Comparison of management and workers' perception, attitudes and beliefs toward health and safety in the Ontario manufacturing sector.

INTRODUCTION: The Ontario manufacturing sector is over-represented when it comes to workers' compensation claims in the province. A previous study suggested that this may be the result of compliance gaps with respect to the province's occupational health and safety (OHS) legislation. These gaps may be, in part, due to differences in perceptions, attitudes, and beliefs toward OHS between workers and management. This is noteworthy as these two cohorts, when working well together, can foster a healthy and safe work environment. Therefore, this study sought to ascertain the perceptions, attitudes, and beliefs of workers and management with respect to OHS in the Ontario manufacturing sector and to identify differences between the groups, if any. METHODS: A survey was created and disseminated online to get the widest reach across the province as possible. Descriptive statistics were used to present the data and chi-square analyses were performed to determine if there were any statistically significant differences in responses between workers and managers. RESULTS: In total, 3,963 surveys were included in the analysis, which consisted of 2,401 (60.6%) workers and 1,562 (39.4%) managers. Overall, workers were more likely to state that their workplace was 'a bit unsafe' relative to managers and this difference was statistically significant. There were also statistically significant differences between the two cohorts with respect to health and safety communication matters, the perception of safety as a high priority, whether people work safely when unsupervised, and whether control measures are adequate. CONCLUSIONS: In summary, there were differences in perception, attitudes, and beliefs toward OHS between workers and managers in Ontario manufacturing and these differences must be addressed in order to improve the sector's health and safety performance. PRACTICAL APPLICATIONS: Manufacturing workplaces can improve their health and safety performance by strengthening labor-management relationships, including having routine health and safety communication.

Side-by-Side Comparison of Methods for Environmental Monitoring for Hazardous Drug Contamination.

Background: Exposure to hazardous drugs is known to have deleterious effects on health care workers. To assess risk, environmental monitoring is conducted to ascertain drug contamination on surfaces, as dermal contact is the main route of exposure. Conventional monitoring employs wipe sampling whereby the wipe must be sent to a laboratory for analysis. This means that quantitative results are not available for some time, during which the risk remains unknown. A new device, the HD Check system, developed by BD, which uses lateral-flow immunoassay technology, allows for near real-time qualitative assessment of contamination (positive or negative); however, its sensitivity relative to the traditional method is unknown. Objective: To evaluate the ability of this novel device to detect drug contamination relative to the conventional method. Methods: Five sets of different known drug concentrations were compared between the conventional wipe sampling method and the HD Check systems for methotrexate (MTX) and cyclophosphamide (CP). Stainless steel surfaces were tested, and the drug concentrations ranged from 0 ng/cm2 to twice the limit of detection (LOD) of each HD Check system. Results: For MTX, positive results were obtained in every test trial at all drug concentrations examined with the HD Check system (LOD = 0.93 ng/cm2). For CP, test results with the HD Check system (LOD = 4.65 ng/cm2) were all positive at the LOD and twice the LOD; however, at 50% and 75% of the LOD, the result was positive in only 90% (9/10) of the trials. The conventional method was able to quantify the test drug concentrations with a high level of accuracy and reproducibility. Conclusions: These results suggest the potential utility of the novel device as a screening tool for higher levels of drug contamination with MTX and CP, but additional research is needed to determine its suitability for lower concentrations, especially of CP.

