IOSH93-M313 An Investigation on the Hygiene Factors in the Hospitals Enviornment of Chemotherapy
IOSH93-M313 An Investigation on the Hygiene Factors in the Hospitals Enviornment of Chemotherapy
i 1986 guidelines 5-FU(100%) Cisplatin(42.4%)
ii
Abstract Chemotherapy is a usual method in cancer therapy. It probably treated by oral or injection to inhibit or control the growth of tumor cells. The major aim is to inhibit the growth of tumor cells and to prevent its dispersion in patients. Most cancer therapy drugs possess cytotoxity. When drugs treatment, paptents care and wastes treatment, relative healthcare workers may exposed via drugs exosmosis, exhalation, droplet. Long term exposure may harm workers hralth. There is a guideline of AIOSH in 1986 that workers expose to chemotherapy drugs would raise the risk of carcinogenesis and some drugs are classified as A1 or A2. There are some reports not only about side effects on patients, but harmful effects on doctors, nurses, drug treatment people and other workers. The schedure of chemotherapy drugs enter into hospital: material drugs movement and storage, chemotherapy injected drugs arrangement, and wastes storage and treatment. Each stage has different level of exposure. Nurses and pharmacists may belong to high exposure group. In this study, we investigate to understand working steps and safety protections. According to pharmacists questionnaires, drugs treat in pharmacy rooms from drugs purchase and there are 80% negative pressure isolated rooms of all questionnaired pharmacy rooms. There are 65% hospitals support drugs safety informations. Less than 10% hospitals treat chemotherapy wastes by themselves and over 80% by cleansing companies. There are 80% hospitals treat used protective clothing with poison wastes. Less than 50% hospitals prepare spray treat packages for drugs exposure emergent treatment, less than half relative workers see a doctor after drugs exposure, and almost 60% workers record sprays treatment protocols. After large amount spray events, it would evecuate relative workers, 60% hospitals would sign the alert, 80% pamacists have attended training courses, and 70% training text books written by hospitals. According to nursrss questionnaires, almost 60% hospitals sign alerts in both location of drugs support and drug bottles. There are almost 60% rest rooms in all nurse stations. iii
When treat with excrements there are 50% nurse units support protective clothing, less than protective masks and gloves. There are only 50% hospitals support spectacles, but high propotion in gloves. There is higher propotion support with cotton masks, surgery masks, active carbon masks, pretective clothing in phamacist room than in nurse stations. Less than 40% hospitals support special protector to who are in pregnant and latation. The most used chemotherapy drug is 5-FU (100%), and than is Cisplatin (42.4%). We might use both two drugs for biodetector markers in the future. Combine all questionnaires, almost all nurses and pharmacists accept safty training, wear protective clothing, and medial regularly. But wear protective clothing correct or not would effect protection. Chemotherapy wastes are treated by cleansing companies feckly. Maybe our investigation should include cancer therapy drugs cleansers. Key Words: Chemotherapy, Occupational Hygiene. iv
... i Abstract... iii... v... vi... 1... 1... 4... 5... 6... 6... 8... 10... 18... 22... 24... 26... 27... 28... 29... 30... 30... 304... 37... 41 v
1... 9 2... 11 3... 11 4... 12 5... 12 6... 13 7... 14 8... 15 9... 17 10... 16 11... 17 12... 20 13... 21 14... 21 15... 22 16... 23 vi
(alkylating agents) (plant alkaloids) (biologic agents) 1
2
3
4
5
