醫院化學治療作業人員抗腫瘤藥劑暴露評估

An Investigation of Chemotherapy Workers in Hospitals Exposed to Antineoplastic Agents

王小芳(Hsaio Fang Wang)

指導教授 ： 陳叡瑜

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00138

摘要

癌症為我國人二十年來十大死因之首，治療癌症因而持續為醫療業務之大宗。然而工作者如藥劑、護理人員，已被證實具有長期(如生殖危害、基因損傷等)、短期(如皮膚刺激、嘔吐等)暴露危害。職業暴露危害與工作者認知有關。
本研究以立意取樣於國內某醫學中心，藥師、腫瘤專科(病房及化治室)護理、非腫瘤專科(病房及門診)護理等五組人員為對象，以院內使用頻律最高的鉑離子製劑(包含Cisplatin, Carboplatin, Oxaliplatin)之總鉑量做為指標藥物，進行作業環境擦拭樣本、個人尿液偵測。鉑離子含量以感應耦合電漿質譜儀(ICP-MS)定量(LOD:0.69ppt, 0.405 pg/cm2)；並以問卷瞭解作業人員危害認知(如個人作業規範了解、防護具佩戴習慣、衛生習慣等)。利用環境汙染、體內暴露與個人危害認知等三方資料，以單變項複迴歸進行相關性統計分析，評估作業者之暴露情形。
個人尿液鉑離子測出情形，工作前、後的測出率沒有呈現趨勢關係。在各單位中，測出率大多介於0~10%，然而非腫瘤門診測出率為20%為測出率最高單位。而測出濃度部份，工作前尿液樣本以非腫瘤門診(170.6ppt)、化治室(170.4ppt)為最高。工作後尿液樣本以化治室(23.66ppt)為最高。
環測結果顯示，各單位中測出污染點主要為點滴架地板、點滴架、化療調配桌前地板等處。而非腫瘤專科單位污染點測出率大於腫瘤專科單位。問卷結果顯示，作業規範認知與護具佩戴衛生分數，均以非腫瘤門診護理人員最低分並顯著異於其他單位。顯示作業程序及規範有明顯不足。
生物測出率與環境測出率有顯著正相關、作業規範為顯著負相關(p<0.05) ，表示環境汙染越多的情形下會導致作業人員體內暴露情形越高，而越理解作業規範的工作者其體內暴露情形越低。護理人員資料顯示，護具佩帶與衛生習慣分數也與生物偵測結果呈現顯著負相關，表示護具佩帶程度越高，可降低體內暴露情形。
為降低化療作業人員暴露風險，建議應定期對環境進行清潔及環境偵測，並確實執行職業教育訓練、提供完整個人防護具，以確保工作人員的健康與安全。

關鍵字

抗腫瘤藥物 ； 環境監測 ； 生物監測

並列摘要

Several epidemiological studies found that exposure to antineoplastic agents were associated with some reproductive and carcinogenic effects. Health care workers involving in chemotherapy were potentially exposed to these agents while handling and administering drugs, or in procedures of caring patients.
One medical center in Taipei, Taiwan was selected as target hospital. Surface wipe samples were collected in the oncology wards, non-oncology wards and chemotherapy pharmacy units. A self-administered questionnaire was used to collect demographic data, working practices, medical and contact history, and perceived work-related symptoms of staff working in the wards, and pharmacy units. Urine samples of subjects were collected for exposure examinations. Platinum-containing drugs (Cisplatin, Carboplatin, Oxaliplatin) were used as indicator drugs in environmental and biological samples.
According to our results, antineoplastic agents were recovered (LODenv: 0.405 pg/cm2) in nearly every sampling area, such as IV stands, the floor of IV stands. The platinum concentrations were detectable (LODbio: 0.69ppt) in few urine samples.
Better control regulations and procedures should be implemented in hospital to minimize workers’ exposure and health risk.

並列關鍵字

antineoplastic drugs ； environmental monitoring ； biological monitoring

參考文獻

何素卿, 張雅慧, & 楊嘉玲 (2007). 提昇化學治療靜脈輸液給藥技術正確率改善方案. 領導護理, 8卷1期 (2007/06/01), 57-68.

熊映美, 陳秋蓉, 余孟庭, 嚴聿沛, & 陳文清 (2008). 醫院化學治療作業工作安全衛生調查. 勞工安全衛生研究季刊, 16卷2期 (2008/06/01), 164-178.

Acampora, A., Castiglia, L., Miraglia, N., Pieri, M., Soave, C., Liotti, F., et al. (2005). A case study: surface contamination of cyclophosphamide due to working practices and cleaning procedures in two Italian hospitals. Ann Occup Hyg, 49, 611-618.

Barbieri, A., Sabatini, L., Indiveri, P., Bonfiglioli, R., Lodi, V., & Violante, F. S. (2006). Simultaneous determination of low levels of methotrexate and cyclophosphamide in human urine by micro liquid chromatography/electrospray ionization tandem mass spectrometry. Rapid Commun Mass Spectrom, 20, 1889-1893.

Ben-Ami, S., Shaham, J., Rabin, S., Melzer, A., & Ribak, J. (2001). The influence of nurses' knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel. Cancer Nursing, 24, 192-200.