Annals of Occupational Hygiene Advance Access originally published online on March 2, 2007
Annals of Occupational Hygiene 2007 51(3):231-239; doi:10.1093/annhyg/mel081
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A Pooled Analysis to Study Trends in Exposure to Antineoplastic Drugs Among Nurses
1 Institute for Risk Assessment Sciences, Utrecht University Utrecht, The Netherlands;
2 Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands;
3 Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
*Author to whom correspondence should be addressed. Tel: +31-30-2539536; fax: +31-30-3529499; e-mail: w.fransman{at}iras.uu.nl
Objectives: Several studies have shown that exposure to antineoplastic drugs can cause toxic effects on reproductive health as well as carcinogenic effects. Numerous studies have corroborated that hospital workers are exposed to these drugs. This study focused on trends in exposure to antineoplastic drugs since the introduction of guidelines in The Netherlands.
Methods: Data from three cross-sectional exposure surveys conducted in The Netherlands were pooled to examine trends in occupational exposure to cyclophosphamide. Nurses' 24 h urine samples were analyzed in separate fractions, surface contamination was determined and gloves used during preparation or while handling patient urine were collected. The difference in detectable urine samples between 1997 and 2000 was determined by a generalized estimating equations (GEE) binomial regression model. Mixed models were used to study the time trend in surface and glove contamination levels.
Results: The percentage of nurses' urine samples with detectable cyclophosphamide had decreased 4-fold between 1997 and 2000. Median cyclophosphamide levels in the positive urine samples were 3-fold lower in 2000 than in 1997. Surface and glove contamination had statistically significantly decreased between 1997 and more recent years.
Conclusions: Nurses working at outpatient clinics or oncology wards are still being exposed to cyclophosphamide, but their exposure decreased considerably between 1997 and 2000, presumably due to the introduction of detailed guidelines and regulations in The Netherlands, the subsequent increased use of LuerLock connections and infusion systems prefilled with saline, and growing hazard awareness of nurses working with antineoplastic drugs.
Keywords: antineoplastic drugs • cyclophosphamide • nurses • occupational exposure • time trend
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