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Antineoplastic drug contamination in the urine of Canadian healthcare workers

  • Original Article
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International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

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 <LOD to 2.37 ng/mL. All eight job categories evaluated had some urinary concentrations in excess of the LOD with unit clerks having the highest average level. Workers who worked in the drug administration unit, but were not responsible for administering the drugs to patients, i.e., volunteers, oncologists, ward aides, and dieticians, had the largest proportion of samples exceeding the LOD. We did not find any correlation between the urinary concentration levels and known contact with CP during the work shift. Two factors were found to be significantly associated with urinary CP concentration: (1) Workers who had a duty to handle antineoplastic drugs had higher concentration levels, and (2) workers who had not received safe drug handling training had higher levels of CP in their urine compared with those who had.

Conclusions

The presence of non-metabolized CP in urine confirms that, despite the existence of control measures, a broad range of healthcare workers are at risk of exposure to antineoplastic drugs. A review of the effectiveness of interventions to reduce exposure is warranted and should apply to all healthcare workers involved in some capacity with the hospital medication system. This study identified two factors that are related to the urine CP concentration levels which can serve as an impetus for reducing exposure.

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Notes

  1. If duplicate response varied by more than 10 %, the batch was re-analyzed to see whether the instrument was an issue or the extraction. Some samples were re-run and the resulting concentrations were used for this study.

  2. Assumed that “day” is equivalent to 24 h.

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Acknowledgments

The authors would like to thank the WorkSafeBC Research Secretariat for funding this Project (RS2008-OG01). We also appreciate the time and cooperation of all participants and their respective facilities. We would like to recognize the assistance of the Dr. Winnie Chu from University of British Columbia who led the team responsible for sample analyses. We would like to acknowledge Jennifer Shum, Pearl Siganporia, and Sarah Chiarello who helped with sample collection efforts.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Chun-Yip Hon, Kay Teschke & Hui Shen

  2. School of Occupational and Public Health, Ryerson University, Toronto, ON, Canada

    Chun-Yip Hon

  3. Occupational Cancer Research Centre, Cancer Care Ontario, Toronto, ON, Canada

    Paul A. Demers

  4. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Paul A. Demers

  5. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Scott Venners

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  1. Chun-Yip Hon
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  2. Kay Teschke
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  4. Paul A. Demers
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Correspondence to Chun-Yip Hon.

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Hon, CY., Teschke, K., Shen, H. et al. Antineoplastic drug contamination in the urine of Canadian healthcare workers. Int Arch Occup Environ Health 88, 933–941 (2015). https://doi.org/10.1007/s00420-015-1026-1

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  • DOI: https://doi.org/10.1007/s00420-015-1026-1

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