Contexte: L'exposition à des médicaments dangereux est connue pour avoir des effets délétères sur les travailleurs de la santé. Pour évaluer les risques, une surveillance environnementale est menée pour vérifier la contamination des surfaces par les médicaments, car le contact cutané est la principale voie d'exposition. La surveillance conventionnelle utilise un échantillonnage par frottis, lequel doit être envoyé à un laboratoire pour analyse. Cela signifie que les résultats quantitatifs ne sont pas disponibles pendant un certain temps ­ temps pendant lequel le risque reste inconnu. Un nouvel appareil, le système HD Check de BD, qui utilise la technologie d'immunodosage à flux latéral, permet une évaluation qualitative en temps quasi réel de la contamination (positive ou négative); cependant, sa sensibilité par rapport à la méthode traditionnelle est inconnue. Objectif: Évaluer la capacité de ce nouveau dispositif pour détecter la contamination médicamenteuse par rapport à la méthode conventionnelle. Méthodes: Cinq ensembles de différentes concentrations connues de médicaments ont été utilisés pour comparer la méthode conventionnelle d'échantillonnage par frottis et les systèmes HD Check pour la méthotrexate (MTX) et la cyclophosphamide (CP). Des surfaces en acier inoxydable ont été testées et les concentrations de médicament variaient de 0 ng/cm2 à deux fois la limite de détection (LD) de chaque système HD Check. Résultats: Pour la MTX, des résultats positifs ont été obtenus dans chaque essai à toutes les concentrations de médicament examinées avec le système HD Check (LD = 0,93 ng/cm2). Pour la CP, les résultats des tests avec le système HD Check (LD = 4,65 ng/cm2) étaient tous positifs à la LD et au double de la LD; cependant, à 50 % et 75 % de la LD, le résultat n'était positif que dans 90 % (9/10) des essais. La méthode conventionnelle a été en mesure de quantifier les concentrations de médicament à l'essai avec un niveau élevé de précision et de reproductibilité. Conclusions: Ces résultats suggèrent l'utilité potentielle du nouveau dispositif comme outil de dépistage pour des niveaux plus élevés de contamination médicamenteuse par la MTX et la CP, mais des recherches supplémentaires sont nécessaires pour déterminer son adéquation à des concentrations plus faibles, en particulier de CP.

Noise exposure assessment of occupational health and safety (OHS) consultants: A preliminary study.

No published noise exposure assessment of occupational health and safety (OHS) consultants exists. An assessment was performed to quantify the noise level of OHS consultants while they were on site at a client's facility. OHS consultants wore a dosimeter set to A-weighting, slow response, 60 s log interval and a criterion level of 85dBA with a 3 dB exchange rate. Both the projected time-weighted average (TWA) and projected dose were recorded. Of the 32 noise assessments collected, three had projected TWAs that exceeded the occupational exposure limit of 85 dBA. Nearly 75% of the projected TWA measurements were equal or greater than the Action Level of 80 dBA. According to best practices, occupational noise levels greater than 80 dBA present a risk for noise-induced hearing loss and, therefore, a hearing loss prevention program should be implemented.

Exploratory study to determine if risk factors for occupational skin disease vary by type of food processing operation.

BACKGROUND: Occupational skin disease (OSD) is a common health issue in the food processing sector. However, risk factors for OSD are suspected to differ according to the nature of the operation. OBJECTIVE: To ascertain if the risk factors for OSD vary depending on the type of food processing operation, namely meat processing vs. a commercial bakery. METHODS: Participants were asked to answer questions regarding workplace exposures and the current skin condition of their hands. Bivariate analyses were conducted to identify differences between the two participating operations. RESULTS: The meat processing workers were more likely to have wet work exposure, used hand sanitizer more often and changed their gloves more frequently. These findings from meat processing represented a statistically significant difference compared to the commercial bakery workers. Also, workers from meat processing reported more severe skin symptoms. CONCLUSIONS: Risk factors for OSD apparently differ between types of food processing operations. Differences in the nature of skin symptoms were also found between the two participating operations. It is therefore suggested that future studies examining OSD within the food processing sector should evaluate this health effect based on the nature of operations rather than the sector as a whole.

Case Study in a Working Environment Highlighting the Divergence between Noise Intensity and Workers' Perception towards Noise.

Excessive noise levels are a prevalent issue in food processing operations and, although there have been numerous studies on occupational noise, no single study has used a concurrent mixed-methods approach. Employing this study design allows for an understanding of the level of convergence (similarity) between measured noise levels and workers' attitudes and perceptions towards noise. This, in turn, allows for the identification of potential challenges with respect to the implementation of hearing conservation efforts. In this study, spot noise measurements were collected using a sound level meter. One-on-one interviews were conducted with workers to determine attitudes and perceptions towards noise in their workplaces. Subsequently, the results of the noise measurements (quantitative data) were integrated with the survey responses (qualitative data) to identify convergence. The majority of the noise measurements were found to exceed 85 dBA-the criterion mandated by the local occupational health and safety legislation. Although all study participants felt that it was noisy in the workplace, a large proportion of respondents indicated that the noise was not bothersome. With workers' perception being contradictory to the measured noise levels, it is a challenge to implement hearing conservation measures unless changes are made to raise the awareness of the risks associated with excessive noise exposure.

The application of novel field measurement and field evaluation protocols for assessing health care workers' exposure risk to antineoplastic drugs.

