Surveillance urinaire des professionnels de la sante exposes aux antineoplasiques dans le cadre de leur travail: revue de la litterature de 2010 a 2015

摘要

Background: There is increasing evidence that traces of hazardous drugs occur in the urine of health care professionals who are exposed to these drugs. Objective: To review the scientific literature regarding urinary monitoring of health care professionals exposed to antineoplastic drugs through their work. Data Sources: A search of PubMed using the Medical Subject Headings "occupational exposure" and "antineoplastic agents" and of Google Scholar using the terms "antineoplastic", "urine", and "occupational exposure". Study Selection and Data Extraction: The analysis covered all articles in English or French pertaining to health care professionals exposed to hazardous drugs in the workplace, published from January 1, 2010, to December 31,2015. Articles that did not discuss the results of urine tests and those concerning veterinarians, as well as literature reviews, editorials, letters to the editor, and conference abstracts, were excluded. Data Synthesis: Twenty-four articles were retained. The studies were conducted in 52 health care institutions in 7 countries. They included 826 workers exposed to hazardous drugs and 175 controls, specifically nurses (n = 16 studies), pharmacists (n = 10), pharmacy technicians (n = 8), physicians (n = 7), health care aides (n = 2), and others (n = 8). Various analytical methods were used to quantify the presence of 13 hazardous drugs, primarily cyclophosphamide (n = 16 studies), platinum-based drugs (n = 7), and alpha-fluoro-beta-alanine, a urine metabolite derived from 5-fluorouracil (n = 3). The proportion of workers with positive results ranged from 0% (n = 10 studies) to 100% (n = 4). Considering only those studies that allowed calculation of the rate of workers with at least one positive urine sample (n = 23), the total proportion was 21% (173/809 workers, for all methods and drugs combined). Conclusion: Twenty-four studies on urine monitoring were conducted in 7 countries between 2010 and 2015. In several studies, no traces of drugs were detected in urine.