Assessment of potential exposure to antineoplastic agents in the health care setting

In response to reports of measurable air levels of antineoplastic agents in hospitals and preliminary evidence of exposure to personnel handling these agents, a survey was designed and conducted to document the current handling practices of injectable antineoplastic drugs by hospital and health care workers at two major teaching hospitals and three affiliated community hospitals. The survey included assessment of drug preparation, administration, and disposal. A sample of nurses, pharmacists, physicians, and other staff who routinely come in contact with these drugs was interviewed for validation of the observed results. Typical working conditions encountered and the potential numbers of people at risk and their job titles are presented here. Drug preparation facilities and methods were not uniform even within a single institution, including local preparation in the pharmacy under controlled or uncontrolled conditions, as well as individual drug preparation and administration on the hospital floors. Handling practices for drug preparation were not consistent from practitioner to practitioner. In some cases, where laboratory coats and disposable gloves were provided, it was not a routine practice to wear them. Based on such analysis of risk factors, recommendations for improved practices are given.