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Exposição ocupacional a citostáticos e efeitos sobre a saúde em duas unidades hospitalares portuguesas
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RESUMO - Introdução: Os citostáticos são fármacos com utilização crescente, que têm em comum inibirem o crescimento tumoral atuando sobre o genoma celular. Afetam não apenas as células neoplásicas mas também as células normais, pelo que determinados grupos profissionais, expostos a estes agentes pelas exigências da sua atividade laboral, se encontram em risco de desenvolver efeitos adversos para a saúde. Os estudos de avaliação ambiental referem uma contaminação generalizada do ambiente de trabalho que as múltiplas normas de segurança não têm conseguido eliminar. Mais preocupante ainda, é referida uma frequência aumentada de diversos indicadores de genotoxicidade nos profissionais expostos quando comparados com indivíduos não expostos. Objetivos e Metodologia: Este projeto visou estudar esta exposição em: a) profissionais de enfermagem de hospitais de dia, responsáveis pela administração de citotóxicos em regime ambulatório; b) profissionais de farmácias hospitalares, envolvidos na preparação destes fármacos. Como fase inicial, caracterizou-se detalhadamente a atividade de trabalho recorrendo à metodologia de análise ergonómica das situações de trabalho. De seguida procedeu-se à avaliação ambiental por estudo da contaminação de superfícies. Finalmente colheu-se material para a determinação de alguns indicadores biológicos de efeito nos profissionais expostos (teste de micronúcleos e teste do cometa em linfócitos de sangue periférico). Resultados: O estudo da atividade de trabalho revelou várias discordâncias entre procedimentos recomendados e atividade real de trabalho e permitiu identificar diversos pontos críticos que devem ser alvo de intervenção. A análise da contaminação de superfícies confirmou a presença de citotóxicos em diversos pontos do ambiente de trabalho, muitos dos quais tocados sem luvas. Os indicadores biológicos apresentaram valores superiores nos trabalhadores expostos face ao grupo controlo, no caso do teste de micronúcleos atingindo significado estatístico. Conclusões: Foi demonstrado existir exposição cutânea dos trabalhadores estudados nas duas unidades hospitalares e que esta tem um efeito biológico significativo. A alteração das diversas práticas de trabalho estudadas bem como a implementação de medidas organizacionais e de proteção, coletiva e individual, sugeridas pelo presente estudo, podem contribuir para reduzir a exposição e assim evitar o aparecimento de efeitos biológicos no organismo dos trabalhadores.
ABSTRACT - Introduction: Cytotoxic agents are increasingly used and have in common the ability to inhibit tumor growth by affecting the cellular DNA and so also damage normal cellswith cancer suffer side effects of treatment but in addition health care professionals who treat them are also exposed to these genotoxic drugs as an inherent part of their labor activity. Several studies demonstrate a widespread contamination of working surfaces and equipment despite the multiple safety regulations published over the last decades. Even more concerning is the increased frequency of biological indicators of genotoxicity in exposed workers when compared with non-exposed ones. Aims and Methods: This project pretends to study occupational exposure to cytotoxics in: a) nurses from units responsible for the administration of cytotoxics in ambulatory regimen; b) pharmacy workers in charge of the preparation of these drugs. In an initial phase we characterize in detail work activity using methods adopted from ergonomic work analysis. Subsequently an environmental study was performed measuring the contamination of working surfaces and equipment. Finally, blood samples were collected from exposed workers for the measurement of some biological indicators of genotoxicity (micronuclei test and comet assay both in peripheral blood lymphocytes) for comparison with a non-exposed control group. Results: Work analysis revelead several discrepancies between recomended procedures and real work activity, identiyfing critical points who should be targeted for intervention. The study on environmental contamination by wipe sampling confirmed widespread presence of cytotoxics in surfaces and equipment, frequently touched without protective gloves. Biological indicators of genotoxicity had higher values in exposed workers, reaching statistical significance for the micronuclei test. Conclusions: Our results demonstrate that cutaneous exposure of workers does indeed occur and has significant biological effect. The modification of several work practices observed as well as the improvement of some aspects of work organization and of coletive and individual protective measures might contribute to lessen exposure and prevent the development of biological effects on the workers.
ABSTRACT - Introduction: Cytotoxic agents are increasingly used and have in common the ability to inhibit tumor growth by affecting the cellular DNA and so also damage normal cellswith cancer suffer side effects of treatment but in addition health care professionals who treat them are also exposed to these genotoxic drugs as an inherent part of their labor activity. Several studies demonstrate a widespread contamination of working surfaces and equipment despite the multiple safety regulations published over the last decades. Even more concerning is the increased frequency of biological indicators of genotoxicity in exposed workers when compared with non-exposed ones. Aims and Methods: This project pretends to study occupational exposure to cytotoxics in: a) nurses from units responsible for the administration of cytotoxics in ambulatory regimen; b) pharmacy workers in charge of the preparation of these drugs. In an initial phase we characterize in detail work activity using methods adopted from ergonomic work analysis. Subsequently an environmental study was performed measuring the contamination of working surfaces and equipment. Finally, blood samples were collected from exposed workers for the measurement of some biological indicators of genotoxicity (micronuclei test and comet assay both in peripheral blood lymphocytes) for comparison with a non-exposed control group. Results: Work analysis revelead several discrepancies between recomended procedures and real work activity, identiyfing critical points who should be targeted for intervention. The study on environmental contamination by wipe sampling confirmed widespread presence of cytotoxics in surfaces and equipment, frequently touched without protective gloves. Biological indicators of genotoxicity had higher values in exposed workers, reaching statistical significance for the micronuclei test. Conclusions: Our results demonstrate that cutaneous exposure of workers does indeed occur and has significant biological effect. The modification of several work practices observed as well as the improvement of some aspects of work organization and of coletive and individual protective measures might contribute to lessen exposure and prevent the development of biological effects on the workers.
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exposição ocupacional citostáticos genotoxicidade occupational exposure cytotoxics genotoxicity