Occupational exposure to antineoplastic drugs: what about hospital sanitation personnel?

OBJECTIVE: Occupational exposure to antineoplastic drugs (ANPs) occurs mainly through dermal contact. Our study was set up to assess the potential exposure of hospital sanitation (HS) personnel, for whom almost no data are available, through contamination of surfaces they regularly touch. METHODS: In the oncology departments of two hospitals around Montreal, surface wipe samples of 120-2000 cm2 were taken at 10 sites cleaned by the HS personnel and five other sites frequently touched by nursing and pharmacy personnel. A few hand wipe samples were collected to explore skin contamination. Wipes were analyzed by ultra-performance liquid chromatography tandem-mass spectrometry for 10 ANPs. RESULTS: Overall, 60.9% of 212 surface samples presented at least one ANP above the limits of detection (LOD). Cyclophosphamide and gemcitabine were most often detected (52% and 31% of samples respectively), followed by 5-fluorouracil and irinotecan (15% each). Highest concentrations of five ANPs were found in outpatient clinics on toilet floors (5-fluorouracil, 49 ng/cm2; irinotecan, 3.6 ng/cm2), a perfusion pump (cyclophosphamide, 19.6 ng/cm2) and on a cytotoxic waste bin cover (gemcitabine, 4.97 ng/cm2). Floors in patient rooms had highest levels of cytarabine (0.12 ng/cm2) and methotrexate (6.38 ng/cm2). Hand wipes were positive for two of 12 samples taken on HS personnel, seven of 18 samples on nurses, and two of 14 samples on pharmacy personnel. CONCLUSIONS: A notable proportion of surfaces showed measurable levels of ANPs, with highest concentrations found on surfaces cleaned by HS personnel, who would benefit from appropriate preventive training. As potential sources of worker exposure, several hospital surfaces need to be regularly monitored to evaluate environmental contamination and efficacy of cleaning.

Risk analysis for confined space entries: Critical analysis of four tools applied to three risk scenarios.

Investigation reports of fatal confined space accidents nearly always point to a problem of identifying or underestimating risks. This paper compares 4 different risk analysis tools developed for confined spaces by applying them to 3 hazardous scenarios. The tools were namely 1. a checklist without risk estimation (Tool A), 2. a checklist with a risk scale (Tool B), 3. a risk calculation without a formal hazard identification stage (Tool C), and 4. a questionnaire followed by a risk matrix (Tool D). Each tool's structure and practical application were studied. Tools A and B gave crude results comparable to those of more analytic tools in less time. Their main limitations were lack of contextual information for the identified hazards and greater dependency on the user's expertise and ability to tackle hazards of different nature. Tools C and D utilized more systematic approaches than tools A and B by supporting risk reduction based on the description of the risk factors. Tool D is distinctive because of 1. its comprehensive structure with respect to the steps suggested in risk management, 2. its dynamic approach to hazard identification, and 3. its use of data resulting from the risk analysis.

Estimating occupational exposure to carcinogens in Quebec.

BACKGROUND: We estimated the extent of exposure to occupational carcinogens in Quebec, Canada, to help raise awareness of occupational cancers. METHODS: Proportions of workers exposed to 21 recognized and 17 probable carcinogens (according to Quebec occupational health regulation and the International Agency for Research on Cancer [IARC] classification) were extracted from various sources: workplace monitoring data, research projects, a population survey, radiation protection data, exposure estimates from the Carcinogen Exposure Canada (CAREX Canada) Project database, and published exposure data. These proportions were applied to Quebec labor force data. RESULTS: Among the 38 studied, carcinogens with the largest proportions of exposed workers were solar radiation (6.6% of workers), night shift work/rotating shift work including nights (6.0%), diesel exhaust fumes (4.4%), wood dust (2.9%) and polycyclic aromatic hydrocarbons (2.0%). More than 15 carcinogens were identified in several industrial sectors, and up to 100,000 young workers are employed in these sectors. CONCLUSION: Although crude, estimates obtained with different data sources allow identification of research and intervention priorities for cancer in Quebec.

Occupational health and safety, metal exposures and multi-exposures health risk in Canadian electronic waste recycling facilities.

