我国10家医院静脉药物调配中心抗肿瘤药物环境污染评估及工作人员防护措施效果比较

Antineoplastic drug environmental pollution assessment and outcome comparisons of different staff protective measures in pharmacy intravenous admixture services at ten domestic hospitals

目的:以环磷酰胺(cyclophosphamide,CP)和阿糖胞苷(cytarabine,CAR)为标志物评估我国10家医院静脉药物调配中心(pharmacy intravenous admixture services,PIVAS)环境污染情况及工作人员个人防护效果。方法:将同时检测环磷酰胺和阿糖胞苷的UPLC-MS/MS方法用于检测工作环境以及混合调配后的口罩和手套样本。结果:洁净区和一般控制区CP和CAR残留总检出率为73.5%。混合调配以及非混合调配岗位的工作人员口罩以及手套内侧均有残留污染,混合调配岗位污染残留更严重,口罩和手套的内侧污染物检出率分别为47.10%和61.85%。增加口罩和手套的层数同时注意及时更换有助于降低渗透性。结论:现有的不同防护措施表现出不同的防护效果,但并未完全阻隔药物渗透,政府和医院应更加关注PIVAS工作人员职业暴露,优化防护措施,并制订标准操作规程,提升防护效果。

OBJECTIVE To evaluate the environmental pollution and personal protective effect of staff in pharmacy intravenous admixture services(PIVAS)at ten Chinese hospitals by using cyclophosphamide(CP)and cytarabine(CAR)as markers.METHODS UPLC-MS/MS method was developed and validated for the simultaneous detection of CP and CPA in workplace,mask and glove samples after infusion preparation services.RESULTS The total detection rate of CP/CAR residues in clean and general control areas was 73.5%.Residue contamination was detected in inside lining of masks and gloves both for mixed and non-mixed deployment positions.It was more serious in mixed deployment positions and the detection rates of pollutants were 47.10%and 61.85%for inside lining of masks and gloves respectively.Increasing the number of layers of masks and gloves and changing them timely could help reduce permeability.CONCLUSION The existing protective measures have demonstrated varying protective effects,yet fail to completely prevent drug penetration.Both government and hospitals should pay more attention to the occupational exposure of PIVAS workers,optimize the protective measures and formulate standard operating procedures to further enhance protective outcomes.