Environmental exposure to anticancer drugs in outpatient chemotherapy center

Author(s)：

Hisako Sato^1,2, Jiichiro Sasaki¹, Fumiko Bansho^1,2, Mitsuhiro Sugawara^1,3, Maki Takao², Masaru Kuranami^1,4

Affiliation(s)：

¹Chemotherapy Center¹, Kitasato Univ. Hospital, ²Dept. of Nursing, Kitasato Univ. Hospital, ³Dept. of Pharmacy, Kitasato Univ., ⁴Dept. of Surgery, Yamato Municipal Hospital, Japan

[Background] Most of antineoplastic agents are generally nonselective and, along with tumor cells, normal cells may undergo mutagenic, cytotoxic, and genotoxic damage. Medical staff s working at the chemotherapy center can be exposed to the agents through inhalation of aerosol, attachment on skin or eye, eating the food touched by hands. We have already established a procedure for protection from exposure to antineoplastic drugs in our working place, but we have never realized where the drugs are spilled or how much the agents are scattered. [Purpose] To clarify the risk of the exposure to antineoplastic agents in our ambulatory chemotherapy center, we measured concentration of both cyclophosphamide (CPA) and 5-FU on the floors or the protective equipments. [Methods] We used Sampling-sheet method which had been developed and commercialized by SHIONOGI ANALYSIS CENTER CO.,LTD. We set the sheets for 24hours on several floors of the treatment room or the restroom, the glove and the gown which a nurse puts on, the mouse of a personal computer, and so on. The sample sheets were collected and sent to Shionogi Analysis Center to measure concentration of CPA and 5-FU. At least 3 times evaluation was done at each site. [Results] We screened the exposure of CPA and 5-FU at 21 sites, and detected either of them at 8 sites (38%). CPA was found on 5 sites including men's restroom, women's restroom, and treatment room. The floor of men's restroom was the most exposed to CPA (average concentration was 217.6ng/100cm2). 5-FU was detected on 3 sites such as floor of men's restroom, a mouse of PC, and a tray for carry of the drugs. We could not find any drugs on floor of nurse room, gown, cap and mask. [Conclusion] Our procedure for protection of exposure to antineoplastic agents is quite effective and promising, but we need to realize that the men's restroom is the most dangerous souse of pollution of antineoplastic agents. We should establish an additional plan to prevent medical stuffs and patients from the secondary environmental exposure in the restroom, immediately.