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Commenced in January 2007 Frequency: Monthly Edition: International Publications Count: 31103

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Risk of Occupational Exposure to Cytotoxic Drugs: The Role of Handling Procedures of Hospital Workers
In order to study environmental contamination by cytostatic drugs in Portugal hospitals, sampling campaigns were conducted in three hospitals in 2015 (112 samples). Platinum containing drugs and fluorouracil were chosen because both were administered in high amounts. The detection limit was 0.01 pg/cm² for platinum and 0.1 pg/cm² for fluorouracil. The results show that spills occur mainly on the patient`s chair, while the most referenced occurrence is due to an inadequately closed wrapper. Day hospitals facilities were detected as having the largest number of contaminated samples and with higher levels of contamination.
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[1] Sessink, P. J. M., & Bos, R. P. (1999). Drugs hazardous to healthcare workers. Evaluation of methods for monitoring occupational exposure to cytostatic drugs. Drug Safety, 20(4), 347–359.
[2] Kiffmeyer, T. K., Tuerk, J., Hahn, M., Stuetzer, H., Hadtstein, C., Heinemann, A., & Eickmann, U. (2013). Application and assessment of a regular environmental monitoring of the antineoplastic drug contamination level in pharmacies-the MEWIP project. Annals of Occupational Hygiene, 57(4), 444–455.
[3] Kromhout, H., Hoek, F., Uitterhoeve, R., Huijbers, R., Overmars, R. F., Anzion, R., & Vermeulen, R. (2000). Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. The Annals of Occupational Hygiene, 44(7), 551–560.
[4] Connor, T. H., DeBord, D. G., Lees, P. S. J. P., Krieg, E. F., Rogers, B., Escalante, C. P., McDiarmid, M. (2010). Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine, 52(10), 1019–1027.
[5] Acampora, A., Castiglia, L., Miraglia, N., Pieri, M., Soave, C., Liotti, F., & Sannolo, N. (2005). A case study: Surface contamination of cyclophosphamide due to working practices and cleaning procedures in two Italian hospitals. Annals of Occupational Hygiene, 49(7), 611–618.
[6] NIOSH, National Institute for Occupational Safety and Health (2004). Preventing occupational exposures to antineoplastic and other harzardous drugs in health care settings (Internet). American: NIOSH; 2004 (cited 2007 Mai 27). Available from:;
[7] Suspiro, A., & Prista, J. (2012). Exposição ocupacional a citostáticos e efeitos sobre a saúde. Revista Portuguesa de Saude Publica, 30(1), 76–88.
[8] Infarmed, Medicamentos antineoplásicos e imunomoduladores. Accessed online in 2014/04/18.
[9] Schierl, R., Böhlandt, A., & Nowak, D. (2009). Guidance values for surface monitoring of antineoplastic drugs in german pharmacies. Annals of Occupational Hygiene, 53(7), 703–711.
[10] Kopjar, N. Garaj-Vrhovac, V. Kasuba, V. Rozgaj, R. Ramic, S. Pavlica, V. Zeljezic, D. (2009). Assessment of genotoxic risk in Croation health care workers occupationally exposed to cytotoxic drugs: A multi-biomaker approach. ScienceDirect revista, pp. 414-431.
[11] Sottani, C., Porro, B., Imbriani, M., & Minoia, C. (2012). Occupational exposure to antineoplastic drugs in four Italian health care settings. Toxicology Letters, 213(1), 107–115.
[12] Silva, J. (2011). Manipulação de citostáticos num hospital: estudo do impacto sobre a contaminação do ambiente ocupacional. Master thesis, Minho University.
[13] Moher, D., Liberati, Tetzlaff, J., Altman, D. G., & Grp, P. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (Reprinted from Annals of Internal Medicine). Physical Therapy, 89(9), 873–880.
[14] Brouwers, E. E. M., Huitema. D. R., Bakker, E. N., Douma, J. W., Schimmel, K. J. M., van Weringh, G., … Beijnen, J. H. (2007). Monitoring of platinum surface contamination in seven Dutch hospital pharmacies using inductively coupled plasma mass spectrometry. International Archives of Occupational and Environmental Health, 80(8), 689–699.
[15] Schmaus, G., Schierl, R., & Funck, S. (2002). Monitoring surface contamination by antineoplastic drugs using gas chromatography–mass spectrometry and voltammetry. American Journal of Health-System Pharmacy, 59, 956–961.
[16] Yoshida, J., Tei, G., Mochizuki, C., Masu, Y., Koda, S., & Kumagai, S. (2009). Use of a closed system device to reduce occupational contamination and exposure to antineoplastic drugs in the hospital work environment. Annals of Occupational Hygiene, 53(2), 153–160.
[17] Connor, T. H., Anderson, R. W., Sessink, P. J., Broadfield, L., & Power, L. A. (1999). Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States. American Journal of Health-System Pharmacy: AJHP: Official Journal of the American Society of Health-System Pharmacists, 56(14), 1427–1432. Retrieved from
[18] Crauste-Manciet, S., Sessink, P. J. M., Ferrari, S., Jomier, J. Y., & Brossard, D. (2005). Environmental contamination with cytotoxic drugs in healthcare using positive air pressure isolators. Annals of Occupational Hygiene, 49(7), 619–628.
[19] Viegas, S., Pádua, M., Veiga, A. C., Carolino, E., & Gomes, M. (2014). Antineoplastic drugs contamination of workplace surfaces in two Portuguese hospitals. Environmental Monitoring and Assessment, 186(11), 7807–7818.
[20] Berruyer, M., Tanguay, C., Caron, N. J., Lefebvre, M., & Bussières, J. F. (2015). Multicenter study of environmental contamination with antineoplastic drugs in 36 Canadian hospitals: a 2013 follow-up study. Journal of Occupational and Environmental Hygiene, 12(2), 87–94.
[21] Odraska, P., Dolezalova, L., Kuta, J., Oravec, M., Piler, P., Synek, S., & Blaha, L. (2014). Association of surface contamination by antineoplastic drugs with different working conditions in hospital pharmacies. Archives of Environmental & Occupational Health, 69(3), 148–58.
[22] Kopp, B., Schierl, R., & Nowak, D. (2013). Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. International Archives of Occupational and Environmental Health, 86(1), 47–55.
[23] Hon, C.-Y., Teschke, K., Chu, W., Demers, P., & Venners, S. (2013). Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. Journal of Occupational and Environmental Hygiene, 10(7), 374–83.
[24] Hon, C.-Y., Teschke, K., Chua, P., Venners, S., & Nakashima, L. (2011). Occupational Exposure to Antineoplastic Drugs: Identification of Job Categories Potentially Exposed throughout the Hospital Medication System. Safety and Health at Work, 2(3), 273.
[25] Dal Bello, F., Santoro, V., Scarpino, V., Martano, C., Aigotti, R., Chiappa, A., … Medana, C. (2016). Antineoplastic drugs determination by HPLC-HRMSn to monitor occupational exposure. Drug Testing and Analysis, 8(7), 730–737.
[26] Hedmer, M., Tinnerberg, H., Axmon, & Jönsson, B. G. (2008). Environmental and biological monitoring of antineoplastic drugs in four workplaces in a Swedish hospital. International Archives of Occupational and Environmental Health, 81(7), 899–911.
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