Exposure of hospital pharmacists and nurses to antineoplastic agents

Adverse effects of antineoplastic drug exposure have been well documented in therapeutically treated patients and proposed as a potential hazard for occupationally exposed populations. Concern stems from accrued evidence of mutagenicity, carcinogenicity, and teratogenicity of many of these drugs. While the clinical significance of occupational exposure is controversial, OSHA issued handling guidelines for these agents in 1986, principally suggesting usage of a vertical laminar airflow biological safety cabinet and good work practices. Industrial hygiene measures of workplace antineoplastic exposure have been few and are limited to air sampling, addressing only the inhalation exposure route. We report here air and surface cyclophosphamide sampling results in a hospital oncology pharmacy and outpatient clinic where OSHA guidelines are in place. Results reveal rare air samples with detectable cyclophosphamide, but multiple surface wipe samples with measurable cyclophosphamide concentrations. Occupational health personnel, therefore, must consider work practices as determinants of surface contamination and recognize the potential importance of dermal and ingestion routes of exposure.