Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study.
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INTRODUCTION: Several studies have shown that exposure to antineoplastic drugs can cause reproductive toxic effects as well as carcinogenic effects. Presence of these drugs in the urine of hospital personnel has been widely studied and some work has been done on exposure by inhalation. So far, assessment of dermal exposure to antineoplastic drugs has not been extensively studied. In this pilot study we assessed potential and actual dermal exposure for several common hospital tasks. Results were used to derive an optimal measurement strategy for a currently ongoing exposure survey. METHODS: Dermal exposure to cyclophosphamide was determined in three Dutch hospitals during five tasks (preparation, decanting urine, washing the patient, removing bed sheets and cleaning the toilet) using pad samples on 10 body locations. In addition, protective medical gloves (worn during the performance of these activities) were collected to estimate potential exposure of the hands. Subsequently, hands were washed to measure actual exposure of the hands. Bulk samples (i.e. application and body fluids) were collected and possible contact surfaces were monitored to assess the amount of cyclophosphamide potentially available for exposure. RESULTS: The results show that hospital personnel (i.e. pharmacy technicians and oncology nurses) are dermally exposed to cyclophosphamide during performance of their daily duties. Exposure occurred predominantly on the hands and sporadically on other body locations (i.e. forehead and forearms). Gloves used during preparation of cyclophosphamide were more contaminated than gloves used in other tasks, however, actual exposure of the hands (underneath the gloves) was highest during decanting of urine of treated patients. Glove samples correlated significantly with handwash samples (r = 0.57, P = 0.03, n = 15). The level of protection from gloves varied between tasks, being highest for gloves used during preparation (median = 98%) and lowest for gloves used during decanting urine (median = 19%). CONCLUSION: This pilot study demonstrated that dermal exposure to cyclophosphamide is common among hospital personnel. The results showed that hands, forearms and forehead accounted for 87% of the cyclophosphamide total body exposure. Glove samples together with handwash samples enabled estimation of glove efficiency, which appeared to vary strongly between tasks observed. (+info)
Determination of dermal exposures during mixing, spraying and wiping activities.
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Dermal exposure measurements were collected as part of RISKOFDERM, a European dermal exposure study which aims to improve the understanding of the nature and range of dermal exposures to hazardous substances throughout the European Union. Exposure measurements were collected to enable a predictive model to be developed for regulatory risk assessment purposes. In this paper dermal exposure data are presented for three generic job tasks: spray painting, wiping surfaces and mixing/dilution of formulations. The particular workplace settings included a dockyard and three medical laboratories. In the dockyard the tasks involved spray application and mixing of anti-foulant paint. For laboratory workers the observed tasks were preparation of biocide solution and wiping of surfaces with the disinfectant. Each dermal exposure measurement was derived from the mass of trace analyte on cotton gloves and 11 fabric patches, which were cut from whole-body dosimeters, representing the main anatomical areas of the body. The percentage mass of trace analyte in the formulation was determined by analysis to enable the total mass of the product on the anatomical areas to be calculated. The sampling periods were recorded to enable calculation of the dermal exposure rate, which is expressed as micro g total formulation/cm(2)/h. The geometric mean dermal exposure rate for the hands during spray painting was 2760 micro g/cm(2)/h (n = 24). The exposure rate for the rest of the body was 175 micro g/cm(2)/h (n = 35). Mixing of the paint involved higher exposure rates for both the hands and body, with a geometric mean of 31 200 micro g/cm(2)/h (n = 9) for the hands and 327 micro g/cm(2)/h (n = 14) for the rest of the body. For small-scale routine disinfection of surfaces using small quantities of biocide the principal anatomical area affected was the hands, with a geometric mean dermal exposure rate of 1840 micro g/cm(2)/h (n = 6). During systematic disinfection of laboratory surfaces with larger quantities of the biocide solution, the geometric mean dermal exposure rate for the hands was increased to 139 000 micro g/cm(2)/h (n = 24). In this case there was increased exposure of the body: principally the arms, legs, chest and head. The measured dermal exposure rate during preparation of the biocides (mixing) was very low, with a geometric mean value for the hands of 13 micro g/cm(2)/h (n = 16). There was a high level of variability observed in the results within each task. It is suggested that dermal exposures are partly dependent on human behaviour and on the occurrence of accidental contact with contaminated surfaces. This makes interpretation of the results difficult for predictive risk assessment purposes. (+info)
Dermal exposure to dry powder spray paints using PXRF and the method of Dirichlet tesselations.
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This paper describes workplace dermal exposure measurements that were carried out by the Health and Safety Laboratory as part of the EU RISKOFDERM project to measure dust contamination. Exposure to dry powder spray paints was measured at five sites on 12 subjects. Twenty-two samples were obtained, of which eight contained triglycidyl isocyanurate (TGIC) and 14 did not. All subjects wore Tyvek whole body oversuits and some wore sampling gloves. These were either analysed in their entirety to extract the TGIC or surface scanned over representative areas using a portable X-ray fluorescence spectrometer (PXRF) to detect barium or titanium in the fillers of the paints. The method of Dirichlet tessellation was used to map the scans and the technique was developed further for these studies to extend measurements to gloves and to take limits of detection into consideration. The PXRF allowed dusts to be measured in situ that would otherwise be difficult to extract from the material and analyse by other means. The geometric mean surface loading rate of the 22 oversuits was 43 micro g/cm/(2)/h (GSD = 6.0) and of the 23 pairs of sampling gloves was 970 micro g/cm(2)/h (GSD = 8.6). Exposure patterns could be attributed to the arrangements of the subjects, spray booths and the workpieces. Similar exposures were found for TGIC and titanium fillers in factories with similar methods of ventilation. (+info)
Blood lead monitoring in a decorative ceramic tiles factory in Singapore.
