Health Hazard Evaluation Report: HETA-2013-0019-3205, March 2014. Evaluation of Chemotherapy Drug Exposure in an Outpatient Infusion Center.

摘要

The Health Hazard Evaluation Program received a request from a regional hospital. The employer was concerned about health symptoms (burning and itchy eyes, itchy skin, hair loss, and metallic taste in the mouth) among outpatient cancer and infusion center employees working with or around chemotherapy drugs. The center employed 10 clinical and administrative staff who typically treated about 4 patients per day. During our visit we talked to employees about their work and health concerns; observed how they received, stored, administered, and disposed chemotherapy drugs; took samples from work surfaces to look for chemotherapy drugs; and evaluated the airflow direction in the center and in an isolator cabinet. Additionally, we reviewed workplace injury and illness logs and employee health records, environmental sampling and inspection reports, training documents, and standard operating procedures for handling hazardous drugs. We found low but detectable levels of chemotherapy drugs in surface wipe samples collected throughout the center, including one drug not in use during our visit. During interviews and as recorded by medical surveillance, staff reported mucous membrane irritation, nausea, metallic taste, and intermittent tiredness. Although we cannot definitively link the symptoms to chemotherapy drug exposures, many were consistent with what is reported in the literature and in other settings where chemotherapy drugs are handled. In our interviews, employees reported inconsistent personal protective equipment use. We noted that procedures for handling hazardous drugs did not apply to all personnel who are exposed to chemotherapy drugs and procedures for proper storage, routine housekeeping, medical surveillance, and the hazardous drug list were incomplete. Air from the pharmacy was not being drawn into the pass-through chamber on the isolator cabinet, as employees believed.