, Bos RP. Occupational exposure to antineoplastic agents and arameters for renal dysfunction. Int Arch Occup Environ Health, 1997:69, 215- 8.
- Sessink PJM, Wittenhorst BCJ, et al..Exposure of pharmacy technicians to antineoplastic agents; reevaluation after additional protective measures. Arch Environ Health, 199752, 240.
- Deschamps FJ, Marinutti-Liberge, Risques liés a l'exposition aux cytostatiques pour le personnel soignant, La Presse Médicale, v30, no32, Novembre 200.
- Rousselin X, Les Médicaments cytostatiques en milieu de soins 2. Recommendations pour la Prévention des Risques Professionnels; Documents pour le médecin du travail, no 45, 1991, pp 17.
- Falcy M, Bosard L. Manipulation des Chimiothérapies Anticancéreuses, Documents pour le médecin du travail, no 68, 4e trimestre 1996, pp 329-336.
- Saurel-Cubizolles MJ, Job-Spira N. Ectopic pregnancy and occupational exposure to antineoplastic drugs. Lancet, 1993:341, 1169.
- Burgaz S, Karahalil B, et al. Urinary cyclophosphamide excertion and micronuclei frequencies lymphocytes and in exfoliated buccal epithelial cells of nurses handling antineoplastics. Mutation Research, 1999:439, 97-104.
- Schreiber C, Radon K, et al. Uptake of antineoplastic agents in pharmacy personel. Part II: study of work related risk factors. Int Arch Occup Environ Health, 2002:76, 11. 19. Mader, Robert M.; Rizovski, Blanka, Exposure of oncologic nurses to methotrexate in the treatment of osteosarcoma, Archives of Environmental Health, 1996:Vol. 51 Issue 4, p310.
- Burgaz Sema, Antineoplastik Ýlaçlarýn Mesleki Kullanýmýndaki Saðlýk Riski?, FABAD, F arm. Bil. Der. 1992, 17,219-232.
- Kubilay G., Fesci H., Erdem Y. ve ark ., Kemoterapi hazýrlayan ve uygulayan hemþirelerere iliþkin durum deðerlendirmesi, Onkoloji Hemþireliði Derneði Bülteni, 1997, 6, 7-15.
- T.C. Saðlýk Bakanlýðý Tedavi Hizmetleri Genel Müdürlüðü, Antineoplastik (Sitotoksik) Ýlaçlarla Güvenli Çalýþma Rehberi, Ankara, 2003, http://www .saglik. gov.tr/extras/birimler/ tedavi/Buran/index.htm, eriþim tarihi: 26/04/06.
- Türk, M.,Davas, A.,Çiçeklioðlu, M., Saçaklýoðlu, F ., Mercan, T., ‘Knowledge, attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital’ Asian Pac J Cancer Prev ., 2004,5(2), 164-8.
- Alemany C, Evaluation des Risques liés a la Manipulation des Anticorps Monoclonaux, T ravail de Diplome, Université de Geneve, http://www .hcuge.ch/ P h a r m a c i e / e n s / t r a v d i p l o m e /2005_ca_eval_risq_manip_antico_monocl.pdf eriþim 21.4.2006
- Selevan SC, Selevan SG, Lindbohm ML, Hornung R W, Hemminki K, A study of occupational e xposure to antineoplastic drugs and fetal loss in nurses, N Engl J Med. 1985 Nov 7;313(19):1173-8.
- Striicker I, Caillard JF, Collin R, Goux M , Poyen D,. Hereon D. Risque d'avortement spontané et préparation. des chimiothérapies anticancéreuses chez les infirmieres, Arch Mal Prof 1988, 49 pp254-58.
- Material Safety Data Sheets, www.msds.com, MSDS Solutions, eriþim 21.4.2006
- Sturm S, A General Unknown Screening for Drugs and Toxic Compounds in Human Serum, Thesis, Submitted to the Faculty of Natural Sciences of the University of Basel, Switzerland, Basel, 2005, www.pages.unibas.ch/diss/2005/ DabsB _7295.pdf Eriþim Tarihi: 19Nnisan 2006.
Abstract
Sağlık çalışanları, özellikle hemşireler kanser tedavisinde kullanılan antineoplastik ajanlara maruz kalmaktadır. Antineoplastikler karsinojenik, teratojenik ve mutajenik oldukları için mesleki maruziyet önemlidir. 2002-2003 yıllarında yapılan bu kesitsel çalışma, Antineoplastik Temas İndeksi ATİ , idrarda atılan sitotoksiklerin araştırılması Bilinmeyenlerin Genel Taranması Yöntemi GUS , yakınmalar ve kan tetkikleri üzerinden maruziyeti değerlendirmek üzere gerçekleştirilmiştir.ATİ hemşirelerin %44.1’inin orta, %41’inin yoğun düzeyde maruz kaldığını ortaya koymuştur. İdrar analizleri herhangi bir kontaminasyon göstermemiştir.Başağrısı, saç dökülmesi ve halsizlik en fazla bildirilen yakınmalardır. Kan tetkikleri yüksek monosit %51.7 ve düşük hemoglobin %23.3 değerleri ortaya koymuştur. ATİ’ye göre alınması gereken önlemler hemşirelerin %85’i için laminar dikey akımlı kabinlerin kullanımı olmasına rağmen hemşirelerin ancak %50’si uygun kabin kullanmaktaydı. Hemşirelerin yalnız % 38.2’si eldiven, önlük ve gözlük/cerrahi maske takmaktaydı. GUS yöntemi ile kontaminasyon gösterilmemesi yöntemin sınırlılığına bağlı olabileceğinden, bulgular sitotoksik ilaçlara mesleki olarak maruz kalan hemşirelerin kişisel korunmalarının geliştirilmesi ve biyolojik izlemin desteklenmesinin önemini vurgulamaktadır.
