{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:30:25Z","timestamp":1792218625723,"version":"4.4.0"},"reference-count":27,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,11]],"date-time":"2023-03-11T00:00:00Z","timestamp":1678492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Antineoplastic drugs used in the treatment of cancers have an intrinsic toxicity, because of their genotoxic, teratogenic, and carcinogenic properties. Their use is recognized as an occupational hazard for healthcare workers (HCWs) who may be exposed. The purpose of this article is to present biological- and environmental-monitoring data collected in twelve French hospitals over eight years. Urine samples were collected from a wide range of HCWs (250 participants) from pharmacy and oncology units, including physicians, pharmacists, pharmacy technicians, nurses, auxiliary nurses, and cleaners. The investigated drugs were cyclophosphamide, ifosfamide, methotrexate, and \u03b1-fluoro-\u03b2-alanine, the main urinary metabolite of 5-fluorouracil. Wipe samples were collected from various locations in pharmacy and oncology units. More than 50% of participants, from all exposure groups, were contaminated with either drug, depending on the unit, the day, or the task performed. However, workers from oncology units were more frequently exposed than workers from pharmacy units. Significant contamination was detected on various surfaces in pharmacy and oncology units, highlighting potential sources of exposure. Risk-management measures should be implemented to reduce and maintain exposures at lowest-possible levels. In addition, regular exposure assessment, including biological and environmental monitoring, is recommended to ensure the long-term efficiency of the prevention measures.<\/jats:p>","DOI":"10.3390\/ijerph20064952","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T04:35:41Z","timestamp":1678682141000},"page":"4952","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Occupational Exposure to Antineoplastic Drugs in Twelve French Health Care Setting: Biological Monitoring and Surface Contamination"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7518-2465","authenticated-orcid":false,"given":"Sophie","family":"Ndaw","sequence":"first","affiliation":[{"name":"Department of Toxicology and Biomonitoring, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), F-54519 Vandoeuvre les Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Remy","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Biomonitoring, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), F-54519 Vandoeuvre les Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,11]]},"reference":[{"key":"ref_1","unstructured":"IARC, International Agency for Research on Cancer (2023, February 03). Agents Classified by the IARC Monographs. Available online: https:\/\/monographs.iarc.who.int\/list-of-classifications\/."},{"key":"ref_2","unstructured":"NIOSH, National Institute for Occupational Safety and Health (2023, February 03). Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings, Available online: https:\/\/www.cdc.gov\/niosh\/docs\/2004-165\/."},{"key":"ref_3","first-page":"761","article-title":"Antineoplastic drug contamination on the hands of employees working throughout the hospital medication system","volume":"58","author":"Hon","year":"2014","journal-title":"Ann. Occup. Hyg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1136\/oem.2005.022723","article-title":"A probabilistic assessment of the impact of interventions on oncology nurses\u2019 exposure to antineoplastic agents","volume":"63","author":"Meijster","year":"2006","journal-title":"Occup. Environ. Med."},{"key":"ref_5","unstructured":"(2023, February 03). Available online: http:\/\/asstsas.qc.ca\/publication\/guide-de-prevention-manipulation-securitaire-des-medicaments-dangereux-gp65."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bernabeu-Mart\u00f5\u00c2nez, M.A., Ramos Merino, M., Santos Gago, J.M., \u00c1lvarez Sabucedo, L.M., Wanden-Berghe, C., and Sanz-Valero, J. (2018). Guidelines for safe handling of hazardous drugs: A systematic review. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0197172"},{"key":"ref_7","unstructured":"(2023, February 03). European Parliament Report. Preventing Occupational Exposure to Cytotoxic and Other Hazardous Drugs. European Policy Recommendations. Available online: https:\/\/www.europeanbiosafetynetwork.eu\/wp-content\/uploads\/2016\/05\/Exposure-to-Cytotoxic-Drugs_Recommendation_DINA4_10-03-16.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2630","DOI":"10.1016\/j.jchromb.2010.02.011","article-title":"Biological monitoring of occupational exposure to 5-fluorouracil: Urinary alpha-fluoro-beta-alanine assay by high performance liquid chromatography tandem mass spectrometry in health care personnel","volume":"878","author":"Ndaw","year":"2010","journal-title":"J. Chromatogr. B"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1007\/s00420-015-1026-1","article-title":"Antineoplastic drug contamination in the urine of Canadian healthcare workers","volume":"88","author":"Hon","year":"2015","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1093\/annweh\/wxx065","article-title":"Monitoring Surface Contamination by Antineoplastic Drugs in Italian Hospitals: Performance-Based Hygienic Guidance Values (HGVs) Project","volume":"61","author":"Sottani","year":"2017","journal-title":"Ann. Work Expo. Health"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Leso, V., Sottani, C., Santocono, C., Russo, F., Grignani, E., and Iavicoli, I. (2022). Exposure to Antineoplastic Drugs in Occupational Settings: A Systematic Review of Biological Monitoring Data. