Evidence of exposure to cytostatic drugs in healthcare staff: a review of recent literature

• Published in: Farmacia hospitalaria 2016-12, Vol.40 (6), p.604-621
• Main Authors: Lancharro, Pablo Martín, de Castro-Acuña Iglesias, Nuria, González-Barcala, Francisco-Javier, González, José Domingo Moure
• Format: Article
• Language: English
• Subjects: Contaminación superficial; Cytostatic drugs; Exposición laboral; Fármacos citostáticos; Manipulación segura; Occupational exposure; Safe handling; Surface contamination
• ISSN: 1130-6343; 2171-8695
• DOI: 10.7399/fh.2016.40.6.9103

Provide updated evidence and learn about the actions that must be implemented in order to prevent the occupational exposure to cytostatic drugs. A bibliographic search was carried out on the MEDLINE, COCHRANE PLUS and WEB OF SCIENCE databases, with the terms “surface contamination”, “cytostatic drug”, “drug preparation”, “occupational exposure”, “safe handling” and “closed-system transfer device”, within the 2010–2015 period. Thirteen articles were selected for review. These articles are from hospitals in U.S.A., Canada, Japan, Australia, Spain, Portugal and Germany. In all of them, surface contamination by cytostatic agents was found in over 15 different surfaces, with concentrations ranging from 1.69 ng/cm2 to 4–784 μg/cm2. The specific drugs were cyclophosphamide, ifosfamide, 5-fluorouracil, methotrexate, paclitaxel, cisplatin, gemcitabine, and docetaxel. Closed-system transfer devices can reduce the contamination in work surfaces significantly, but do not eliminate it. Presence of contamination by cytostatic drugs was confirmed in many hospitals across all 5 continents. In all cases, contamination was found in the cabinet, on the floor in front of the cabinet, and in other places of the Hospital Pharmacy. The drug most frequently found was cyclophosphamide. The most effective action used to reduce contamination was the closed-system transfer devices (CSTDs). Disponer de la evidencia más actual y conocer las medidas a aplicar para evitar la exposición laboral a citostáticos. Se realizó una búsqueda bibliográfica en las bases de datos MEDLINE, COCHRANE PLUS y WEB OF SCIENCE con los términos “surface contamination”, “antineoplastic drug”, “drug preparation”, “occupational exposure”, “safe handling” y “closed-system transfer device” para el periodo 2010–2015. Se seleccionaron 13 artículos para la revisión. Estos artículos corresponden a hospitales de USA, Canadá, Japón, Australia, España, Portugal y Alemania. En todos ellos se ha encontrado contaminación por fármacos citostáticos en más de 15 superficies distintas con concentraciones que van desde los 1,69 ng/cm2 hasta 4,784 μg/cm2. Los fármacos determinados han sido ciclofosfamida, ifosfamida, 5-fluorouracilo, metotrexato, paclitaxel, cisplatino, gemcitabina y docetaxel. El sistema cerrado reduce la contaminación de las superficies de trabajo significativamente, pero no la elimina. Se verifica la presencia de contaminación por fármacos citostáticos en numerosos hospitales de los 5 continentes. En todos lo