Work practice and some adverse health effects in nurses handling antineoplastic drugs.

BACKGROUND: Widespread use of antineoplastic drugs has led to higher health risks of personnel who prepare and administer these drugs. The short-term, non-specific health effects in nurses handling antineoplastic drugs (AND) have been documented. OBJECTIVES: To establish work practices and preventive measures for nurses handling antineoplastic drugs and to determine the risk of developing symptoms. METHODS: In eight Belgrade hospitals, 263 nurses were selected (response rate 90.1%) for the study. Among these, 186 were involved in preparation and administration of AND, and 77 were not exposed. Data on exposure, work practice, safety precautions, and symptoms were obtained via a questionnaire. The mean age of exposed nurses was lower than in a control group (35 vs. 39 yrs). RESULTS: Only 38% of all nurses used vertical laminar safety cabinets while mixing AND, 82% used gloves, and 57% masks. Special medical rooms for mixing AND, written instructions and special containers for waste material were available only sporadically. No exposure monitoring had ever been performed in any hospital or department. Periodic medical check-ups were rare (24.7% of all nurses). In exposed nurses ORs adjusted for age, smoking habit and shift work were significantly elevated for almost all symptoms, mostly for the following: hair loss (OR = 7.14), skin rash (OR = 4.70), and light-headedness (OR = 4.33), as well as the disappearance of symptoms during the weekend (OR = 4.78). The mean number of symptoms revealed an exposure-effect relationship, with the highest number of symptoms in daily exposed nurses and lowest in non-exposed nurses (6.3 vs. 3.1) (p < 0.001). CONCLUSIONS: Our results indicate without doubt that exposed nurses reported more symptoms than non-exposed nurses, an effect that was not dependent on age, smoking, or night shift. The use of safety precautions was inadequate and reflected the lack of awareness of potential hazards due to occupational exposure to AND.

Environmental and biological monitoring in carbon disulfide exposure assessment.

Carbon disulfide (CS2) exposure was assessed in several ways in a viscose fiber plant. Environmental exposure was measured by static area sampling and by personal monitoring using diffusive passive ORSA-5 Draeger badges. At the same time, as biological indicators of exposure the iodine-azide test (IAT) and 2-thiothiazolidine-4-carboxylic acid (TTCA) in urine samples obtained at the end of work shift were performed. The aim was to estimate the relationship between parameters of environmental exposure and biological indicators of internal exposure as well as to determine the influence of the exposure duration on urinary TTCA values. Environmental exposure determined by personal samplers as time-weighted average (TWA) concentrations was twice as high than when measured by static area sampling: 62.2 vs. 31.1 mg/m3 in the spinning rooms, and 18.3 vs 12.2 mg/m3 in the viscose manufacturing departments. The iodine-azide test showed high linear correlation with CS2, but only for very high CS2 values. In highly exposed spinners, higher urinary TTCA levels were found related to longer exposure to CS2, but without statistical significance. For TTCA levels in urine a high correlation coefficient existed, but in this case even for low CS2 levels. Using a linear regression equation, a biological limit value for TTCA which corresponds to the Yugoslav MAC of 30 mg/m3 for CS2 was calculated (9.89 mg/g creatinine) for the study population, which is higher than in other investigations.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of long-term occupational exposure to carbon disulphide on serum lipids.

No definite conclusion can be made from many epidemiological and clinical studies of lipid metabolism in workers exposed to carbon disulphide (CS2). The aim of our investigation was to study the serum lipid levels in workers exposed to different CS2 levels to establish possible exposure-response relationships. The first group, spinners, were exposed to high CS2 levels; the second group, workers in viscose production, to low CS2 levels; and the third group included non-exposed workers. As a part of a large examination, total and free serum cholesterol, total lipid and triglyceride levels were determined. Mean total lipid levels were similar in high and low CS2 exposed workers, but significantly lower in non-exposed workers. The total serum cholesterol mean levels were also similar in both groups, but significantly higher in the non-exposed group. Only serum triglyceride values were related to the CS2 levels: the most elevated were in the high exposed workers, somewhat lower in the low exposed, and the lowest in the non-exposed group. The finding is especially important as triglycerides are the most specific for developing atherosclerosis, which is often reported in workers with long-term exposure to carbon disulphide.