Analytical strategies for assessing occupational exposure to antineoplastic drugs in healthcare workplaces.

BACKGROUND: Cytotoxic antineoplastic drugs (ADs), widely used in treating cancer, are considered hazardous in the workplace and thus require safe handling practices. An analytical protocol for environmental and biological AD monitoring in the healthcare environment has been developed, since Europe lacks clear guidelines and regulations for cytostatic preparation and handling. MATERIAL AND METHODS: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used for measuring contemporaneously 20 multi-class cytostatic compounds and urinary α-fluoro-ß-alanine, whereas platinum was detected by inductively coupled plasma mass spectrometry (ICP-MS). Sampling procedures and analytical conditions were optimized and the assays were validated. Environmental AD monitoring data, collected in 2009-2017, for a total of 3749 wipe tests and 57 720 determinations, was evaluated. RESULTS: The proportion of positive samples gradually decreased from 11.7% in 2010 to 1% in 2017, however, 2266 determinations were positive. No urine sample had detectable concentrations of any of the 4 drugs considered (0/398 samples). CONCLUSIONS: These improvements are so large that the key role played by the new, more stringent rules for preparing and administering ADs is evident. Hence, the analytical method involving multi-element determinations allows for a more thorough and complete investigation into the AD contamination of work environments. Med Pr 2018;69(6):589-604.

[Burn-out in the human service professions: four experiences]. / Curare brucia: quattro esperienze a confronto.

Human work is never exclusively a pure goods production but include the structuring of relevant dimensions such as identity, interrelationship, sense creation and this is specifically true in the domain of health care. In spite of technological improvement, still today healthcare workers represents the very technological instrument. The paper refers the results of the study carried out in four geographical different health environments to evaluate the relative importance of individual and organizational factors. In spite of the differences observed the relational dimension appears a fundamental necessity for almost all workers but more specifically for the nursing personnel as well as the need of a case manager expert.

A new approach to assessing occupational exposure to antineoplastic drugs in hospital environments.

Cytotoxic antineoplastic drugs (ADs) pose occupational risk and therefore require safe handling practices. We created, optimised, and validated an innovative monitoring protocol for simultaneously assessing 21 ADs in the healthcare environment, and also proposed surface exposure levels (SELs) to facilitate the interpretation of monitoring results, as there are currently no occupational exposure limits for ADs. The environmental AD monitoring data were collected in nine Italian hospitals between 2008 and 2017 and include 74,565 measurements in 4,814 wipe samples. Excellent overall recovery and sensitivity of the analytical methods along with innovative desorption automation make this protocol useful for routine monitoring. AD contamination was found in 3,081 measurements, confirming potential exposure in healthcare workers. Samples taken at the beginning and the end of work shifts, allowed to calculate 75th and 90th percentile values for each ADs both in preparation and administration units and we created a traffic-light colour-coding system to facilitate interpretation of the findings. The introduction of SELs will provide a solid basis for improving occupational safety and focusing on contamination control.

Gas chromatographic determination of glutaraldehyde in the workplace atmosphere after derivatization with 0-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine on a solid-phase microextraction fibre.

Glutaraldehyde is used primarily in hospital environments for the disinfection of various instruments (e.g., endoscopes). We describe in this paper the measurement of glutaraldehyde in a hospital environment using solid-phase microextraction. The method includes, prior to sampling, the adsorption of O-(2,3,4,5,6-pentafluorobenzyl)hydroxylamine on to the fibre (with polydimethylsiloxane-divinylbenzene). The fibre is then exposed to air, after which desorption is performed in the GC injection port. This process results in the formation of a stable derivative of the glutaraldehyde that is suitable for chromatographic purposes and detectable with classical detection methods, such as flame ionisation and electron-capture detection. We demonstrate that the procedure of adsorption, thermal desorption and derivatization is robust and reproducible. We were able to detect concentrations of 60 microg/m3 (10 s sampling) or 6 microg/m3 (120 s sampling) by electron-capture detection, and 80 microg/m3 (120 s sampling) by flame ionisation detection. We compared our method to currently existing methods of glutaraldehyde measurement and highlighted several important advantages of the method.

Air monitoring and assessment of occupational exposure to peracetic acid in a hospital environment.

A new automated method based upon solid phase micro-extraction (SPME)/fast gas chromatography-mass spectrometry (GC-MS) was developed for the quantitative determination of airborne peracetic acid (PAA). The method is suitable for the quick assessment of brief acute exposure as well as for long-term environmental monitoring of PAA and can assist in improving safety and environmental quality in workplaces where disinfectants are used. During a monitoring campaign in the Regional Hospital of Florence, Italy, the 8-h average air concentration of PAA was 1/10 of the threshold limit value of time weighted average in 87% of the clinical units tested. However, the application of the new SPME method showed that short-term exposure to PAA could be relatively elevated in some hospital units with poor ventilation, allowing prompt intervention in order to reduce worker exposure to this potentially toxic compound.

Determination of organic acids in urine by solid-phase microextraction and gas chromatography-ion trap tandem mass spectrometry previous 'in sample' derivatization with trimethyloxonium tetrafluoroborate.

A method for the determination of the organic acids directly in the urine employing derivatization with trimethyloxonium tetrafluoroborate as a methylating agent and sequential extraction by head space and direct immersion/solid phase microextraction is reported. Furoic acid, hippuric acid, methylhippuric acid, mandelic acid, phenylglyoxylic acid and trans, trans muconic acid contained in urine and proposed by the American Conference of Governmental Industrial Hygienists as biological exposure indices were determined after a fast and economically convenient preparation step and sensitive gas chromatography-ion trap-mass spectrometry/tandem mass spectrometry analysis. Urine is rather a complex sample and hence the acquisition method required specific GC-MS instrumentation capable of supporting the changeover, fully automated during a single chromatographic separation, from mass to tandem mass spectrometry and both chemical and electron ionization modes. The automation of the analytical method provides a number of advantages, including reduced analysis time for both routine analysis and method development, and greater reproducibility. The equilibrium and kinetics of this substances vs head space/direct immersion-solid phase microextraction were investigated and evaluated theoretically.