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103 - 110 pieri.qxp - Italian Journal of Occupational and Environmental Hygiene Professional exposure to antineoplastic drugs in oncology wards:environmental pollution levels found in several oncology wards andrisks reduction strategiesEsposizione professionale a chemioterapici antiblastici in ambito sanitario: con-siderazioni sui livelli di contaminazione degli ambienti di lavoro e strategie diminimizzazione del rischio Maria Pieri*,1, Loredana Castiglia2, Angela Silvestre1, Nadia Miraglia2, Raffaele D’Angelo3, Nicola Sannolo2,Antonio Acampora1 1Dipartimento di Medicina Pubblica e della Sicurezza Sociale - Università degli Studi di Napoli “Federico II” 2Sezione di Igiene, Medicina del Lavoro e Medicina Legale - Area di Medicina del Lavoro - Napoli 3CONTARP - INAIL- Direzione Regionale per la Campania *Corresponding author:Maria Pieri, Dipartimento di Medicina Pubblica e della Sicurezza Sociale, Università degli Studi di Napoli “Federico II”, ViaS. Pansini, 5, 80131 Napoli, Italy; Ph. ++39 081 7463474; Fax. ++39 081 5469185; e-mail: Many antineoplastic drugs (AD) commonly used in therapies display cytotoxic activity and are classified as potentially carci-nogen, mutagen or teratogen. Since antineoplastic drugs are not selective towards malignant cells, their use may derive in thedevelopment of primary tumours in healthy subjects occupationally exposed to such agents, an occupational risk against whichworkers must be defended. The Environmental Monitoring represents a valid instrument in risk reduction strategies, since itallows the definition of the pollution levels actually present in the whole working areas and at the same time it can point outeventual structural and/or organizational lacks to be improved for pollution reduction. The present work reports results ofEnvironmental Monitoring campaigns performed between 2004 and 2008 in oncology wards of different Italian hospitals.
Analytes were chosen considering both their intrinsic toxicity properties and the amount handled for therapies. In particular,cyclophosphamide (CP), ifosfamide (IF), 5-floruracil (5FU), doxorubicin (DOXO) and epirubicin (EPI) were considered.
Environmental Monitoring was performed by wipe-test sampling of potentially contaminated surfaces, analytes purification andGC/MSMS (CP, IF), HPLC/UV (5FU) or HPLC/FL (DOXO, EPI) analysis. Analytical methods used were fully validated accor-ding to the Food and Drug Administration Guidelines. The descriptive analysis (concentration ranges, median or mean, disper-sion indices etc.) was performed to give a global image of the pollution situation of the examined drug preparation rooms.
Inferential analyses were applied to evaluate the correctness of working and cleaning modalities, i.e. the effectiveness of for-mation/information training courses, as well as the actual application of national/international directives about antineoplasticdrugs handling. In all examined oncology wards several discrepancies between actual working modalities/organization andItalian Guidelines for AD manipulation have been evidenced. Pollution levels found for the considered analytes varied in awide concentration ranges, being almost 1000 times greater with respect to data reported in the international literature (µg/dm2vs. ng/dm2). A diffuse contamination throughout the drug preparation rooms was found and analytes were found, even if intraces, in days when they were not used at all. Obtained data suggest the non-adequacy of both working modalities and clea-ning procedures adopted, thus evidencing the need of new formation/information training courses for nurses devoted to ADmanipulation. In fact, nurses of almost all examined wards seemed to be not consciousness of the risks related to their job acti-vities. Results further highlighted the crucial role played by Environmental Monitoring campaigns, as unique tool for verifyingthe effectiveness of risk management strategies adopted for AD exposure reduction.
Key words: Antineoplastic drugs, occupational exposure, environmental monitoring Il presente lavoro illustra i risultati di diverse campagne di Monitoraggio Ambientale condotte tra il 2004 ed il 2008 indiverse realtà ospedaliere. Gli analiti, scelti in base alla loro tossicità intrinseca e alla percentuale di utilizzo nelle terapie,erano ciclofosfamide (CP), ifosfamide (IF), 5-fluoruracile (5FU), doxorubicina (DOXO) ed epirubicina (EPI). Il monitoraggioambientale è stato effettuato mediante tecnica del wipe-test; gli analiti sono stati purificati ed analizzati mediante metodipienamente validati in accordo con le Linee Guida della Food and Drug Administration (FDA). In tutti i reparti oncologiciesaminati è stata evidenziata una non aderenza alle indicazioni delle Linee Guida relative alla manipolazione dei chemio-terapici antiblastici. Il grado di contaminazione riscontrato risultava 1000 volte superiore rispetto ai valori riportati nellaletteratura internazionale. I dati suggeriscono una non adeguatezza delle modalità di lavoro e delle procedure di pulizia,evidenziando la necessità di procedere con campagne d’informazione/formazione degli addetti alla manipolazione, al finedi renderli pienamente consapevoli dei rischi connessi all’attività lavorativa. Appare, inoltre, di primaria importanza la pia-nificazione di campagne di monitoraggio su base annuale, quale strumento imprescindibile per verificare l’efficacia dellestrategie di risk management adottate per diminuire i livelli di esposizione a chemioterapici antiblastici.
The Italian Association of Industrial Hygienists - AIDII [2012] Ital. J. Occup. Environ. Hyg., 2012, 3(2) | 103 - 110


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Hamdee Y. Attallah, M.D. Office Address: Division of Endocrinology, Diabetes and Metabolism Education: 1992 B.S. Wayne State University, Detroit, MI M.D. Wayne State University, Detroit, MI Training: 2001-2005 Postdoctoral research fellow, Endocrinology, Diabetes and Metabolism, Stanford University, Stanford, CA Clinical fellow, Endocrinology, Diabetes and M

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