• Advancing the Capability of Low and Middle Income Latin American Countries in the Evaluation of Occupational Exposures to Hazardous Drugs among Health Care Workers

      Muller Ramirez, Claudio Felipe; Squibb, Katherine S. (2015)
      Hazardous drugs are toxic not only to patients who receive them as part of their pharmacological therapy, but also to health care workers who handle these drugs. Antineoplastic drugs are classified as hazardous drugs; and workers who participate of their manipulation are considered to be at occupational risk. Adherence to safety guidelines has been an issue since their implementation, especially in low-to-middle income countries with limited resources. In addition, measurable amounts of antineoplastic drugs on work surfaces and in urine of health care workers exposed to hazardous drugs have been well documented. Unfortunately, most of Latin American countries do not pose adequate capabilities of investigating environmental contamination generated by antineoplastic drugs in oncology health care settings. Primary goal: To establish more accessible analytical methods that can be used by low-to-middle income countries in Latin America to give them the ability to measure levels of environmental contamination generated by the handling of antineoplastic drugs in oncology health care settings. Results: The developed methodology demonstrated to be adequately sensitive to measure ifosfamide, cyclophosphamide, and paclitaxel in wipe samples as contaminants of the work place. Wipe sample concentration steps allowed a ten-fold increase in sensitivity when measuring all three drugs making the proposed more accessible methodology an alternative to the state-of-the-art technology when establishing contamination levels in oncology health care settings with limited resources. Sample analysis showed high levels of contamination for ifosfamide, cyclophosphamide, and paclitaxel in both preparation and administration areas of the oncology institution. Also, decontamination procedures were ineffective in completely removing contamination from contaminated work surfaces. Conclusions: Results of the environmental monitoring study provided the health care facility with quantitative information about current contamination levels with antineoplastic drugs. Comprehensive review of internal safety protocols should be done in order to reduce contamination levels and avoid unnecessary occupational exposures. A second environmental monitoring study should be conducted to efficiently assess reduction of contamination.