Electronic waste recycling (e-recycling) involves manual operations that expose workers to toxic metals. We aim to describe occupational health and safety practices and workers' exposures to metals in the Canadian formal e-recycling industry, and to estimate the health risk associated with multiple exposures. This cross-sectional study documented practices through observations and questionnaires, and assessed metal exposures using personal air samples and biomarkers. Health risks were estimated relative to recognised occupational exposure guidelines, and using an additive approach for consideration of multiple exposures. Six e-recycling and one commercial recycling facilities were investigated, and the metal exposures of 99 workers (23 women) were measured. In most facilities, dust control was inadequate and personal protective equipment was improperly worn. In e-recycling, lead was detected in all air samples and in most blood samples, up to 48 µg/m3 and 136 µg/l, respectively. Other quantified metals included beryllium, mercury, arsenic, barium, cadmium, chrome, cobalt, copper, indium, manganese, nickel and yttrium. When handling cathode ray tube screens, workers were 4.9 times and 8.5 times more likely to be exposed to lead and yttrium, respectively, than workers who were not assigned to a specific type of electronics. Overall, exposures were largely associated with facility size and airborne dust concentration. The additive hazard indices for airborne exposures raised concerns for kidney disorders, for peripheral and central nervous systems, and for the male reproductive system. Minimizing airborne dust through collective control methods and adequately using personal protection should reduce metal exposures and associated health risks in this growing industry.

Characterization and Quantification of Ultrafine Particles and Carbonaceous Components from Occupational Exposures to Diesel Particulate Matter in Selected Workplaces.

Questions still exist regarding which indicator better estimates worker's exposure to diesel particulate matter (DPM) and, especially for ultrafine particles (UFP), how exposure levels and the characteristics of the particles vary in workplaces with different exposure conditions. This study aimed to quantify and characterize DPM exposures in three workplaces with different exposure levels: an underground mine, a subway tunnel, and a truck repair workshop. The same sampling strategy was used and included measurements of the particle number concentration (PNC), mass concentration, size distribution, transmission electron microscopy (TEM), and the characterization of carbonaceous fractions. The highest geometric means (GMs) of PNC and elemental carbon (EC) were measured in the mine [134 000 (geometric standard deviation, GSD = 1.5) particles cm-3 and 125 (GSD = 2.1) µg m-3], followed by the tunnel [32 800 (GSD = 1.7) particles cm-3 and 24.7 (GSD = 2.4) µg m-3], and the truck workshop [22 700 (GSD = 1.3) particles cm-3 and 2.7 (GSD = 2.4) µg m-3]. This gradient of exposure was also observed for total carbon (TC) and particulate matter. The TC/EC ratio was 1.4 in the mine, 2.5 in the tunnel and 8.7 in the workshop, indicating important organic carbon interference in the non-mining workplaces. EC and PNC were strongly correlated in the tunnel (r = 0.85; P < 0.01) and the workshop (r = 0.91; P < 0.001), but a moderate correlation was observed in the mine (r = 0.57; P < 0.05). Results from TEM showed individual carbon spheres between 10 and 56.5 nm organized in agglomerates, while results from the size distribution profiles showed bimodal distributions with a larger accumulation mode in the mine (93 nm) compared with the tunnel (39 nm) and the truck workshop (34 nm). In conclusion, the composition of the carbonaceous fraction varies according to the workplace, and can interfere with DPM estimation when TC is used as indicator. Also, the dominance of particles <100 nm in all workplaces, the high levels of PNC measured and the good correlation with EC suggest that UFP exposures should receive more attention on occupational routine measurements and regulations.

Multi-exposures to suspected endocrine disruptors in electronic waste recycling workers: Associations with thyroid and reproductive hormones.

