Occupational dermal exposure to antineoplastic drugs throughout the hospital medication system at Canadian hospital pharmacies

Introduction
Studies have found that pharmacy personnel and nurses are at risk of dermal exposure to antineoplastic drugs. However, our earlier study found drug contamination on many surfaces throughout the hospital medication system suggesting that other job cohorts are also at risk. The current study aimed to ascertain dermal contamination levels of those job categories that potentially contact drug-contaminated surfaces. We also examined glove usage and handwash practices to determine if these influenced contamination levels.

Methods
Site observations were conducted to identify the healthcare job categories that regularly contact antineoplastic drugs and/or drug-contaminated surfaces. Up to three workers per job category per site were recruited to participate. The front and back of both hands of each subject were wiped. Samples were analyzed by HPLC MS/MS to quantify the amount of cyclophosphamide in nanograms per wipe (ng/wipe).

Results
From 115 subjects, we collected 225 samples of which 180 (80%) were less than the limit of detection (LOD) of 0.356 ng/wipe. Of the 14 job categories sampled, 5 had a mean concentration greater than the LOD: oncologist, pharmacy receiver, porter, nurse, and ward aide. Notably, one sample from a ward aide had the second highest contamination level overall (21.7 ng/wipe). With respect to glove usage, individuals wearing double gloves still had detectable contamination. The highest contamination level found (22.1 ng/wipe) was for an individual who reported washing their hands less than 10 minutes before sample collection.

Discussion
Our results suggest that additional healthcare job categories, besides pharmacy personnel and nurses, are at risk of occupational dermal exposure to antineoplastic drugs. Even though gloves were worn, there were detectable levels on workers’ hands suggesting that drugs may permeate the gloves or the subject may have self-contaminated during donning or doffing. Current handwashing and surface cleaning protocols need to be scrutinized as they may not be effective.