Anti-cancer Drugs Exposure Evaluation Services

Exposure evaluation are categorized as “Environmental Monitoring” and “Biological Monitoring” (see table 1.) You can use any sample collecting method depending on your purpose of exposure evaluation.

For healthcare personnel, understanding how anti-cancer drugs are taken in their body is important. The following four routes are considered for them to take in anti-cancer drugs.

① Absorption: directly taking anti-cancer drugs on the skin or mucous membrane in the body,
② Injection: erroneously sticking skin with a needle when compounding anti-cancer drugs or blending components,
③ Inhalation: inhaling aerosol generated by anti-cancer drugs, and
④ Oral ingestion: indirectly ingesting anti-cancer drugs when having food or drink using hands contaminated with them.

Examples of potential opportunities of exposure to hazardous drugs are written as follows in “Guidelines of Preventing Occupational Exposure in Cancer Chemotherapy Drugs” * (hereinafter the Guidelines).
*Japanese Society of Cancer Nursing: Guidelines of Preventing Occupational Exposure in Cancer Chemotherapy Drugs, P31, Chapter 2, Background Knowledge and Recommendations・Commentary

• When piercing a vial with a needle or withdrawing it from the vial.
• When moving an anti-cancer drug using a needle or a syringe.
• When cutting an ampoule containing an anti-cancer drug.
• When expelling air from a syringe containing an anti-cancer drug.
• When administrating an anti-cancer drug to a patient.
• When piercing an infusion bag with a needle or changing a tube.
• When leakage occurs in an infusion line or at a connection.
• When disposing of hazardous drugs or waste.
• When handling body fluid (e.g., vomit, blood or feces) of the patient who had the medical treatment within 48 hours.
• When cleaning areas contaminated by anti-cancer drugs.

Doctors who took part in the creation of the Guidelines emphasize the significance of anti-cancer drug monitoring. The Guidelines states that exposure to the hazardous drugs may be diminished if the sources of the exposure are identified by environmental monitoring and appropriately dealt with. The environmental monitoring can be a useful method to decrease the hazardousness of the anti-cancer drugs to personnel. As there are no clear data regarding the clinical impact of contaminated environment on personnel or method of environmental monitoring, periodical environment monitoring is recommended.

The following Statements were made by doctors who took part in the creation of the Guidelines.

1) History

*As for wipe testing and extraction method and other anti-cancer drugs, please contact us.

US Oncology Nursing Society published in 2011 the second version of “Safe Handling of Hazardous Drugs.” Safe handling of hazardous drugs is a must in EU and US. In Japan “Occupational Safety and Health Guideline for health and safety of nurses” was published by Japanese Nursing Association in 2018. This guideline states “Consciousness to industrial health and safety has been recently improving In Japan and secure implementation of methods to prevent exposure to hazardous drugs is expected to maintain healthcare personnel’s health by making work environment safer.” Table 3 lists our services to evaluate your current working environment, when appropriate, using placebo instead of actual anti-cancer drugs.

Contamination levels by anti-cancer drugs were quite different depending on the use of medical closed system equipment or cleanliness of workplaces. Our evaluation results obtained from outpatient chemotherapy rooms and hospital wards between 2013 and 2019 show that gloves worn by nurses are most highly contaminated followed by toilets. The toilets were proven to be contaminated by the splash of patients’ urine.

Exposure evaluation to anti-cancer drugs will enable you to know the current contamination of your work environment and implement appropriate measures against needed locations to lessen the contamination level of your work environment. We sometimes hear from healthcare personnel that exposure evaluation to anti-cancer drugs has led to the mitigation of the occupational contamination. Periodical monitoring has enabled them to evaluate the effectiveness of their approaches against the contaminated environment and keep them under control.
When sole use of medical closed system equipment is not effective enough for outpatient chemotherapy rooms or toilets, you can remove contaminants by our anti-cancer drug decomposition solution.
Shionogi Pharma will continue to support healthcare personnel through monitoring of their workplaces where anti-cancer drugs are handled so that they can work for medical treatment without any concern about their work environment.