Research And Application Of Analysis Methods Glove Penetration Of Eight Kinds Of Cytotoxic Drugs And Of Surface Contamination In Medical Environment

Objective:Occupational exposure to cytotoxic agents in medical institutions attracted more and more attention.Our research team preliminary confirmed the existence of occupational exposure in medical institutions through the detection and analysis of the metabolites of PIVAS and medical staff in oncology department.Therefore,establishing an efficient and sensitive analysis method to evaluate the protection capabilities of domestic occupational protection tools and equipment,as well as accurately locating the key parts of occupational exposure,both of which will help improve the professional protection capability and level of our country’s medical institutions.In this study,an indirect monitoring analysis method with regional specificity and high sensitivity will be established for glove penetration and environmental exposure pollution analysis,the experimental research on the penetration of cytotoxic drugs gloves made of different materials and the environmental pollution monitoring of cytotoxic drugs will be carried out on this basis,which provides laboratory basis and technical support of analysis methods for medical institutions in China to further improve occupational protection.Methods:(1)Eight cytotoxic drugs with different chemical structure classifications in the top 20 sales in Yunnan Province were selected as the target drugs.(2)The LC-MS/MS detection method was established and confirmed for the target drug content in the filter paper used to adsorb cytotoxic drugs in the glove penetration model experiment.(3)LC-MS/MS analysis technology was used to establish and confirm the content determination method of seven cytotoxic drugs in the wiping medium of environmental samples.After the analysis of the above target drugs,the samples were retained,extracted and purified again,and the qualitative analysis of platinum drugs in the environment was carried out.(4)SPSS was used to analyze the Pearson time correlation of the glove penetration experiment data,and the generalized estimation equation GEE was used to compare the repeated measurement data to determine the influencing factors of drug penetration and obtain the best glove wearing combination.Results:(1)The positive and negative ion switching LC-MS/MS method for the determination of eight target drugs in filter paper was established and confirmed.The method has good selectivity,accuracy and precision,high sensitivity,well stability and little matrix interference.,which is suitable for the determination of cellular drugs adsorbed on filter paper through gloves.(2)Based on the LC-MS/MS analysis method for the quantitative determination of eight target drugs in the glove penetration experiment.The quantitative detection method of seven cytotoxic drugs and the qualitative detection method of platinum drugs in environmental swab samples were established and confirmed,and the results of methodological investigation met the determination requirements.(3)The three drugs of methotrexate,vincristine and epirubicin did not penetrate the gloves of five different materials;the penetration of docetaxel and etoposide on the gloves was related to the time of the drug and the gloves,and the longer it penetrated,the more it penetrated;The CPE,PVC,LDPE had better protection against cyclophosphamide than rubber and nitrile gloves;LDPE and nitrile had better protection against fluorouracil than CPE and rubber gloves;nitrile had better protection against docetaxel than LDPE gloves;nitrile had the worst protective effect on etoposide in five gloves;CPE had better protective effect on cisplatin than LDPE gloves;Finally,CPE and PVC scored the highest in the scores of the last five kinds of gloves,and they had better protection against most target drugs,followed by LDPE.(4)Intravenous deployment centers,oncology and hematology departments all had varying degrees of cytotoxic drug pollution.Fluorouracil,cyclophosphamide,and platinum drugs were the main pollutants in the intravenous deployment centers and oncology departments.The main pollutants in hematology were fluorouracil,cyclophosphamide and methotrexate.Conclusions:(1)The penetration of drugs into gloves is mainly related to the physical and chemical properties of drugs,the composition of drugs and the microstructure of gloves,such as the molecular weight of drugs,the presence or absence of organic solvents in the solvent,the polymer pores of gloves,the manufacturing process and its constituent materials.It is recommended that PVC,CPE and LDPE with a higher comprehensive score in the evaluation of the protective ability of gloves against drugs are used as protective gloves for the preparation and use of cytotoxic drugs.(2)The cytotoxic agents in clinical departments have a wide range of contamination,but the degree of contamination is generally smaller than that of the intravenous deployment center.The nursing staff in clinical departments are inconvenient to wear personal protective equipment due to their busy work,and the exposure risk is greater than that of deployment personnel equipped with a full set of protective equipment.Effective cleaning measures can reduce the pollution level of cytotoxic drugs.Whether it is an intravenous distribution center that specializes in dispensing drugs or a clinical department that uses cytotoxic drugs,adequate daily cleaning should be done.Meanwhile,it is recommended that the nursing staff wear gloves during the whole process of touching the surface of the medicine bag and medicine frame.