Internal contamination of gloves: routes and consequences.
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The effect of internal glove contamination was investigated using N-methyl pyrrolidone (NMP) as a biological marker to assess systemic absorption when wearing internally contaminated gloves, and when not wearing gloves but subjected to the same challenge contaminant. The routes by which the insides of gloves become contaminated were also investigated. The area of dermal contamination was quantified using a fluorescent tracer dye and a surface monitoring fluorimeter. The main routes of internal glove contamination were found to be self-contamination, cuff entry and failed gloves. Wearing internally contaminated gloves led to higher systemic absorption than was gained from the equivalent skin contamination when not wearing gloves. Repeat wetting of fingers with aqueous NMP, when gloves were not worn, gave higher systemic absorption than the equivalent continuous exposure, probably due to the low volatility of NMP leading to increased concentration and longer residence time on the skin. (+info)
Exposure to antineoplastic drugs in two UK hospital pharmacy units.
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STUDY OBJECTIVES: To carry out an environmental and biological monitoring study in two UK hospital pharmacy units involved in the preparation of antineoplastic drugs. PARTICIPANTS AND METHODS: The two units studied used isolators for drug preparation. One used isolators operating at positive pressure relative to external atmospheric pressure, whereas the other used negative pressure isolators. Monitoring utilized the measurements of methotrexate, ifosfamide, cyclophosphamide and platinum reflecting the platino-coordinated drugs, such as cisplatin and carboplatin. Personal and static atmospheric and floor wipe samples were collected together with preshift and post-shift urine samples over a 4-day consecutive monitoring period. During the study period both units operated to their normal procedures. RESULTS: Measurable amounts of cytotoxic drugs were detected on the floors of both units and on the disposable gloves worn by staff preparing the drugs. There was also evidence in both units of some very low-level drug absorption from urine measurements, using the most sensitive analytical technique of platinum analysis. The absorption of platinum containing drugs in the unit using negative-pressure isolators was significantly higher, even though less platinum containing drug was prepared per day. Urine measurements in both units were below the detection limit for the other measured drugs. Although the unit using positive-pressure isolators handled daily approximately five times the drug quantities handled with the negative pressure unit, the general levels of external contamination and urine measurements did not reflect this difference. Comparison of the relative levels of glove and floor contamination between the two units was not clear-cut and appeared to depend on the specific cytotoxic drug being monitored. CONCLUSIONS: The levels of external contamination on the floor and gloves, and absorbed dose from urine measurements found in this study showed considerable improvement over many earlier, non-UK studies using comparable exposure measurements. These earlier studies were in facilities using laminar flow/microbiological safety cabinets and where staff were likely to be involved in both drug preparation and administration. Our data did not suggest that the differential pressure of the isolator to the pharmacy atmosphere was an overarching factor in the risk of operator exposure under normal operation. There remains a need to investigate the sources of the low-level drug contamination found in the pharmacies even when using isolators to prepare cytotoxic drugs. This study, and related studies of hospital oncology ward staff, appear to be the only recent UK studies of occupational cytotoxic drug exposure using environmental and biological monitoring techniques. (+info)
Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand.
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PURPOSE: Onycholysis and skin toxicity occur in approximately 30% of patients treated with docetaxel. We investigated the efficacy and safety of an Elasto-Gel (84400 APT Cedex, Akromed, France) frozen glove (FG) for the prevention of docetaxel-induced onycholysis and skin toxicity. PATIENTS AND METHODS: Patients receiving docetaxel 75 mg/m2 alone or in combination chemotherapy were eligible for this case-control study. Each patient wore an FG for a total of 90 minutes on the right hand. The left hand was not protected and acted as the control. Onycholysis and skin toxicity were assessed at each cycle by National Cancer Institute Common Toxicity Criteria and documented by photography. Wilcoxon matched-pairs rank test was used. RESULTS: Between August 2002 and September 2003, 45 patients were evaluated. Onycholysis and skin toxicity were significantly lower in the FG-protected hand compared with the control hand (P = .0001). Onycholysis was grade (G) 0 in 89% v 49% and G1 to 2 in 11% v 51% for the FG-protected hand and the control hand, respectively. Skin toxicity was G0 in 73% v 41% and G1 to 2 in 27% v 59% for the FG-protected and the control hand, respectively. Median time to nail and skin toxicity occurrence was not significantly different between the FG-protected and the control hand, respectively (106 v 58 days for nail toxicity; 57 v 58 days for skin toxicity). Five patients (11%) experienced discomfort due to cold intolerance. CONCLUSION: FG significantly reduces the nail and skin toxicity associated with docetaxel and provides a new tool in supportive care management to improve a patient's quality of life. (+info)
Occupational dermal exposure to permanent hair dyes among hairdressers.
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Skin exposure to permanent hair dye compounds was assessed in 33 hairdressers using a previously evaluated hand rinse method. Hand rinse samples were collected from each hand before the start of hair dyeing, after application of the dye and after cutting the newly-dyed hair. Sixteen of the hairdressers did not use gloves during dye application, and none used gloves while cutting the dyed hair. The samples were analysed for pertinent aromatic amines and resorcinol (RES) using an HPLC method. 10 of 54 hair dye mixtures contained 1,4-phenylenediamine (PPD), 40 toluene-2,5-diaminesulphate (TDS), and 44 RES. After application of the hair dye, PPD was found in samples from 4 hairdressers, TDS in 12 and RES in 21. PPD was found in samples from 3 of the 17 hairdressers that used gloves during application of the hair dye, TDS in 5 and RES in 11. In the group that did not use gloves during the application of hair dye (n = 16) PPD was found in samples from 1 hairdresser, TDS in 7 and RES in 11. After cutting the dyed hair, PPD was found in samples from 5 hairdressers, TDS in 14 and RES in 20. Analysis of samples of newly-dyed hair cuttings revealed the presence of aromatic amines and/or RES in 11/12 samples. Our conclusion is that hairdressers' skin is exposed to allergenic compounds during hair dyeing. Exposure occurs from dye application, from cutting newly-dyed hair and from background exposure. The exposure loadings are in the level, where there is a risk of sensitization and/or elicitation of contact allergy (i.e. for PPD 22-939 nmol per hand). The glove use observed in this study was often improper, and was insufficient to prevent exposure. To reduce exposure, improved skin protection and work routines are important. (+info)
Evaluation of antivibration glove test protocols associated with the revision of ISO 10819.
