ยาเคมีบำบัดกับผลกระทบต่อสุขภาพต่อบุคลากรทางการแพทย์

ยาเคมีบำบัดกับผลกระทบต่อสุขภาพต่อบุคลากรทางการแพทย์

1. Cytogenetic Effects 
   
   a.  A number of studies have examined the relationship of exposure to CD's in the workplace to chromosomal aberrations. These studies have looked at a variety of markers for damage, including sister chromatid exchanges (SCE), structural aberrations (e.g., gaps, breaks, translocations), and micronuclei in peripheral blood lymphocytes. The results have been somewhat conflicting. Several authors found increases in one or more markers.^74,75,80,113 Increased mutation frequency has been reported as well.¹⁷ 
   
   b.  Other studies have failed to find a significant difference between workers and controls.^99,101 Some researchers have found higher individual elevations²⁸ or a relationship between the number of drugs handled and SCE's.⁸ These disparate results are not unexpected. The difficulties in quantitating exposure have resulted in different exposure magnitudes between studies; workers in several negative studies appear to have a lower overall exposure.¹⁰¹ In addition, differences in the use of PPE and work technique will alter absorption of CD's and resultant biologic effects. 
   
   c.  Finally, techniques for SCE measurement may not be optimal. A recent study that looked at correlation of phosphoramide-induced SCE levels with duration of anticancer drug handling found a statistically significant correlation coefficient of zero.^63,66 Taken together, the evidence indicates an excess of markers of mutagenic exposure in unprotected workers. 
2. Reproductive Effects 
   
   a.  Reproductive effects associated with occupational exposure to CD's have been well documented. Hemminki et al.³² found no difference in exposure between nurses who had spontaneous abortions and those who had normal pregnancies. However, the study group consisted of nurses who were employed in surgical or medical floors of a general hospital. When the relationship between CD exposure and congenital malformations was explored, the study group was expanded to include oncology nurses, among others, and an odds ratio of 4.7 was found for exposures of more than once per week. This observed odds ratio is statistically significant. 
   
   b.  Selevan et al.⁸⁹ found a relationship between CD exposure and spontaneous abortion in a case-control study of Finnish nurses. This well-designed study reviewed the reproductive histories of 568 women (167 cases) and found a statistically significant odds ratio of 2.3. Similar results were obtained in another large case-control study of French nurses,¹⁰² and a study of Baltimore-area nurses found a significantly higher proportion of adverse pregnancy outcomes when exposure to antineoplastic agents occurred during the pregnancy.⁸⁵ The nurses involved in these studies usually prepared and administered the drugs. Therefore, workplace exposure of these groups of professionals to such products has been associated with adverse reproductive outcomes in several investigations. 
3. Other Effects 
   
   a.  Hepatocellular damage has been reported in nurses working in an oncology ward; the injury appeared to be related to intensity and duration of work exposure to CD's.⁹⁶ Symptoms such as lightheadedness, dizziness, nausea, headache, and allergic reactions have also been described in employees after the preparation and administration of antineoplastic drugs in unventilated areas.^22,86 In occupational settings, these agents are known to be toxic to the skin and mucous membranes, including the cornea.^69,82 
   
   b.  Pentamidine has been associated with respiratory damage in one worker who administered the aerosol. The injury consisted of a decrease in diffusing capacity that improved after exposure ceased.²⁹ The onset of bronchospasm in a pentamidine-exposed worker has also been reported.²² Employees involved in the aerosol administration of ribavirin have noted symptoms of respiratory tract irritation.⁵⁵ A number of medications including psyllium and various antibiotics are known respiratory and dermal sensitizers. Exposure in susceptible individuals can lead to asthma or allergic contact dermatitis.

Ref. OSHA 

http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi_2.html#5