Despite the link between exposure and adverse health risks, regulatory Occupational Exposure Limits (OELs) defining acceptable inhalation or dermal exposure, as acceptable surface contamination levels, have not been established in Canada, or elsewhere. Lacking credible, acceptable OELs for inhalation or dermal exposure against which to compare measured levels, personal exposure studies are sparse (Hon, Barzan, & Astrakianakis, 2014) and limit our understanding of intra– and inter-individual variability as well variability of contaminants across surfaces.
Concern regarding occupational exposure to AD has led to the development of guidelines for safe handling (National Institute for Occupational Safety and Health, 2004; Hon, Barzan, & Astrakianakis, 2014; Brookhaven National Laboratory, 2014; Neuss et al., 2013), and monitoring using surface wipe testing is now a requirement in <USP 800> (Gabay, 2014). Until an OEL is established it is best practice to maintain exposure to AD “as low as reasonably achievable”. Accurate sampling and analytical methods must be developed to assess trace levels of drug contamination on surfaces. Regular screening for surface contamination of AD will help to identify contamination levels, sources, paths and determinants of exposure, with the ultimate goal to prevent worker exposure.
While the guidelines are helpful, without regulatory enforcement, adherence to them is inconsistent (Walton, Eisenberg, & Friese, 2017). Several U.S. states, (California, Washington State, North Carolina and Michigan) have initiated legislative action to require compliance with the NIOSH guidelines, while Minnesota is exploring initiating a dialogue with Industry and Labor (Graeve, personal communication). These initiatives amplify the need for research to inform policy about the best way to reduce AD exposures.
Guidelines are available for veterinarians undertaking chemotherapy in companion animals (e.g. American College of Veterinary Internal Medicine’s small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice, 2018; European college of veterinary internal medicine; ECVIM, 2007) and “gold standard” for safety has been suggested, based on this.
Brookhaven National Laboratory. (2014). IH75190: Surface Wipe Sampling Procedure. Upton, NY: Brookhaven National Laboratory, Safety & Health Services Division, Industrial Hygiene Group.
Edery, E. G. (2017). Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey. Veterinary Record, 180(21). doi: 10.1136/vr.104154
European College of Veterinary Internal Medicine of Companion Animals. (2007). Preventing occupational and environmental exposure to cytotoxic drugs in veterinary medicine. Retrieved from: https://chemopet.co.uk/wp-content/uploads/Guidelines-ECVIM-Hazards-Cytotoxic-drugs-2nd-version-July-2007.pdf
Gabay, M. (2014). USP <800>: Handling Hazardous Drugs. Hospital Pharmacy, 49(9), 811–812. doi: 10.1310/hpj4909-811
Hon, C.-Y., Barzan, C., & Astrakianakis, G. (2014). Identification of Knowledge Gaps Regarding Healthcare Workers Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe. Safety and Health at Work, 5(4), 169–174. doi: 10.1016/j.shaw.2014.06.001
National Institute for Occupational Safety and Health. (2004). Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Retrieved from https://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf?id=10.26616/NIOSHPUB2004165
Neuss, M. N., Polovich, M., Mcniff, K., Esper, P., Gilmore, T. R., Lefebvre, K. B., … Jacobson, J. O. (2013). 2013 Updated American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration Safety Standards Including Standards for the Safe Administration and Management of Oral Chemotherapy. Journal of Oncology Practice, 9(2S). doi: 10.1200/jop.2013.000874
Smith, A. N., Klahn, S., Phillips, B., Parshley, L., Bennett, P., Flory, A., & Calderon, R. (2018). ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice. Journal of Veterinary Internal Medicine, 32(3), 904–913. doi: 10.1111/jvim.15077
Walton, A. M., Eisenberg, S., & Friese, C. (2017). Hazardous Drugs: Legislative and Regulatory Efforts to Improve Safe Handling. Clinical Journal of Oncology Nursing, 21(2), 254–256. doi: 10.1188/17.cjon.254-256