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Cytotoxic drugs: risks for healthcare professionals

Exposure to cytotoxic drugs, which are often genotoxic, carcinogenic or reprotoxic, poses a risk to the health of healthcare and other professionals.

Cytotoxic drugs, mainly used to treat cancer, often have genotoxic, carcinogenic and/or reprotoxic properties. The cancer risk associated with the exposure of health professionals to these drugs has not been established. However, several studies have highlighted genotoxic effects in healthcare professionals working in oncology. Some studies have also shown reproductive harms: reduced fertility in women, increased risk of abortions and fetal malformations.

Occupational exposure to cytotoxic drugs is mainly related to the contamination of work surfaces, as well as to splashes, inhalation of aerosols and even ingestion if hygiene is poor. Occupational exposure is evaluated by assaying cytotoxic drugs or their metabolites in urine, and through surface wipe testing to identify potential sources of exposure.

All professionals in healthcare facilities who handle cytotoxic drugs or are in contact with patients receiving them, including hospital support staff, are at risk of exposure. In some cases, the risk extends to other professionals such as couriers who transport cytotoxic preparations.

Staff need regular refresher courses providing information on potential sources of exposure and health risks, training in the wearing and removal of personal protective equipment and incident management. Pregnant and breastfeeding women must not be involved in the reconstitution, administration or disposal of these products.

©Prescrire 1 May 2020

"Exposure of healthcare professionals to cytotoxic drugs: a proven risk requiring preventive measures" Prescrire Int 2020; 29 (215): 138-139. (Pdf, subscribers only).

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