Contamination of multiple antineoplastic drugs (ADs) on work surfaces presents an exposure concern for health care workers. Surface wipe sampling is a recognized method to evaluate the degree of contamination present. Our research team has previously reported on wipe sampling and analytical methods to simultaneously detect 10 commonly used ADs from a single wipe. Our objectives here were: to field test a protocol consisting of the wipe sampling method and an accompanying wipe sample collection tool kit and confirm this protocol can be effectively used by health care workers to assess drug contamination levels in their facilities; and, to confirm the potential for simultaneous exposure to multiple antineoplastic drugs. Three facilities within one health authority in British Columbia, Canada participated in this field study. In collaboration with the site health and safety advisors, up to 25 surfaces within each facility were considered for sampling. Collected wipe samples were analyzed using HPLC-MS/MS to quantify the 10 analyte, resulting in 750 potential analyses. Following the sampling, each of the three facilities' safety advisors provided feedback regarding the usability of the protocols. Among the 72 wipe samples actually collected (or 720 analyses conducted), detectable levels and simultaneous contamination of work surfaces of five of the 10 analytes were found at all three participating sites: 5-fluorouracil, cyclophosphamide, vincristine, paclitaxel, and methotrexate; (range < LoD to 33.0 ng/cm2) with 5-fluorouracil having the highest concentration in every instance. Drug contamination was found on a variety of different work surfaces in pharmacies and patient care areas among all three sites. Users of the sampling protocols were generally satisfied with the wipe sample collection toolkit with some minor suggestions for improvement. Our findings support the hypothesis that health care workers may be simultaneously at risk of exposure to several ADs. Our toolkit was found to be user-friendly and manageable by those who were not experienced in collecting wipe samples to monitor contamination of ADs on the work surfaces in their facilities.

Emissions and health risks from the use of 3D printers in an occupational setting.

The aim of this study was to determine concentrations of particulates and volatile organic compounds (VOCs) emitted from 3D printers using polylactic acid (PLA) filaments at a university workroom to assess exposure and health risks in an occupational setting. Under typical-case (one printer) and worst-case (three printers operating simultaneously) scenarios, particulate concentration (total and respirable), VOCs and formaldehyde were measured. Air samples were collected in the printing room and adjacent hallway. Size-resolved levels of nano-diameter particles were also collected in the printing room. Total particulate levels were higher in the worst-case scenario (0.7 mg/m3) vs. typical-case scenario (0.3 mg/m3). Respirable particulate and formaldehyde concentrations were similar between the two scenarios. Size-resolved measurements showed that most particles ranged from approximately 27 to 116 nm. Total VOC levels were approximately 6-fold higher during the worst-case scenario vs. typical situation with isopropyl alcohol being the predominant VOC. Airborne concentrations in the hallway were generally lower than inside the printing room. All measurements were below their respective occupational exposure limits. In summary, emissions of particulates and VOCs increased when multiple 3D printers were operating simultaneously. Airborne levels in the adjacent hallway were similar between the two scenarios. Overall, data suggest a low risk of significant and persistent adverse health effects. Nevertheless, the health effects attributed to 3D printing are not fully known and adherence to good hygiene principles is recommended during use of this technology.

Wipe Sampling Method and Evaluation of Environmental Variables for Assessing Surface Contamination of 10 Antineoplastic Drugs by Liquid Chromatography/Tandem Mass Spectrometry.

This paper describes a novel wipe sampling and high-performance liquid chromatography/tandem mass spectrometry (HPLC-MS/MS) method capable of simultaneously detecting 10 antineoplastic drugs (5-fluorouracil, oxaliplatin, methotrexate, vindesine, ifosfamide, cyclophosphamide, vincristine, vinblastine, docetaxel, and paclitaxel). The good overall recoveries and sensitivity values of this method along with the comparatively short run time (8 min) allows for its use in routine monitoring in health care facilities. The long-term behavior of the studied drugs on contaminated surfaces and the effect of surface roughness on drug recoveries were studied to gain insights about how these environmental variables influence the detection, cleaning, and occupational exposure of these drugs. Surfaces with higher roughness parameter (Ra) values (rougher) had the lowest recoveries while those with lower Ra (smoother) presented the highest recoveries. Long-term assessments evidence distinctive drug behaviors with oxaliplatin, vindesine, vincristine, and vinblastine being the less persistent drugs (~20% was recovered after 24 h) and docetaxel and paclitaxel the most persistent drugs with recoveries of 40% and 80% after 1 month. This information indicates the importance of collecting ancillary information about drug usage (throughput, timing, cleaning procedures, etc.) to interpret the results in the context of potential exposure. Finally, the method was successfully applied to evaluate trace surface contamination down to the single picogram per square centimeter in multiple work areas within three local health care centers on Vancouver Island, Canada.