References
- ASHP Technical Assistance Bulletin on Handling Cytotoxic and Hazardous Drugs. Am J Hosp Pharm, 1990: 47, 1033-49.
- IARC Monographs on the evaluation of the carcinogenic risk of chemicals to man. 1976:Vol 10 (daunomycin).
- IARC Monographs on the evaluation of carcinogenic risk of chemicals to humans: some antineoplastic and immunosuppressive agents. 1981:V 26,370-84.
- OSHA Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs. Am J Hosp Pharm,1986: 43, 1193-1204.
- Ensslin Angela S, Huber R, Pethran Angelika, et al. Biological monitoring of hospital pharmacy personel occupationally exposed to cytostatic drugs: urinary excretion and cytogenetic studies. Int Arch Occup Environ Health, 1997.70, 205-8.
- Pethran A, Schierl R, Hauff K, et al. Uptake of antineoplastic agents in pharmacy personel. Part I: monitoring of urinary concentrations. Int Arch Occup Environ Health, 2002: 76, 5-10.
- Sessink PJM, Boer KA, Scheefhals APH, et al. Occupational exposure to antineoplastic agents at several departments in a hospital. Environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. Int Arch Occup Environ Health, 1992: 64, 105-12.
- Sessink PJM, Van de Kerkhof MCA, Anzion RBM, et al. Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route? 1994:Arch Environ Health, 49, 165-9.
- Sessink PJM, Verplanke AJW, Herber RFM, Bos RP. Occupational exposure to antineoplastic agents and arameters for renal dysfunction. Int Arch Occup Environ Health, 1997:69, 215- 8.
- Sessink PJM, Wittenhorst BCJ, et al..Exposure of pharmacy technicians to antineoplastic agents; reevaluation after additional protective measures. Arch Environ Health, 199752, 240.
- Deschamps FJ, Marinutti-Liberge, Risques liés a l'exposition aux cytostatiques pour le personnel soignant, La Presse Médicale, v30, no32, Novembre 200.
- Rousselin X, Les Médicaments cytostatiques en milieu de soins 2. Recommendations pour la Prévention des Risques Professionnels; Documents pour le médecin du travail, no 45, 1991, pp 17.
- Falcy M, Bosard L. Manipulation des Chimiothérapies Anticancéreuses, Documents pour le médecin du travail, no 68, 4e trimestre 1996, pp 329-336.
- Saurel-Cubizolles MJ, Job-Spira N. Ectopic pregnancy and occupational exposure to antineoplastic drugs. Lancet, 1993:341, 1169.
- Burgaz S, Karahalil B, et al. Urinary cyclophosphamide excertion and micronuclei frequencies lymphocytes and in exfoliated buccal epithelial cells of nurses handling antineoplastics. Mutation Research, 1999:439, 97-104.
- Schreiber C, Radon K, et al. Uptake of antineoplastic agents in pharmacy personel. Part II: study of work related risk factors. Int Arch Occup Environ Health, 2002:76, 11. 19. Mader, Robert M.; Rizovski, Blanka, Exposure of oncologic nurses to methotrexate in the treatment of osteosarcoma, Archives of Environmental Health, 1996:Vol. 51 Issue 4, p310.
- Burgaz Sema, Antineoplastik Ýlaçlarýn Mesleki Kullanýmýndaki Saðlýk Riski?, FABAD, F arm. Bil. Der. 1992, 17,219-232.
- Kubilay G., Fesci H., Erdem Y. ve ark ., Kemoterapi hazýrlayan ve uygulayan hemþirelerere iliþkin durum deðerlendirmesi, Onkoloji Hemþireliði Derneði Bülteni, 1997, 6, 7-15.
- T.C. Saðlýk Bakanlýðý Tedavi Hizmetleri Genel Müdürlüðü, Antineoplastik (Sitotoksik) Ýlaçlarla Güvenli Çalýþma Rehberi, Ankara, 2003, http://www .saglik. gov.tr/extras/birimler/ tedavi/Buran/index.htm, eriþim tarihi: 26/04/06.
- Türk, M.,Davas, A.,Çiçeklioðlu, M., Saçaklýoðlu, F ., Mercan, T., ‘Knowledge, attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital’ Asian Pac J Cancer Prev ., 2004,5(2), 164-8.
- Alemany C, Evaluation des Risques liés a la Manipulation des Anticorps Monoclonaux, T ravail de Diplome, Université de Geneve, http://www .hcuge.ch/ P h a r m a c i e / e n s / t r a v d i p l o m e /2005_ca_eval_risq_manip_antico_monocl.pdf eriþim 21.4.2006
- Selevan SC, Selevan SG, Lindbohm ML, Hornung R W, Hemminki K, A study of occupational e xposure to antineoplastic drugs and fetal loss in nurses, N Engl J Med. 1985 Nov 7;313(19):1173-8.
- Striicker I, Caillard JF, Collin R, Goux M , Poyen D,. Hereon D. Risque d'avortement spontané et préparation. des chimiothérapies anticancéreuses chez les infirmieres, Arch Mal Prof 1988, 49 pp254-58.
- Material Safety Data Sheets, www.msds.com, MSDS Solutions, eriþim 21.4.2006
- Sturm S, A General Unknown Screening for Drugs and Toxic Compounds in Human Serum, Thesis, Submitted to the Faculty of Natural Sciences of the University of Basel, Switzerland, Basel, 2005, www.pages.unibas.ch/diss/2005/ DabsB _7295.pdf Eriþim Tarihi: 19Nnisan 2006.
Details
| Primary Language | Turkish |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | November 1, 2006 |
| Published in Issue | Year 2006 Volume: 7 Issue: 28 |