Airborne transmission of SARS-CoV-2 Prather, Kimberly A; Marr, Linsey C; Schooley, Robert T ...
Science (American Association for the Advancement of Science),
10/2020, Volume:
370, Issue:
6514
Journal Article
OBJECTIVES:Antineoplastic drugs are known reproductive and developmental toxicants. Our objective was to review the existing literature of reproductive health risks to workers who handle ...antineoplastic drugs.
METHODS:A structured literature review of 18 peer-reviewed, English language publications of occupational exposure and reproductive outcomes was performed.
RESULTS:Although effect sizes varied with study size and population, occupational exposure to antineoplastic drugs seems to raise the risk of both congenital malformations and miscarriage. Studies of infertility and time to pregnancy also suggested an increased risk for subfertility.
CONCLUSIONS:Antineoplastic drugs are highly toxic in patients receiving treatment, and adverse reproductive effects have been well documented in these patients. Health care workers with long-term, low-level occupational exposure to these drugs also seem to have an increased risk of adverse reproductive outcomes. Additional precautions to prevent exposure should be considered.
The toxicity of antineoplastic drugs has been well known since they were introduced in the 1940s. Because most antineoplastic drugs are nonselective in their mechanism of action, they affect ...noncancerous as well as cancerous cells, resulting in well‐documented side effects. During the 1970s, evidence came to light indicating health care workers may be at risk of harmful effects from antineoplastic drugs as a result of occupational exposure. Since that time, reports from several countries have documented drug contamination of the workplace, identified drugs in the urine of health care workers, and measured genotoxic responses in workers. Evidence also exists of teratogenic and adverse reproductive outcomes and increased cancers in health care workers. During the past 30 years, professional organizations and government agencies have developed guidelines to protect health care workers from adverse effects from occupational exposure to antineoplastic drugs. Although many safety provisions were advanced to reduce worker exposure in the 1980s, recent studies have shown that workers continue to be exposed to these drugs despite safety policy improvements. In 2004, the National Institute for Occupational Safety and Health (NIOSH) published an alert reviewing the most recent information available and promoting a program of safe handling during their use.
Objective: To determine the frequency of "signature" chromosomal abnormalities in oncology workers handling anticancer drugs. Methods: Peripheral blood from health care personnel (N = 109) was ...examined with probes for targets on chromosomes 5, 7, and 11. The effect of drug-handling frequency on chromosome abnormalities was assessed. Results: An excess of structural (0.18 vs 0.02; P = 0.04) and total abnormalities (0.29 vs 0.04; = 0.01) of chromosome 5 was observed in the high-exposure group compared with the unexposed. Increased incidence rate ratios (IRRs) for abnormalities of chromosome 5 (IRR = 1.24; P = 0.01) and for either chromosome 5 or 7 (IRR = 1.20; P = 0.01) were obtained at 100 handling events. Effect sizes were augmented 2- to 4-fold when alkylating agent handling alone was considered. Conclusions: Biologically important exposure to genotoxic drugs is apparently occurring in oncology work settings despite reported use of safety practices.
Possessing every hazard class, the health care sector poses significant health threats to its workforce in both high-resource settings and low- and middle-income countries (LMICs).
The aim of this ...paper was to examine the applicability of the classical hierarchy of hazard control technologies in resource-constrained health care settings.
Using a biologic and chemical hazard example, the hazard control hierarchy was applied for risk mitigation.
Even when resource constraints force a reordered selection of hazard control elements, risk reduction can be achieved across a variety of hazard classes.
For LMICs with limited resources, the hazard control hierarchy can be effectively employed, although the selection of methods may be reordered, to achieve significant hazard control. Such prevention strategies can thereby strengthen and sustain a critical pillar of the health system, its workforce.
•Health care workers reported that respirator use did not affect patient care.•Personal protective equipment interference with patient care would affect compliance with expected use.•PAPR users ...reported more interference with patient care than other respirator users.•Heatlh care workers may trade inconvenience for safety.
In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.
Chronic diseases are increasing among children in Latin America.
To examine environmental risk factors for chronic disease in Latin American children and to develop a strategic initiative for control ...of these exposures, the World Health Organization (WHO) including the Pan American Health Organization (PAHO), the Collegium Ramazzini, and Latin American scientists reviewed regional and relevant global data.
Industrial development and urbanization are proceeding rapidly in Latin America, and environmental pollution has become widespread. Environmental threats to children's health include traditional hazards such as indoor air pollution and drinking-water contamination; the newer hazards of urban air pollution; toxic chemicals such as lead, asbestos, mercury, arsenic, and pesticides; hazardous and electronic waste; and climate change. The mix of traditional and modern hazards varies greatly across and within countries reflecting industrialization, urbanization, and socioeconomic forces.
To control environmental threats to children's health in Latin America, WHO, including PAHO, will focus on the most highly prevalent and serious hazards-indoor and outdoor air pollution, water pollution, and toxic chemicals. Strategies for controlling these hazards include developing tracking data on regional trends in children's environmental health (CEH), building a network of Collaborating Centres, promoting biomedical research in CEH, building regional capacity, supporting development of evidence-based prevention policies, studying the economic costs of chronic diseases in children, and developing platforms for dialogue with relevant stakeholders.
Objective: This study evaluated health care worker exposure to antineoplastic drugs. Methods: A cross-sectional study examined environmental samples from pharmacy and nursing areas. A 6-week diary ...documented tasks involving those drugs. Urine was analyzed for two specific drugs, and blood samples were analyzed by the comet assay. Results: Sixty-eight exposed and 53 nonexposed workers were studied. Exposed workers recorded 10,000 drug-handling events during the 6-week period. Sixty percent of wipe samples were positive for at least one of the five drugs measured. Cyclophosphamide was most commonly detected, followed by 5-fluorouracil. Three of the 68 urine samples were positive for one drug. No genetic damage was detected in exposed workers using the comet assay. Conclusions: Despite following recommended safehandling practices, workplace contamination with antineoplastic drugs in pharmacy and nursing areas continues at these locations.
Mesothelioma, a cancer of mesothelial cells that line the chest, lungs, heart, and abdomen, is a relatively rare disease. In the United States, approximately 3000 individuals are diagnosed with ...mesothelioma annually. The primary risk factor for mesothelioma is occupational asbestos exposure which can occur decades prior to disease development, though in approximately 20% of cases, known asbestos exposure is lacking. While several other countries have developed mesothelioma registries to collect key clinical and exposure data elements to allow better estimation of incidence, prevalence, and risk factors associated with disease development, no national mesothelioma registry exists in the U.S. Therefore, as part of a larger feasibility study, a patient exposure questionnaire and a clinical data collection tool were created using a series of key informant interviews. Findings suggest that risk factor and clinical data collection via an on-line questionnaire is feasible, but specific concerns related to confidentiality, in the context of employer responsibility for exposure in the unique U.S. legal environment, and timing of enrollment must be addressed. Lessons learned from piloting these tools will inform the design and implementation of a mesothelioma registry of national scope.
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