The development and testing of a tool to assess joint health and safety committee functioning and effectiveness.

BACKGROUND: Concern regarding functioning and effectiveness of joint health and safety committees (JHSCs) in Ontario hospitals was raised following the Severe Acute Respiratory Syndrome outbreak in 2003. A subsequent literature review revealed a lack of studies focused within the healthcare sector. METHODS: A tool to measure JHSC effectiveness was developed by a panel of occupational health and safety experts based on a framework from the healthcare sector. Usability testing was conducted in two phases with members of five hospital JHSCs before, during and after a committee meeting. RESULTS: Usability of the tool was scored high overall with an average of > 4 on a 5 point scale across twelve items. Downward adjustment of self-assessment scores was reported following JHSC meetings. CONCLUSION: Findings demonstrated that the tool was easy to use, effective in supporting discussion and in assisting participants in reaching consensus on rating a large number of JHSC characteristics. Am. J. Ind. Med. 60:368-376, 2017. © 2017 Wiley Periodicals, Inc.

Exposure assessment of non-electric ice resurfacer operators in indoor ice rinks: a pilot study.

Exposure of ice resurfacer operators to indoor air contaminants was measured in six indoor ice arenas. A standardized questionnaire on technical and operational features was employed and indoor airborne concentrations of carbon monoxide (CO), carbon dioxide (CO2), nitric oxide (NO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and total volatile organic compounds (VOCs) were measured. Air samples were collected using a range of direct reading instruments attached to the driver's seat of the resurfacer. The range of mean exposure concentrations via positional sampling (i.e. as close as able to the operator's breathing zone) were 5.7-7.4 ppm, 694-2171 ppm, <0.5 to 0.5 ppm, and < 0.1 to 0.2 ppm, for CO, CO2, NO, and NO2, respectively. Exposure levels for SO2 and VOC were below detection. Overall, each of the measured indoor air contaminants was found to be below its respective occupational exposure limits (OEL), suggesting that the risk of hazardous exposure is low. The use of natural gas as a fuel source is believed to contribute to low contaminant concentrations.

Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector.

N95 filtering facepiece respirators are used by healthcare workers when there is a risk of exposure to airborne hazards during aerosol-generating procedures. Respirator fit-testing is required prior to use to ensure that the selected respirator provides an adequate face seal. Two common fit-test methods can be employed: qualitative fit-test (QLFT) or quantitative fit-test (QNFT). Respiratory protection standards deem both fit-tests to be acceptable. However, previous studies have indicated that fit-test results may differ between QLFT and QNFT and that the outcomes may also be influenced by the type of respirator model. The aim of this study was to determine if there is a difference in fit-test outcomes with our suite of respirators, 3M - 1860S, 1860, AND 1870, and whether the model impacts the fit-test results. Subjects were recruited from residential care facilities. Each participant was assigned a respirator and underwent sequential QLFT and QNFT fit-tests and the results (either pass or fail) were recorded. To ascertain the degree of agreement between the two fit-tests, a Kappa (Κ) statistic was conducted as per the American National Standards Institute (ANSI) respiratory protection standard. The pass-fail rates were stratified by respirator model and a Kappa statistic was calculated for each to determine effect of model on fit-test outcomes. We had 619 participants and the aggregate Κ statistic for all respirators was 0.63 which is below the suggested ANSI threshold of 0.70. There was no statistically significant difference in results when stratified by respirator model. QNFT and QLFT produced different fit-test outcomes for the three respirator models examined. The disagreement in outcomes between the two fit-test methods with our suite of N95 filtering facepiece respirators was approximately 12%. Our findings may benefit other healthcare organizations that use these three respirators.

Historical occupational isocyanate exposure levels in two Canadian provinces.

