Erratum: Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys (Annals of Occupational Hygiene (2000) 44 (551-560) PII: S003487800000508)

Dermal exposure to anti-neoplastic drugs has been suggested as a potentially important route
of exposure of hospital workers. Three small-scale workplace surveys were carried out in
several hospitals focusing on contamination by leakage from IV infusion systems; contami-
nation by spilled urine of patients treated with anti-neoplastic drugs and particulate phase
anti-neoplastic drugs in the air of outpatient and nursing clinics. A new visual scoring tech-
nique using a fluorescent tracer was developed. The method showed a very low limit of
detection (0.02 ml of contamination) and a very high inter-observer agreement (ICC 0.99).
Evaluation of IV systems and connectors showed distinct differences between the systems. It
was estimated that 0.5–250 mg of a drug can become available for contamination during
each infusion. Differences in average contamination between nurses were negligible in the
experimental set-up. Widespread and frequent contamination due to spillage of contaminated
urine was revealed and appeared not to be restricted to the patient’s room. Airborne particu-
late concentrations went undetected for 80% of the measurements. However, in a few cases
concentrations up to 2 ng/m3 of cyclophosphamide were measured predominantly in a room
of a patient treated with this anti-neoplastic drug.
Based on these results and a recently proposed conceptual model for dermal exposure a
most likely exposure scenario was postulated both for nurses involved in administering drugs
and nurses caring for treated patients. Estimation of all relevant mass transport rates will
be a challenge for the near future.