Healthcare workers and antineoplastic drugs: Identifying the determinants of exposure and current challenges to reducing exposure

In health care settings, antineoplastic drugs are prepared and administered daily, mainly for the treatment of cancer. These drugs are inherently toxic and can therefore affect normal, healthy cells. On-the-job (occupational) exposure to antineoplastic drugs has been shown to cause a variety of health effects including cell mutations, adverse developmental and reproductive outcomes, and cancer. Absorption through the skin is suspected to be the main route of occupational exposure to antineoplastic drugs, and in spite of control measures used during their handling and preparation, studies have found antineoplastic drug contamination of surfaces in health care facilities. However, few studies have examined the potential for occupational dermal exposure. Chun-Yip Hon previously conducted a pilot study assessing the occupational dermal exposure risks of antineoplastic drugs to healthcare workers, and evaluated the cleaning protocols for drug-contaminated surfaces. He found that antineoplastic drug contamination of the drug preparation area is likely in British Columbian hospital pharmacies even after cleaning, and that the hands of pharmacy personnel may be contaminated even if the worker was not responsible for preparing the drug products. He’s now undertaking a full-scale study at hospitals situated within the Lower Mainland, investigating the procedures and process flows of antineoplastic drug handling, and determining who may come into contact with the drugs. He is quantifying antineoplastic drug contamination levels on surfaces throughout their process flow in each hospital, assessing workers’ knowledge of safe handling procedures as well as their risk of occupational dermal exposure. He will also determine the presence of antineoplastic drugs in health care workers through biological monitoring. Hon’s findings will determine the risk factors associated with occupational exposure to antineoplastic drugs in the health care sector, providing key information for those who work with antineoplastic drugs, occupational health and safety professionals, risk managers and policy makers.