Isocyanates such as toluene 2, 4-diisocyanate (TDI), methylene bisphenyl isocyanate (MDI), and hexamethylene diisocyanate (HDI) are known sensitizers and exposure to these chemicals can result in isocyanate-induced asthma-the leading cause of occupational asthma. A newly created exposure database was available containing occupational isocyanate measurements spanning 1981-1996 from Ontario and British Columbia (BC)-two of the largest provinces in Canada. The aim was to describe the historical measurements relative to exposure thresholds, ascertain differences in the data between provinces, and identify time trends. Descriptive statistics of the observations were summarized and stratified by isocyanate species and province. Chi-square tests and Student's t-test were performed to determine differences between provinces. To investigate time trends in the odds of a measurement exceeding the limit of detection (LOD) and time-weighted average (TWA), mixed effects logistic regression models were constructed. In total, 6,984 isocyanate measurements were analyzed, the majority of which were below the LOD (79%). Overall, 8.3% of samples were in excess of the 2014 TLV-TWA of 0.005 ppm. Comparing the two provinces, the proportion of samples exceeding the LOD and TLV-TWA was greater in BC for all isocyanate species. Differences in time trends were also observed between provinces-the odds of a sample exceeding the TLV-TWA decreased over time in the case of MDI (Ontario only), TDI (both Ontario and BC), and other isocyanates (BC only). Our finding that a majority of the exposure measurements was below the LOD is similar to that reported by others. Differences between provinces may be due the fact that isocyanates are classified as a designated substance in Ontario and must adhere to specific exposure control regulations. Limitations of the database, such as finite number of variables and measurements available until 1996 only, presents challenges for more in-depth analysis and generalization of results. An argument is made that a Canadian occupational exposure database be maintained to facilitate risk assessments as well as for occupational epidemiology research.

Causes of Health Care Workers' Exposure to Antineoplastic Drugs: An Exploratory Study.

BACKGROUND: The exposure of health care workers to antineoplastic drugs is associated with several adverse health effects, including reproductive toxicities and mutagenic effects. Recent studies have confirmed that Canadian health care workers are at risk of exposure to these agents. However, the causes leading to occupational exposure to antineoplastic drugs are unknown. OBJECTIVE: To perform an exploratory study to ascertain the immediate and contributing causes of health care workers' exposure to antineoplastic drugs. METHODS: Participants were recruited from 6 acute care facilities in Vancouver, British Columbia. Those agreeing to participate were asked to complete a questionnaire about previous exposure to antineoplastic drugs while at work and to describe the circumstances of each exposure incident. Responses were qualitatively analyzed, and the causes of each incident were classified as immediate (unsafe work acts and/or unsafe working conditions) or contributing (related to the management of the organization, the environment, and/or the physical and mental status of the worker). RESULTS: Completed questionnaires were received from 120 participants, 18 (15.0%) of whom reported having had previous occupational exposure to antineoplastic drugs. Qualitative analysis of the responses showed 4 categories of immediate causes (needlestick injury, spill, direct contact, and other unintended exposure) and 3 categories of contributing causes (poor communication, inadequate controls, and lack of training). Some incidents had multiple immediate and/or contributing causes. CONCLUSIONS: According to a review of the immediate and contributing causes identified in this study, many of the exposure incidents were deemed preventable. A "hierarchy of controls" should be implemented, including (in the following order) engineering controls, administrative controls, and personal protective equipment. The findings of this study can be used to develop job safety analyses, which can in turn be adopted in guidelines for safe handling of hazardous drugs. Future similar studies are suggested to ensure the generalizability of results.

CONTEXTE: L'exposition des travailleurs de la santé aux antinéoplasiques est associée à plusieurs effets indésirables sur la santé, notamment de la toxicité pour la reproduction et des effets mutagènes. De récentes études ont montré que les travailleurs canadiens de la santé courent le risque d'être exposés à ces agents. Cependant, les causes qui mènent à l'exposition professionnelle aux antinéoplasiques sont inconnues. OBJECTIF: Réaliser une étude préliminaire dans le but de découvrir les causes immédiates et secondaires entraînant l'exposition des travailleurs de la santé aux antinéoplasiques. MÉTHODES: On a recruté des participants auprès de six établissements de soins de courte durée situés à Vancouver en Colombie-Britannique. Ceux qui ont accepté de participer devaient remplir un questionnaire à propos de leurs expositions professionnelles passées aux antinéoplasiques et décrire les circonstances de chacun de ces incidents. Les réponses ont été analysées qualitativement et chaque incident était classé comme de causes : immédiates (gestes dangereux au travail ou conditions de travail dangereuses) ou secondaires (liées à la gestion de l'organisation, de l'environnement ou de l'état physique ou mental du travailleur). RÉSULTATS: Cent vingt participants ont rempli un questionnaire. Parmi eux, 18 (15,0 %) ont signalé avoir déjà subi une exposition professionnelle aux antinéoplasiques. Une analyse qualitative des réponses a montré l'existence de quatre catégories de causes immédiates (piqûre accidentelle avec une aiguille, produit renversé, contact direct et autres expositions non intentionnelles) et de trois catégories de causes secondaires (mauvaise communication, mesures de contrôle inadéquates et manque de formation). Certains incidents avaient plusieurs causes immédiates ou secondaires. CONCLUSIONS: Selon une analyse des différentes causes relevées dans la présente étude, bon nombre des incidents signalés auraient pu être évités. Une « hiérarchisation des contrôles ¼ doit être mise en place. Elle devrait comprendre (dans cet ordre) : des mesures d'ingénierie, des mesures administratives et l'utilisation d'équipement de protection individuelle. Les conclusions de la présente étude peuvent servir à élaborer des analyses de sécurité au travail, qui peuvent à leur tour être intégrées à des lignes directrices pour la manipulation sécuritaire des médicaments dangereux. Il est conseillé de réaliser d'autres études semblables pour s'assurer que les résultats sont généralisables.

