Occupational exposure to antineoplastic drugs in hospital environments: potential risk associated with contact with cyclophosphamide- and ifosfamide-contaminated surfaces
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University of Florence, Florence, Italy (Department of Experimental and Clinical Medicine)
Careggi University Hospital, Florence, Italy (Industrial Hygiene and Toxicology Laboratory, Occupational Medicine Unit)
University of Bologna, Bologna, Italy (Department of Medical and Surgical Sciences)
University of Turin, Turin, Italy (Department of Public Health and Pediatric Sciences)
University of Catania, Catania, Italy (Department of Clinical and Experimental Medicine)
University of Cagliari, Cagliari, Italy (Department of Medical Sciences and Public Health)
Stefano Dugheri   

Careggi University Hospital, Industrial Hygiene and Toxicology Laboratory, Occupational Medicine Unit, Largo Giovanni Alessandro Brambilla 3, I-50134 Florence, Italy
Online publication date: 2020-07-09
Med Pr 2020;71(5):519–529
Background: Cyclophosphamide (CP) and ifosfamide (IP) contaminations have been detected in hospital environments. This study was conducted to determine if there was any contamination in the spaces (floors and door handles) between the hospital exit and the antineoplastic drugs (ADs) preparation and administration units. At the same time, the authors proposed a new automation of the analytical procedure to considerably decrease the time needed for sample preparation and analysis. Material and Methods: To evaluate the ADs contamination of surfaces, 829 wipe tests were performed in a campaign involving 3 hospitals located in Italy. Sampling was performed using an innovative kit. The levels of ADs were measured in each wipe sample using liquid chromatography/triple quadrupole. Results: On-line solid-phase extraction guarantees the construction of a robust and reproducible analytical method. The CP and IP recoveries from stainless steel, polycarbonate and polyvinyl chloride ranged >80%, and the wipe holders and the automation tested ensured desorption efficiencies close to 100% for both the ADs. Of the 552 wipes taken on the spaces between the hospital exit and the preparation, administration and pharmacy warehouse units, 22 were greater than or equal to the limit of quantification, all adjacent to the administration units. Conclusions: This study provides an insight into the exposure situation against ADs residues. In order to improve environmental monitoring programs, the authors propose to evaluate the ADs contamination also outside the preparation, administration and pharmacy warehouse units. Med Pr. 2020;71(5):519–29