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INTRODUCTION: To illustrate the lead hazard in the ceramics art industry and the importance of blood lead monitoring and suspension of workers with high blood lead levels. METHODS: Interviews were conducted for workers exposed to the lead hazard from a factory manufacturing decorative ceramic tiles. Serial blood lead levels were taken and measurements of lead-in-air and lead in the bulk samples were conducted. RESULTS: High blood lead levels were observed in four out of 12 workers. Three workers were suspended from further lead exposure and one left the factory. These workers were not aware of the hazards of lead and the importance of good personal hygiene. They were educated on the hazards of lead, the importance of good personal hygiene practices and on the use of the appropriate personal protective equipment. There was an improvement in overall blood lead results in the subsequent months. CONCLUSION: Lead hazard is present in the ceramics art industry and ingestion is probably an important route of absorption. The monitoring of blood lead levels was useful to identify and follow-up workers with high blood lead levels. Suspension of workers from further lead exposure was effective in decreasing the blood lead levels of the workers. (+info)
Unrecognized abrasions and occupational exposures to blood-borne pathogens among health care workers in Turkey.
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AIMS: To evaluate the prevalence of exposures to potentially infective biological material, the use of gloves and the presence and awareness of skin abrasions amongst health care workers (HCWs). METHODS: Analysis of reported exposures during a 12 month period, questionnaire and skin examination by a dermatologist on HCWs at the University Hospital in Duzce, Turkey. RESULTS: Out of 415 HCWs, 278 responded to the questionnaire giving a response rate of 67%. There were 152 potentially infectious exposures reported on the questionnaire. Only 14% (21) of exposures were recorded between October 2001 and October 2002 at the time of the incident. Sharps injuries (57%) were reported most frequently in nurses, while splashes to mucous membranes occurred most frequently in physicians (36%). The operating theatre was the major location of incidents (56%). The frequency of abrasions on the hands was higher in female HCWs (60%) (P < 0.05). Wearing gloves for all procedures was most common in laboratory workers (60%). Abrasions were found on the hands of 142 (51%) of 278 HCWs. Sixteen per cent of the HCWs were unaware of abrasions on their hands. CONCLUSION: There appears to be under-reporting of potentially infectious exposures by HCWs. HCWs are not always aware of abrasions on their hands. This study reinforces the need to report exposures and to use personal protective equipment. (+info)
The management of facial injuries in rugby union.
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BACKGROUND: There are as yet no guidelines in rugby union for the management of facial lacerations which account for one-third of total injuries sustained by players. METHOD: We devised a questionnaire to establish the current standards in rugby union clubs in England. The questionnaire covered such issues as inadequate wound cleansing, inappropriate suture material, the use of sterile suture equipment, and advice required for suture removal. RESULTS: We recommend that a dedicated medical room should be available in all clubs, the doctor should always wear gloves, and local anaesthetic and sterile suture packs and instruments should be provided. (+info)
Critical incidents of nonadherence with standard precautions guidelines among community hospital-based health care workers.
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OBJECTIVE: To identify, categorize, and assess critical incidents of nonadherence to standard precautions. DESIGN: Qualitative and quantitative analysis of a written, mail-out survey. SETTING: Community hospitals. PARTICIPANTS: Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE: Responses to the question: "Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere." RESULTS: Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available. CONCLUSIONS: Using specific information about local incidents of nonadherence to standard precautions may enhance training, especially if the program identifies incidents of unanticipated exposure and helps workers plan for them in the future. Closer examination of job demands and responsibilities that interfere with standard precautions may increase the likelihood of adherence. (+info)
Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants.
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OBJECTIVE: To assess the incidence of late onset (> 72 hours) infection and necrotising enterocolitis (NEC) in very low birthweight (VLBW) infants in two 36 month periods using two hand hygiene protocols: conventional handwashing (HW; first 36 month period); an alcohol hand rub and gloves technique (HR; second 36 month period). METHOD: VLBW infants admitted to the neonatal intensive care unit during the period December 1993-November 1999 were eligible. A new hand hygiene protocol using alcohol handrub and gloves was introduced in December 1996. Each patient's case record was reviewed retrospectively by two independent investigators using a standard data collection form. The incidence of NEC and systemic infections, including bacterial or fungal septicaemia, meningitis, and peritonitis, in the two periods were compared. RESULTS: The HW and HR groups contained 161 and 176 VLBW infants respectively. The incidence of late onset systemic infection decreased from 13.5 to 4.8 episodes (including NEC)/1000 patient days after introduction of the HR regimen, representing a 2.8-fold reduction. Similarly, the incidence of Gram positive, Gram negative, and fungal infections decreased 2.5-fold, 2.6-fold, and 7-fold respectively. There was also a significant reduction in the incidence of NEC in the HR group (p < 0.0001). Subgroup analysis revealed that the incidence of methicillin resistant Staphylococcus aureus (MRSA) septicaemia was significantly decreased in the second 36 month period (p = 0.048). The clinical data suggest that infants in the HW group had significantly earlier onset of sepsis (p < 0.05) and required oxygen supplementation for longer (p < 0.05) than those in the HR group. Significantly more VLBW infants were discharged from the neonatal intensive care unit without ever being infected (p < 0.0001), and also significantly fewer infants had more than one episode of infection in the HR group (p < 0.0001). CONCLUSION: The introduction of the HR protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of MRSA septicaemia and NEC in VLBW infants. This decrease in infection rate was maintained throughout the second 36 month period. (+info)