A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers.

An effective wipe sampling and LC-MS/MS method was developed to simultaneously analyze six commonly administered antineoplastic drugs in stainless steel surface. The analyzed drugs were methotrexate, paclitaxel, cyclophosphamide, 5-fluorouracil, vincristine, and oxaliplatin, a frequently prepared antineoplastic drug that has not been included among any of the published simultaneous detection methods. The established method was used to evaluate the recoveries of antineoplastic drugs on brand new and worn stainless steel surfaces by wiping the plates with a Whatman filter paper wetted with 0.5 mL of water/methanol (20:80) with 0.1% formic acid followed by LC-MS/MS before desorbing the filter with a water/methanol (50:50) solution. A significant decrease in the recovery of all evaluated drugs was found when worn plates were used. Additionally, the inter-personnel variability on drug recoveries during wiping procedures was evaluated. Significantly higher recoveries were achieved by the personnel with more training and experience versus personnel without prior experience. Finally, a laboratory stability test was developed to assess the degradation of the antineoplastic drugs during replicated shipping conditions. With the exception of vincristine sulfate which exhibited a significant (p < 0.05) degradation after 48 h, all evaluated drugs were stable during the first 24-48 h. However, after 144 h, an increase in the degradation of all evaluated drugs was observed, with oxaliplatin and 5-fluorouracil exhibiting the most degradation.

Corrigendum to "Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe" [Saf Health Work 5 (4) (2014) 169-174].

[This corrects the article DOI: 10.1016/j.shaw.2014.06.001.].

Health Care Workers' Knowledge, Perceptions, and Behaviors Regarding Antineoplastic Drugs: Survey From British Columbia, Canada.

Although nurses are knowledgeable regarding the risk of exposure to antineoplastic drugs, they often do not adhere with safe work practices. However, the knowledge, perceptions, and behavior of other health care job categories at risk of exposure has yet to be determined. This study aimed to survey a range of health care workers from British Columbia, Canada about their knowledge, perceptions, and behaviors regarding antineoplastic drugs. A self-administered questionnaire was sent to participants querying the degree of contact with antineoplastics, knowledge of risks associated with antineoplastics, perceptions of personal risk, previous training with respect to antineoplastics, and safe work practices. Subjects were recruited from health care facilities in and around Vancouver. Fisher's exact tests were performed to ascertain whether there were differences in responses between job categories. We received responses from 120 participants representing seven different job categories. Pharmacists, pharmacy technicians, and nurses were more knowledgeable regarding risks than other job categories examined (statistically significant difference). Although 80% of respondents were not afraid of working with or near antineoplastics, there were concerns about the suitability of current control measures and practices employed by co-workers. Only half of respondents felt confident that they could handle all situations where there was a potential for exposure. Only one of the perception questions, self-perceived risk of exposure to antineoplastic drugs, differed significantly between job categories. Not all respondents always wore gloves when directly handling antineoplastic drugs. Further, hand hygiene was not regularly practiced after glove usage or after being in an area where antineoplastic drugs are handled. The majority of responses to questions related to safe work practices differed significantly between job categories. Our results suggest that knowledge regarding risks associated with antineoplastic drugs can be improved, especially among job categories that are not tasked with drug preparation or drug administration. There is also a gap between knowledge and compliance with glove usage and hand hygiene.Training is also recommended to improve health care workers' perceptions of the risks associated with antineoplastic drugs.

