Association between occupational exposure levels of antineoplastic drugs and work environment in five hospitals in Japan.

PURPOSE: The aim of the present study was to evaluate the measurement of contamination by antineoplastic drugs for safer handling of such drugs by medical workers. We investigated the relationship between the contamination level of antineoplastic drugs and the conditions of their handling. METHODS: Air samples and wipe samples were collected from equipment in the preparation rooms of five hospitals (hospitals A-E). These samples were subjected to measurement of the amounts of cyclophosphamide (CPA), fluorouracil (5FU), gemcitabine (GEM), and platinum-containing drugs (Pt). Twenty-four-hour urine samples were collected from the pharmacists who handled or audited, the antineoplastic drugs were analyzed for CPA and Pt. RESULTS: Pt was detected from air samples inside BSC in hospital B. Antineoplastic drugs were detected from wipe samples of the BSC in hospitals A, B, D, and E and of other equipment in the preparation rooms in hospitals A, B, C, and D. Cyclophosphamide and 5FU were detected from wipe samples of the air-conditioner filter in hospital A, and CPA was detected from that in hospital D. Cyclophosphamide was detected from urine samples of workers in hospitals B, D, and E. CONCLUSION: The contamination level of antineoplastic drugs was suggested to be related with the amount of drugs handled, cleaning methods of the equipment, and the skill level of the technique of maintaining negative pressure inside a vial. In order to reduce the contamination and exposure to antineoplastic drugs in the hospital work environment very close to zero, comprehensive safety precautions, including adequate mixing and cleaning methods was required in addition to BSC and closed system device.

Ortho-phthalaldehyde exposure levels among endoscope disinfection workers.

OBJECTIVES AND METHODS: Recently, the use of ortho-phthalaldehyde (OPA) has been increasing as an alternative to glutaraldehyde for endoscope disinfection. To better understand OPA exposure and its health effects among disinfection workers, we conducted environmental monitoring and administered a questionnaire in 17 endoscope disinfection rooms. There were 9 manual disinfection rooms using immersion vats for scope disinfection and 8 automatic rooms using automatic washers. RESULTS: OPA exposure concentration during the disinfection process of scope was significantly higher in the manual group (median: 1.43ppb, range: not detected (ND-5.37ppb) than in the automatic group (median: 0.35 ppb, range: ND-0.69 ppb). Similarly, during charging and discharging the antiseptic solution, OPA levels were significantly higher in the manual group (median: 2.58 ppb, range: 0.92-10.0 ppb) than in the automatic group (median: 0.46ppb, range: ND-1.35 ppb). Time-weighted averages of OPA exposure concentration during work shifts were 0.33 to 1.15 ppb (median 0.66 ppb) in the manual group and 0.13 to 1.28 ppb (median 0.33 ppb) in the automatic group, which suggests that manual workers are exposed to OPA at higher levels. Among 80 female disinfection workers who used only antiseptic solutions containing OPA, the incidence of disinfection-related complaints were 10% skin, 9% eye, and 16% respiratory symptoms. CONCLUSIONS: These findings suggest that it is desirable to introduce automatic washers to decrease OPA exposure levels among disinfection workers.

[Occupational health of endoscope sterilization workers in medical institutions in Osaka Prefecture].

To clarify the actual condition of endoscope sterilization work and the adverse health effects of disinfectants on personnel, a questionnaire was sent to 173 medical institutions in Osaka Prefecture. Glutaraldehyde (GA), ortho-phtalaldehyde (OPA), and hyperacetic acid were used as disinfectants of endoscopes by 55.5%, 32.4%, and 8.7% of the medical institutions respectively. The kind of disinfectant used had been changed in 57.8% of these institutions during the past five years, and it was confirmed that the use of substitutes for GA, such as OPA and hyperacetic acid, has increased. Personnel in 35.8% of the institutions complained about symptoms during sterilization work. The kind of disinfectant being used when they complained was GA in many cases and OPA in others. A general ventilation system has now been installed in 72.3% of the institutions; local exhaust systems have been installed in fewer, only 23.4%. Protective gloves were used at about half of the institutions, but protective masks and glasses were seldom used. This study shows that the occupational health problems of endoscope sterilization work have not been resolved. Consequently, it is necessary to promote the installation of ventilation systems and the use of protective devices in all institutions. Health education in regard to the handling of disinfectants is also necessary. Because little information is available about the toxic effects of OPA and hyperacetic acid, epidemiological studies must be conducted to clarify the human health effect of these disinfectants.

[Load on the low back of care workers in nursing homes for the elderly].

In order to evaluate the load on the low back of care workers in nursing homes for the elderly, basic activities and working postures were analyzed for six care workers using the 30-s snap reading method. The trunk inclination angle (TIA) was also measured continuously using an inclination monitor. The analysis of basic activities showed that 22.5% and 21.1% of the workshift were spent on 'bathing and ablution' and 'meal', respectively, and 9.3%, 8.7% and 8.3% were spent on 'assistance with elimination', 'assistance with moving and repositioning' and 'exchange of bed sheet', respectively. Total of the assistance activity was 43.7% of the workshift. The analysis of working posture showed that 'standing' and 'standing bent forward' accounted for 36.1% and 29.5%, respectively, of the workshift. Total of three postures loading the low back ('standing bent forward', 'squatting', 'kneeling') accounted for 39.0%. The time spent in TIA of 20 degrees or more was 45.7%. The postures loading the low back during 'bathing and ablution', 'exchange of bed sheet' and 'assistance with elimination' account for 68.3%, 58.2% and 49.6%, respectively, which suggests that these activities load the low back of the care workers considerably.