Comparison of permeabilities of eight different types of cytotoxic drugs to five gloves with different materials by LC-MS/MS methods to reduce occupational exposure of medical personnel

Abstract

Purpose

Occupational exposure is a long-standing public health concern, which has drawn more and more attention in recent years to the problem of how to carry out occupational protection effectively. Gloves are regarded as the most critical protective equipment for cytotoxic medications. However, there is still little research conducted on the protective performance of gloves made of different materials and the optimal glove combination for cytotoxic agents.

Methods

In this research, a specific instrument intended for glove permeation experiment was designed, with various methods of liquid chromatography-tandem mass spectrometry (LC-MS/MS) developed and validated. By using the specific instrument and LC-MS/MS methods, a study was conducted on the permeation ability of eight selected cytotoxic drugs (fluorouracil, epirubicin (EPI), docetaxel (DCT), methotrexate (MTX), cyclophosphamide (CTX), etoposide (ETP), vincristine sulfate (VCR), and cisplatin derivatives Pt-(DDTC)³) into five kinds of gloves (rubber (RB), nitrile (NT), chlorinated polyethylene (CPE), low-density polyethylene, and polyvinylchloride (PVC) resin) given different contact times. Then, the experimental data were analyzed through a generalized estimation equation and Pearson correlation analysis.

Results

The results show that within a short period of time (less than five minutes), ETP, CTX, fluorouracil, DCT, and cisplatin passed through five types of gloves but the level of MTX, VCR, and EPI permeation was minimal, despite the duration of contact between the three drugs and the gloves reaching as long as three hours. Furthermore, the permeation of DCT and ETP was found to be positively correlated with time.

Conclusions

Chlorinated polyethylene and PVC resin perform well in protecting against most cytotoxic drugs and are recommendable for clinical practice. Due to the poor protective ability, RB gloves are not recommended for this purpose. Based on the performance of various gloves in offering protection, the protection grade of two gloves can be deduced. Chlorinated polyethylene + PVC resin, CPE + NT glove combination shows good protective performance against most target drugs and can be recommended for clinical practice.

Keywords

occupational health occupational protection personal protective equipment

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References

Ferlay

Soerjomataram

Dikshit

, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359–E386.

Umar

Dunn

Greenwald

. Future directions in cancer prevention. Nat Rev Cancer 2012; 12: 835–848.

Yoshida

Koda

Nishida

, et al. Association between occupational exposure levels of antineoplastic drugs and work environment in five hospitals in Japan. J Oncol Pharm Pract 2011; 17: 29–38.

McDiarmid

Oliver

Roth

, et al. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. J Occup Environ Med 2010; 52: 1028–1034.

Rombaldi

Cassini

Salvador

, et al. Occupational risk assessment of genotoxicity and oxidative stress in workers handling anti-neoplastic drugs during a working week. Mutagenesis 2009; 24: 143–148.

Fransman

Vermeulen

Kromhout

. Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities. Int Arch Occup Environ Health 2005; 78: 403–412.

Sessink

Van de Kerkhof

Anzion

, et al.

Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route?

Arch Environ Health 1994; 49: 165–169.

Wallemacq

Capron

Vanbinst

, et al. Permeability of 13 different gloves to 13 cytotoxic agents under controlled dynamic conditions. Am J Health Syst Pharm 2006; 63: 547–556.

Klein

Lambov

Samev

, et al. Permeation of cytotoxic formulations through swatches from selected medical gloves. Am J Health Syst Pharm 2003; 60: 1006–1011.

10.

Krzemińska

Pośniak

Szewczyńska

. Resistance of gloves and protective clothing materials to permeation of cytostatic solutions. Int J Occup Med Environ Health 2018; 31: 341–350.

11.

Edlich

Wind

Heather

, et al. An update on the innovative surgical double-glove hole puncture indication systems: reliability and performance. J Long Term Eff Med Implants 2017; 27: 339–353.

12.

Endres

Alun-jones

Morrissey

. The effectiveness of double-gloving in otolaryngology. Clin Otolaryngol Allied Sci 1990; 15: 535–536.

13.

Makama

Okeme

Makama

, et al. Glove perforation rate in surgery: a randomized, controlled study to evaluate the efficacy of double gloving. Surg Infect (Larchmt) 2016; 17: 436–442.

14.

Chao

Wang

Lee

. Modeling organic solvents permeation through protective gloves. J Occup Environ Hyg 2004; 1: 57–61.

15.

Phalen

Wong

. Changes in chemical permeation of disposable latex, nitrile, and vinyl gloves exposed to simulated movement. J Occup Environ Hyg 2014; 11: 716–721.

16.

Dugheri

Bonari

Pompilio

, et al. A new approach to assessing occupational exposure to antineoplastic drugs in hospital environments. Arh Hig Rada Toksikol 2018; 69: 226–237.

17.

Blazevska-Gilev

Spaseska

. Chemical recycling of poly(vinyl chloride): alkaline dechlorination in organic solvents and plasticizer leaching in caustic solution. Gilev 2007; 42: 29–34.

18.

Cai

Zhou

. Basic characteristics and selection criteria of protective gloves. China Personal Protective Equipment 2003; 000: 27–29.

19.

Zou

. Study on the penetration of four cytotoxic drugs to gloves of different materials. Journal of West China Pharmacy 2019; 05: 475–480. The doi: 10.13375 / j.carol carroll nki WCJPS. 2019.05.009.

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