Electronic waste recycling (e-recycling) exposes workers to substances such as flame retardants and metals. Some of them are known or suspected endocrine disruptors that could affect hormonal homeostasis and eventually result in adverse health outcomes. Our aim was to measure biological concentrations of organophosphate ester (OPE) metabolites, polybrominated diphenyl ethers (PBDEs), mercury, lead and cadmium in e-recycling workers, and to explore associations with thyroid and sexual hormones. In a cross-sectional study, end-of-shift blood and urine spot samples were collected from 23 women and 77 men in six e-recycling facilities and one commercial recycling facility. Urinary concentrations of 15 OPE metabolites and mercury, and blood concentrations of 12 PBDE congeners, lead, cadmium, and thyroid (thyroxine [T4], triiodothyronine [T3], thyroid stimulating hormone [TSH]) and sexual (testosterone [T], estradiol, Follicle Stimulating Hormone [FSH], Luteinizing hormone [LH]) hormones were measured. E-recycling workers had higher concentrations of BDE209, all OPE metabolites, and lead than commercial recycling workers. In e-recycling workers, plasma geometric mean concentration of BDE209 was 18 ng/g lipids (geometric standard deviation [GSD]: 2.8) vs.1.7 ng/g lipids (GSD: 2.8) in commercial recycling, and urinary geometric mean concentration of diphenyl phosphate (DPhP), a major metabolite of triphenyl phosphate, was 1.7 ng/ml (GSD: 2.5), vs. 0.95 ng/ml (GSD: 2.0). In men, a two-fold increase in BDE209 was associated with 3.1% (95% Confidence interval: 0.07, 6.1) higher levels of total T4, and a two-fold increase in tert-butyl diphenyl phosphate (tb-DPhP) was associated with 18% (-29, -4.7) lower total T, 18% (-27, -6.9) lower free T and 13% (-25, 0.70) lower free T/estradiol ratio. In women, a two-fold increase in BDE153 was associated with 10% (-17, -3.2) lower free T3. To our knowledge, this is the first study to show associations between OPE metabolites and sex hormones in adults. Although some of our results are not conclusive and need replication, they suggest that prudent avoidance should be applied in risk management of flame retardants.

Halogenated flame retardants and organophosphate esters in the air of electronic waste recycling facilities: Evidence of high concentrations and multiple exposures.

BACKGROUND: In response to a worldwide increase in production of electronic waste, the e-recycling industry is rapidly rowing. E-recycling workers are exposed to many potentially toxic contaminants, among which flame retardants (FRs), mainly suspected of being endocrine disruptors, are thought to be the most prevalent. OBJECTIVE: To conduct an exposure assessment of four chemical groups of FRs in Canadian e-recycling facilities, and to identify the main cofactors of exposure. METHODS: Personal air samples were collected over a workday for 85 workers in six e-recycling facilities, grouped into three facility sizes, and for 15 workers in control commercial waste facilities. Total particulate matter was measured by gravimetry with stationary air samples. FRs were collected on OSHA versatile samplers, which allow particulate and vapor phases collection. Fifteen polybrominated diphenyl ether congeners (PBDEs), nine novel brominated (NBFRs), two chlorinated (ClFRs), and fourteen organophosphate ester (OPEs) flame retardants were analysed by gas chromatography-mass spectrometry. Sociodemographic data, tasks performed and materials processed by participating workers were recorded. Tobit regressions were used to identify cofactors of exposure, and their conclusions were corroborated using semi-parametric reverse Cox regressions. RESULTS: Thirty-nine of the 40 FRs analysed were detected in at least one air sample in e-recycling, and workers in this industry were exposed on average to 26 (range 12 to 39) different substances. The most detected chemical group of FRs in e-recycling was PBDEs with geometric mean sums of all congeners ranging from 120 to 5100 ng/m3, followed by OPEs with 740 to 1000 ng/m3, NBFRs with 7.6 to 100 ng/m3, and finally ClFRs with 3.9 to 32 mg/m3. The most important cofactor of exposure was the size of the e-recycling facility, with the largest one presenting on average 12 times the concentrations found in the control facility. Among tasks as potential cofactors of exposure, manual dismantling and baler operation exposed workers to some of the highest concentrations of PBDEs and ClFRs. There was a reduction of up to 27% in exposure to FRs associated with a 3-year increase in seniority. Finally, particulate matter concentrations in e-recycling facilities were highly correlated with all chemical classes except OPEs, and were higher in the large facility. CONCLUSIONS: Among the FRs analysed, PBDE exposure was particularly high in e-recycling. Dust and particulate matter reduction strategies in these workplaces, together with training on proper working practices would certainly be important first steps to lower occupational exposures and prevent potential health effects.

Cross-sensitivities of electrochemical detectors used to monitor worker exposures to airborne contaminants: false positive responses in the absence of target analytes.

Ideally, the response of electrochemical detectors is proportional to the concentration of targeted airborne chemicals and is not be affected by concomitantly present substances. Manufacturers provide a limited list of cross-sensitivities but end-users have anecdotally reported unexpected interferences by other substances. Electrochemical detectors designed to measure airborne levels of CO, H(2)S, NO, NO(2), or SO(2), were challenged with potentially interfering substances in the absence of target analytes. Cross-sensitivities undocumented by the manufacturers were observed and were found to vary between different models of instruments for the same challenge chemical.