静脉药物配置中心作业环境中5-氟尿嘧啶的污染情况

Investigation on occupational exposure to 5-fluorouracil in pharmacy intravenous admixture service of a hospital

目的评价医院静脉药物配置中心（PIVAS）作业环境中5-氟尿嘧啶（5-Fu）的污染情况，发现抗癌药物的污染环节。方法采集不同区域表面、物品的样品，经洗脱后，用紫外-见光分光光度法测定5-Fu浓度。结果空气样品中未检出5-Fu。生物安全柜内操作台表面、左侧、右侧、内侧和前窗表面5-Fu浓度分别为（22．00±6．35）、（13．99±2．46）、（14．13±0．72）、（7．25±1．19）、（9．87±1．23）ng／cm^2,显高于非使用区域的相应位置[分别为（3．14±0．04）、（5．43±0．65）、（2．26±0．17）、（2．26±0．17）、（3．63±0．46）ng／cm^2],异均有统计学意义（P〈0．05）。操作台下方地板、距安全柜正面1m处地板、准备间地板、阳台地板、更衣室垃圾桶旁边地板上5-Fu浓度分别为（18．19±5．22）、（10．25±2．57）、（11．64±2．53）、（99．89±14．06）、（24．54±0.23ng／cm^2，明显高于非使用区域地板上的5-Fu浓度[（3．36±0．11）ng／cm^2],差异均有统计学意义（P〈0．05或P〈0．01）。配置间桌面、准备间桌面5－Fu浓度[分别为（7．22±1．04）、（11．81±1．18）ng／cm]明显高于非使用区域[（5．56±0．14）ng／cm^2]，差异均有统计学意义（P〈0．05或P〈0．01）。物流进窗口、出窗口和配置间门内把手擦拭物5-Fu浓度明显高于非使用区域相应表面，差异有统计学意义（P〈0．05或P〈0．01），而配置间门边地板、配置间门外把手与非使用区域相应表面相比，差异无统计学意义（P〉0．05）。药袋、药筐表面5-Fu浓度与相应表面对照比较，差异有统计学意义（P〈0．05）。配置人员外层口罩、内层口罩与相应对照比较，差异无统计学意义（P〉0．05）。配置人员双手外层和左手内层手套、核对人员手套的5-Fu浓度明显高于相应对照，差异有统计学意义（P〈0．05或P〈0．01）。结论抗癌药物配置、核对和医疗垃圾处理是抗癌药物污染的重要环节。

Objective To investigate the level of occupational exposure to 5-fluorouracil （5-Fu） in the pharmacy intravenous admixture service （PIVAS） of a hospital, and identify the sources of 5-Fu contamination. Methods The 5-Fu concentrations in air, on the surface of different areas in PIVAS and personal protective equipments were detected using UV-vis spectrophotometry. Results The 5-Fu in air could not be detected. The 5-Fu concentrations on five different surfaces of biological safety cabinets were （22.00±6.35）, （13.99±2.46）, （14.13 ±0.72）, （7.25 ±1.19） and （9.87±1.23） ng/cm^2, respectively, which were significantly higher than those [（3.14±0.04）, （5.43±0.65）, （2.26±0.17）, （2.26±0.17） and （3.63±0.46） ng/cm^2] of corre- sponding controls （P〈0.05 or P〈0.01 ）. The 5-Fu concentrations of the floor under cabinets [（ 18.19±5.22） ng/cm^2], the floor in front of cabinets [（ 10.25 ± 2.57）ng/cm^2], the office floor [（ 11.64±2.53） ng/cm^2], the terrace floor [（99.89 ±14.06 ）ng/cm^2], the floor beside trash can in dressing room [（24.54±0.23 ） ng/cm^2] were significantly higher than those of control [（3.36 ± 0.11 ）ng/cm^2] （P〈0.05 or P〈0.01 ）. The 5-Fu concentrations of the tables in preparation room [（7.22 ±1.04）ng/cm2] and the tables in office [（11.81±1.18） ng/cm^2] were significantly higher than those of control [ （5.56±0.14） ng/cm^2] （P〈0.05 or P〈0.01 ）. The 5-Fu concentrations of the indoor handle in preparation room were significantly higher than those of controls （P〈0.05 or P〈0.01 ）. 5-Fu concen- trations on the surfaces of outdoor handle and floor beside door in preparation room were not significantly increased compared with controls （P〉0.05）. The 5-Fu concentrations on the surfaces of infusion bags, transfer box, transfer trays were significantly higher than those of controls（P〈0.05 ）. The differences of 5-Fu concentrations between outer and inner masks and controls were not significant （P〉0.05）. The 5-Fu concentrations of gloves of preparing and checking staffs were significantly higher than those of controls （P〈0.05 or P〈0.01 ）. Conclusion The preparing and checking process of 5-Fu and the treatment of medical wastes are major sources of 5-Fu contamination.