Occupational exposure of pharmacy technicians and cleaning staff to cytotoxic drugs in Dutch hospitals

Figures & data

Table 1. Analyzed cytotoxics and their limit of detection in hand rinse samples.

Drug	Abbreviation	Limit of Detection (µg/L)
Cyclophosphamide	CP	0.01
5-Fluorouracil	5-FU	0.1
Iphosphamide	IF	0.01
Gemcitabine	Gem	0.025
Etoposide	Eto	0.025
Methotrexate	MTX	0.025
Paclitaxel	Pac	0.025
Docetaxel	Doc	0.025

Table 2. Survey results into the frequency and duration of tasks where exposure to cytotoxics can occur.

Profession	Task	Respondents (n)	Frequency of task per week				Duration of task (minutes)
			mean	sd*	min	max	mean	sd*	min	max
Pharmacy technician	Reconstitution and compounding help, preparatory work, and checking of final product	42	24	53.8	1	300	6.3	4.3	2	20
	Cleaning of BSC^#	59	4.1	4	0	21	11.9	7.1	0	30
Cleaner	Cleaning patient room, daycare unit, or pharmacy	31	3.4	2.1	1	12	15.2	10.5	6	60
	Cleaning sanitary facilities	26	8.5	10.5	1	50	11.3	5.7	3	30

*sd = standard deviation, #BSC = biological safety cabinet

Table 3. Contamination in the hand rinse samples (in µg/L).

Drug	Samples with contamination above the LOD	Contamination in samples of the pharmacy technicians				Contamination in samples of the cleaners
	n (% of total)	n (%)	min	max	n (%)		min	max
Cyclophosphamide	16 (23%)	11 (26%)	0.0116	0.124	5 (19%)		0.0212	0.393
5-Fluorouracil	1 (1.4%)	1 (3.7%)	0.556	0.556	0 (0%)		–	–
Iphosphamide	3 (4.3%)	3 (7.0%)	0.027	0.11	0 (0%)		–	–
Gemcitabine	3 (4.3%)	2 (4.7%)	0.0124	0.117	1 (3.7%)		0.0725	0.0725
Etoposide	1 (1.4%)	1 (2.3%)	0.243	0.243	0 (0%)		–	–
Methotrexate	0 (0%)	0 (0%)	–	–	0 (0%)		–	–
Paclitaxel	1 (1.4%)	1 (2.3%)	0.0465	0.0465	0 (0%)		–	–
Docetaxel	0 (0%)	0 (0%)	–	–	0 (0%)		–	–

n = number of samples

min = minimum concentration in samples with quantity above the LOD, in µg/L

max = maximum concentration in samples with quantity above the LOD, in µg/L

Table 4. Calculated weekly exposure to cyclophosphamide on the hands per function type.

Function	Calculated weekly exposure (µg/week)
	Median value (50^th percentile)	10th percentile	90^th percentile	Probability of exceeding 0.74 µg/week
Pharmacy compounding technician	0.053	0.013	0.261	1.4%
Pharmacy technician doing preparatory and checking tasks	0.155	0.032	0.965	13.0%
Cleaner	0.020	0.006	0.081	0.04%