Biological Monitoring via Urine Samples to Assess Healthcare Workers’ Exposure to Hazardous Drugs: A Scoping Review

Abstract

Although biological monitoring is beneficial as it assesses all possible routes of exposure, urine sampling of healthcare workers exposed to hazardous drugs is currently not routine. Therefore, a scoping review was performed on this subject matter to understand what is known about exposure and identify knowledge gaps. A literature search was performed on three databases: ProQuest, Web of Science, and PubMed. Articles published between 2005 and 2020 and written in English were included. Overall, this review consisted of 39 full-text articles. The studies varied with respect to design, sample sizes, sample collection times, and drugs examined. Many articles found at least one sample had detectable levels of a hazardous drug. Studies reported urinary drug contamination despite controls being employed. Knowledge gaps included a lack of an exposure limit, lack of a standardized sampling method, and lack of correlation between health effects and urinary contamination levels. Due to differences in sample collection and analysis, a comparison between studies was not possible. Nevertheless, it appears that biological monitoring via urine sampling is meaningful to aid in understanding healthcare workers’ exposure to hazardous drugs. This is supported by the fact that most studies reported positive urine samples and that case-control studies had statistically significant findings.