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Effects of modifying the palm adapter geometry on ISO 10819 antivibration glove test results were investigated. 30 rigid acrylic adapters were designed, fabricated, and evaluated. The length of the adapters that met ISO 10819 requirements covered 70-80% of the width of the palm. The upper curvatures of the adaptors were greater than or equal to the radius specified in ISO 10819:1996. Glove vibration transmissibility tests were conducted using a constant velocity vibration input with a value of 0.01 m/s in each third octave frequency band from 16-1,600 Hz (F spectrum). Glove vibration transmissibility results obtained using the M (16-400 Hz) and H (100-1,600 Hz) spectra specified in ISO 10819:1996 were compared to similar results using the constant velocity spectrum. The results obtained from the constant velocity spectrum, when divided into the M and H frequency ranges, were nearly the same as those obtained from the ISO 10819 M and H spectra. Test subject training was required to ensure reliable glove vibration transmissibility results. The measured transmissibility values obtained with the M, H, and F spectra were all higher at the beginning of the test program. The transmissibility values decreased and approached lower limiting values as the test subjects became more experienced. (+info)
A randomised controlled intervention study on prevention of work related skin problems among gut cleaners in swine slaughterhouses.
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AIMS: To evaluate the effect of an intervention to reduce work related skin problems in gut cleaning departments in Danish swine slaughterhouses. The intervention consisted of an evidence based prevention programme and a documented method for implementation. METHODS: Randomised controlled intervention study with a one year follow up. The intervention included educational activities and evidence based recommendations. The effect of the intervention was evaluated by telephone interviews using a standardised questionnaire based on the Nordic Occupational Skin Questionnaire (NOSQ-2002) with modified and additional questions on exposure, preventive measures, information, and discussions on prevention of skin problems, etc. RESULTS: A total of 644 (87.5%) responded at the baseline interview and 622 (71.6%) at the one year follow up interview. A total of 495 participated in both interviews (67.3%). In the intervention departments the frequency of eczema on hands or forearms within the past three months at follow up was reduced significantly from 56.2% at baseline to 41.0% at follow up, while a slight non-significant increase was observed in the comparison departments (from 45.9% to 50.2%). The intervention activities resulted in more frequent use of protective gloves in general and the use of cotton gloves worn underneath rubber and plastic gloves. At follow up three times as many in the intervention departments used the recommended high fat skin care products introduced as part of the intervention activities. At follow up, discussion of skin problems was increased in the intervention group while no changes were observed in the comparison group. CONCLUSIONS: A significant 27% relative reduction of occupational eczema in a high risk group was feasible through implementation of an evidence based prevention programme. (+info)
Environmental contamination with cytotoxic drugs in healthcare using positive air pressure isolators.
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Occupational exposure to cytotoxic drugs of hospital personnel involved in their preparation and administration is a major issue: ever since the introduction of protective measures in recent decades, the handling of these drugs has always been referred to as an occupational health hazard. Isolator technology was one of the protective equipments aimed at providing safe handling, but it has not yet been studied regarding contamination. The present study evaluates surface contamination with four cytotoxic drugs [cyclophosphamide (CP), ifosfamide (IF), 5 fluorouracil (5FU) and methotrexate (MTX)] by wipe sampling in two hospital pharmacies. Wipe samples were taken from work surfaces both located inside and outside the isolators. In addition, working gloves, the surface of infusion bags filled with 5FU or CP, and gloves used in simulation of drug administration were analyzed. Contamination was routinely found inside the isolators but rarely outside the isolators, indicating that the isolator technology is offering good protection of the cytotoxic drug handlers as well as the environment during preparation. On the other hand, contamination was found on the surfaces of infusion bags and gloves in contact with infusion bags filled with cytotoxic drugs. Consequently, personal protective equipment is still recommended during the manipulation and administration of the drugs because of potentially contaminated drug vials and final products. (+info)
Evaluation of the extraction method for the cytotoxicity testing of latex gloves.
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In this study, the cytotoxicity of medical latex gloves to cultured L-929 cells was determined using various extraction conditions. According to the extraction time and temperature, three types of extraction conditions were used: 1) 24 h at 37 degrees C; 2) 72 h at 37 degrees C; 3) 72 h at 50 degrees C. Also, four different extraction vehicles were used, namely, distilled water (DW), 9 g/l sodium chloride (saline) in DW, and culture media with or without serum. Under the above-mentioned conditions, the samples were extracted and then 2-fold serially diluted in the concentration range 3.13 - 50%. When extracted with either DW or saline for 24 h or 72 h at 37 degrees C, only 50% diluted samples showed distinct cytotoxicity to L-929 cells. Moreover, no cytotoxic potentials were observed when gloves were extracted with DW or saline at 50 degrees C for 72 h. Cytotoxicity was markedly greater when gloves were extracted with culture medium, irrespective of the presence of serum in the medium. These results suggest that optimal extraction conditions should be established for the cytotoxicity evaluations of biomaterials and medical devices. (+info)