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19063737"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.toxlet.2018.05.031","article-title":"Occupational exposure to platinum drugs during intraperitoneal chemotherapy. Biomonitoring and surface contamination","volume":"298","author":"Ndaw","year":"2018","journal-title":"Toxicol. Lett."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1177\/1078155216643860","article-title":"Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers","volume":"23","author":"Poupeau","year":"2017","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_14","first-page":"703","article-title":"Guidance Values for Surface Monitoring of Antineoplastic Drugs in German Pharmacies","volume":"53","author":"Schierl","year":"2009","journal-title":"Ann. Occup. Hyg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Simon, N., Guichard, N., Odou, P., Decaudin, B., Bonnabry, P., and Fleury-Souverain, S. (2020). Efficiency of Four Solutions in Removing 23 Conventional Antineoplastic Drugs from Contaminated Surfaces. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0235131"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/1078155210381931","article-title":"Occupational exposure to antineoplastic drugs in seven Italian hospitals: The effect of quality assurance and adherence to guidelines","volume":"17","author":"Turci","year":"2011","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.toxlet.2011.03.028","article-title":"Occupational exposure to antineoplastic drugs in four Italian health care settings","volume":"213","author":"Sottani","year":"2012","journal-title":"Toxicol. Lett."},{"key":"ref_18","first-page":"368","article-title":"Biological monitoring of nurses exposed to doxorubicin and epirubicin by a validated liquid chromatography\/fluorescence detection method","volume":"54","author":"Pieri","year":"2010","journal-title":"Ann. Occup. Hyg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.jchromb.2016.10.021","article-title":"Highly sensitive LC-MS\/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide, ifosfamide, and methotrexate antineoplastic drugs and routine application","volume":"1038","author":"Khennoufa","year":"2016","journal-title":"J. Chromatogr. B"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.toxlet.2018.10.007","article-title":"A new, sensitive and versatile assay for quantitative determination of _-fluoro-_-alanine (AFBA) in human urine by using the reversed-phase ultrahigh ultrahigh performance-tandem mass spectrometry (rp-UHPLC-MS\/MS) system","volume":"298","author":"Sottani","year":"2018","journal-title":"Toxicol. Lett."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"122305","DOI":"10.1016\/j.jchromb.2020.122305","article-title":"A highly sensitive UHPLC-MS\/MS method for urine biological monitoring of occupational exposure to anthracycline antineoplastic drugs and routine application","volume":"1156","author":"Villa","year":"2020","journal-title":"J. Chromatogr. B"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/1078155210369851","article-title":"Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan","volume":"17","author":"Sugiura","year":"2011","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_23","first-page":"374","article-title":"Environmental and biological monitoring of platinum-containing drugs in two hospital pharmacies using positive air pressure isolators","volume":"57","author":"Kopp","year":"2013","journal-title":"Ann. Occup. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1007\/s00420-021-01706-x","article-title":"Nurses\u2019 internal contamination by antineoplastic drugs in hospital centers: A cross-sectional descriptive study","volume":"94","author":"Villa","year":"2021","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_25","first-page":"603","article-title":"Exposure to Antineoplastic Drugs in Two UK Hospital Pharmacy Units","volume":"49","author":"Mason","year":"2005","journal-title":"Ann. Occup. Hyg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/15459624.2014.949725","article-title":"Multicenter Study of Environmental Contamination with Antineoplastic Drugs in 36 Canadian Hospitals: A 2013 Follow-up Study","volume":"12","author":"Berruyer","year":"2015","journal-title":"J. Occup. Environ. Hyg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Sottani, C., Grignani, E., Cornacchia, M., Negri, S., Cuna, F.S.R.d., Cottica, D., Bruzzese, D., Severi, P., Strocchi, D., and Verna, G. (2022). Occupational Exposure Assessment to Antineoplastic Drugs in Nine Italian Hospital Centers over a 5-Year Survey Program. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148601"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4952\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:52:40Z","timestamp":1760122360000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/6\/4952"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,11]]},"references-count":27,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["ijerph20064952"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20064952","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,11]]}}}