IARC GROUP1 AzathioprineBusulfanprocarbazine vincristine prednisone nitrogen mustard Chlorambucil Cyclophosphamide Melphalan Thiotepa Tamoxifen itrate,gen-tamoxifen, Nolvadex Nolvadex-D, Novo-TamoxifenDiethylstilbestrol sodium diphosphate (Honvol) Group 1 Cyclophosphamide Melphalan Methyl-CCNU Group 2A Cisplatin EtoposideChloroethyl Nitrosoureas (CNU) BCNU CCNU Adramycin Fluorouracil OSHA ONS 1) 2) 6
3) 4) 5) 6) 7) 1) 2) 3) 1) 2) 3) cytotoxic safety cabinet (2) 1) Hepa Filter 2) 3) 4) 1) 0.160.20.3105.0 2) 3) 4)UV 5) Hepa Filter Hepa Filter,, 1 7
8 57 ( ) (1) : (2) : (3) : 1. 30 30 ( )
1 (%) 27 96.4 1 3.6 29 96.7 1 3.3 27 93.1 2 6.9 25 83.3 5 16.7 28 93.3 2 6.7 29 96.7 1 3.3 21 70.0 9 30.0 27 90.0 3 10.0 19 65.5 10 34.5 5 17.2 24 82.8 2 6.9 25 86.2 2 6.9 30 9
39.3 62 24 18.9 34 4 39 300 3 7.9 24 1 34.9 46 26 169.3 306 60 135.3 301 7 72.7 192 5 39.3 62 24 18.9 34 4 39 300 3 7.9 24 1 34.9 46 26 169.3 306 60 135.3 301 7 72.7 192 5 29 29 10
2 * 34 39.3 9.5 (24~62) 26 34.9 5.6 (26~46) 41 29.2 26.7 ND** ND (1~120) - () 40 9.3 17.5 (1~72) 31 169.3 69.5 (60~306) - () 41 18.9 7.0 (6~34) ND ND () ND ND 31 135.371.6 (7~301) () 39 70.0 73.4 (3~300) 30 72.7 50.8 (5~192) 37 3.3 2.6 (0~12) ND ND () 40 7.9 3.0 (1~24) 1*** () 37 1.2 1.0 (0~5) ND ND * ( ~ ) **ND: *** 4.4 7.9 1 3 1 3.4 16 55.2 11 37.9 1 3.4 29 100.0 11
97.6% 85.4% 41 4 (%) 39 95.1 2 4.9 23 56.1 18 43.9 32 78.0 9 22.0 8 19.5 33 80.5 18 43.9 23 56.1 40 97.6 1 2.4 38 92.7 3 7.3 80.5% 12
% % % % % 5 (%) 80.5 17.1 90.0 10.0 77.5 22.5 87.5 12.5 40.0 60.0 77.5 22.5 90.0 10.0 95.0 5.0 92.3% % % % % 13
6 (%) (95.0%) 14
7 (%) (9)80.5 61.0 90.2 92.7 95.1 95.1 15
41 8 (%) 39 95.1 2 4.9 33 84.6 6 15.4 40 97.6 1 2.4 37 90.2 4 9.8 37 90.2 4 9.8 33 82.5 7 17.5 28 70.0 12 30.0 41 97.6% 16
9 (%) 97.6 2.4 62.5 37.5 90.0 10.0 80.0 20.0 17
1. 31 96.8 % 10 (%) 30 96.8 1 3.2 20 64.5 11 35.5 30 96.8 1 3.2 6 19.4 14 45.2 19 61.3 10 32.3 28 100.0 0 0.0 0 0.0 20 100.0 31 87.1 % 18
31 96.8 % 48.8 % 48.8 11 (%) 27 87.1 4 12.9-24 77.4 7 22.6-15 48.4 16 51.6-15 48.4 16 51.6 30 96.8 1 3.2 15 48.4 16 51.6 15 48.4 16 51.6 31 100.0 0 0.0 3 9.7 28 90.3 3 9.7 28 90.3 18 58.1 13 41.9 13 41.9 18 58.1 16 51.6 15 48.4 5 16.1 26 83.9 31 (100 %) 19
9.7 % 9.7 % 58.1 41.9 % 51.6 31 77.7 % 77.7 % 12 (%) 25 80.6 6 19.4 24 77.4 7 22.6 24 77.4 7 22.6 16 51.6 15 48.4 96.8 % (100 %) % % 20
13 (%) 30 96.8 1 3.2 31 100.0 0 0.0 30 96.8 1 3.2 29 96.7 1 3.3 30 96.8 1 3.2 12 38.7 19 61.3 2. 31 14 (%) 28 90.3 3 9.7 31 100.0 0 0.0 26 86.7 4 13.3 27 87.1 4 12.9 21
31 ( ) (90.2 %) (87.1 %) 15 37 90.2 27 87.1 4 9.8 4 12.9 22
(95.1 %) (96.8 %) 19.5 % 9.7 % (56.1 %) (41.9 %) (78.0 (58.1 (97.6 %) (87.1%) 16 (%) (%) 39 95.1 30 96.8 2 4.9 1 3.2 8 19.5 3 9.7 33 80.5 28 90.3 23 56.1 13 41.9 18 43.9 18 58.1 32 78.0 18 58.1 9 22.0 13 41.9 40 97.6 27 87.1 1 2.4 4 12.9 23
24 (1) (2) (3) (4) (5) (1) (2). 5
25
(DNA) Mutagenicity (Carcinogenicity) (Cytokine) DNA 26
1. 2. 3. 4. 夲 3~5 5. 6. 27
1. 2. 5-FU Cisplatin(42.4%) 3. 28
[1] [2] Recommendations for the Safe Handling of Cytotoxic Drugs. http://www.nih.gov/od/ors/ds/pubs/cyto/step3.htm. [9] The Globally Harmonized System of Classification and Labelling of Chemicals,http://www.unece.org/trans/danger/publi/ghs/officialtext.htmlsfsdfd ds sd 29
2. 3.,. 15. 4. 0.22µm chemotherapy dispensing pin Luerlock 30
5. chemotherapy dispensing pin 6. 7. 5 8. ( ) 9. 70% 31
10. 11. 12. ( NIH Recommendations for the Safe Handling of Cytotoxic Drugs. http://www.nih.gov/od/ors/ds/pubs/cyto/step3.htm.) 32
33
34
2 1 2 31. 1 2 32. 1 2 33. 1 2 34. 1 35
2 35. 1 2 36. 1 2 37. 1 2 38. 1 2 39. 1 2 40. 1 2 3 4 5 6 7 41. 1 2 3 4 5 6 42. 1 2 36
43. 1 2 44. 1 2 45. 1 2 37
38
39
40
6. 1 2 7. 1 2 8. 1 2 9. 1 2 10. 1 2 11. 1 2 12. 1 2 41
= An investigation in the hygiene factors in the hospitals environment of chemotherapy/. --1. --, 94 ISBN: 986-00-0645-8( ) 1. 412.78 94004634 221 407 99 02-26607600 http://www.iosh.gov.tw/ 94 3 1 1 100 http://www.sanmin.com.tw/ 6 61 04-22260330 02-23617511 386 5 02-25006600 04-7252792 http://www.govbooks.com.tw/ 141 3 10 B1 07-3324910 02-25781515#643 http://www.iosh.gov.tw/ GPN: 1009400539 ISBN: 986-00-0645-8