Antineoplastic drug contamination in the urine of Canadian healthcare workers.

PURPOSE: The purpose of this study was to quantify the urine concentration of non-metabolized cyclophosphamide (CP), a commonly administered antineoplastic drug, among potentially exposed Canadian healthcare workers and to identify factors associated with the drug concentration levels. METHODS: Participants were asked to provide two sets of 24-h urine samples (at two different sampling events), and the level of CP was quantified using high-performance liquid chromatography-tandem mass spectrometry. In addition to demographic information, participants were surveyed regarding their frequency of handling of antineoplastic drugs, safe drug handling training, and known contact with CP on their work shift. Descriptive and inferential statistical analyses were performed. A backward stepwise linear mixed effect model was conducted to identify the factors associated with urine concentration levels. RESULTS: We collected 201 urine samples, and 55 % (n = 111) had levels greater than the LOD of 0.05 ng/mL. The mean urinary CP concentration was 0.156 ng/mL, the geometric mean was 0.067 ng/mL, the geometric standard deviation was 3.18, the 75th percentile was 0.129 ng/mL, and the range was

Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe.

We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.

Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system.

We previously reported that antineoplastic drug contamination is found on various work surfaces situated throughout the hospital medication system (process flow of drug within a facility from initial delivery to waste disposal). The presence of drug residual on surfaces suggests that healthcare workers involved in some capacity with the system may be exposed through dermal contact. The purpose of this paper was to determine the dermal contamination levels of healthcare employees working throughout a hospital and to identify factors that may influence dermal contamination. We selected participants from six hospitals and wiped the front and back of workers' hands. Wipe samples were analyzed for cyclophosphamide (CP), a commonly used antineoplastic drug, using high-performance liquid chromatography-tandem mass spectrometry. Participants were asked about their frequency of handling antineoplastic drugs, known contact with CP on their work shift, gender, job title, and safe drug handling training. In addition, participants were surveyed regarding their glove usage and hand washing practices prior to wipe sample collection. We collected a total of 225 wipe samples. Only 20% (N = 44) were above the limit of detection (LOD) of 0.36ng per wipe. The average concentration was 0.36ng per wipe, the geometric mean < LOD, the geometric standard deviation 1.98, and the range < LOD to 22.8ng per wipe. Hospital employees were classified into eight different job categories and all categories had some dermal contamination levels in excess of the LOD. The job category with the highest proportion of samples greater than the LOD were those workers in the drug administration unit who were not responsible for drug administration (volunteer, oncologist, ward aide, dietician). Of note, the highest recorded concentration was from a worker who had no known contact with CP on their work shift. Our results suggest that a broader range of healthcare workers than previously believed, including those that do not directly handle or administer the drugs (e.g. unit clerks, ward aides, dieticians, and shipper/receivers), are at risk of exposure to antineoplastic drugs. A review of control measures to minimize antineoplastic drug exposure that encompasses a wide array of healthcare workers involved with the hospital medication system is recommended.

Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study.

Occupational exposure to antineoplastic drugs has been documented to result in various adverse health effects. Despite the implementation of control measures to minimize exposure, detectable levels of drug residual are still found on hospital work surfaces. Cleaning these surfaces is considered as one means to minimize the exposure potential. However, there are no consistent guiding principles related to cleaning of contaminated surfaces resulting in hospitals to adopt varying practices. As such, this pilot study sought to evaluate current cleaning protocols and identify those factors that were most effective in reducing contamination on drug preparation surfaces. Three cleaning variables were examined: (1) type of cleaning agent (CaviCide®, Phenokil II™, bleach and chlorhexidine), (2) application method of cleaning agent (directly onto surface or indirectly onto a wipe) and (3) use of isopropyl alcohol after cleaning agent application. Known concentrations of antineoplastic drugs (either methotrexate or cyclophosphamide) were placed on a stainless steel swatch and then, systematically, each of the three cleaning variables was tested. Surface wipes were collected and quantified using high-performance liquid chromatography-tandem mass spectrometry to determine the percent residual of drug remaining (with 100% being complete elimination of the drug). No one single cleaning agent proved to be effective in completely eliminating all drug contamination. The method of application had minimal effect on the amount of drug residual. In general, application of isopropyl alcohol after the use of cleaning agent further reduced the level of drug contamination although measureable levels of drug were still found in some cases.