Evidence of exposure to cytostatic drugs in healthcare staff: a review of recent literature.

Abstract

Provide updated evidence and learn about the actions that must be implemented in order to prevent the occupational exposure to cytostatic drugs. A bibliographic search was carried out on the MEDLINE, COCHRANE PLUS and WEB OF SCIENCE databases, with the terms "surface contamination", "cytostatic drug", "drug preparation", "occupational exposure", "safe handling" and "closed-system transfer device", within the 2010-2015 period. Thirteen articles were selected for review. These articles are from hospitals in U.S.A., Canada, Japan, Australia, Spain, Portugal and Germany. In all of them, surface contamination by cytostatic agents was found in over 15 different surfaces, with concentrations ranging from 1.69 ng/cm2 to 4-784 μg/cm2. The specific drugs were cyclophosphamide, ifosfamide, 5-fluorouracil, methotrexate, paclitaxel, cisplatin, gemcitabine, and docetaxel. Closed-system transfer devices can reduce the contamination in work surfaces significantly, but do not eliminate it. Presence of contamination by cytostatic drugs was confirmed in many hospitals across all 5 continents. In all cases, contamination was found in the cabinet, on the floor in front of the cabinet, and in other places of the Hospital Pharmacy. The drug most frequently found was cyclophosphamide. The most effective action used to reduce contamination was the closed-system transfer devices (CSTDs).