Analytical strategies for assessing occupational exposure to antineoplastic drugs in healthcare workplaces
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Careggi University Hospital, Florence, Italy (Occupational Medicine Division, Laboratory of Industrial Hygene and Toxicology)
Careggi University Hospital, Florence, Italy (Department of Clinical and Experimental Medicine)
Careggi University Hospital, Florence, Italy (Pharmacy AD Preparation Unit)
Careggi University Hospital, Florence, Italy (Health and Safety Service)
Stefano Dugheri   

Careggi University Hospital, Occupational Medicine Division, Laboratory of Industrial Hygene and Toxicology, Largo Piero Palagi 1, 50139 Florence, Italy
Online publication date: 2018-11-29
Med Pr 2018;69(6):589–604
Background: Cytotoxic antineoplastic drugs (ADs), widely used in treating cancer, are considered hazardous in the workplace and thus require safe handling practices. An analytical protocol for environmental and biological AD monitoring in the healthcare environment has been developed, since Europe lacks clear guidelines and regulations for cytostatic preparation and handling. Material and Methods: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for measuring contemporaneously 20 multi-class cytostatic compounds and urinary α-fluoro-β-alanine, whereas platinum was detected by inductively coupled plasma mass spectrometry (ICP-MS). Sampling procedures and analytical conditions were optimized and the assays were validated. Environmental AD monitoring data, collected in 2009–2017, for a total of 3749 wipe tests and 57 720 determinations, was evaluated. Results: The proportion of positive samples gradually decreased from 11.7% in 2010 to 1% in 2017, however, 2266 determinations were positive. No urine sample had detectable concentrations of any of the 4 drugs considered (0/398 samples). Conclusions: These improvements are so large that the key role played by the new, more stringent rules for preparing and administering ADs is evident. Hence, the analytical method involving multi-element determinations allows for a more thorough and complete investigation into the AD contamination of work environments. Med Pr 2018;69(6):589–604