A County-Level Program for the Evaluation of the Potential for Take-Home Lead Exposures Among Children in Michigan

Objective: Take-home lead exposure involves lead dust inadvertently carried from the worksite by employees that becomes deposited in their homes and vehicles. We piloted a program in 2 counties in Michigan to investigate the countywide potential for take-home lead exposures across industries. Methods: During 2018-2020, we identified establishments through internet searches and industry-specific registries. We visited establishments with a physical storefront in-person; we attempted to contact the remaining establishments via telephone. We administered questionnaires at the establishment level to assess the presence of lead and the current use of practices meant to mitigate the potential for take-home lead exposures. We recruited workers for wipe sampling of lead dust from their vehicle floors to test for lead levels. Results: We identified 320 establishments with potential lead use or exposures. Questionnaire responses revealed widespread worker exposures to lead and a lack of education and implementation of best practices to prevent lead from leaving the worksite. Dust samples (n = 60) collected from employee vehicles showed a ubiquitous tracking of lead out of the workplace, with a range of 5.7 to 84 000 µg/ft2 and a geometric mean of 234 µg/ft2. Of the sample results, 95.0% were above the lead dust clearance levels for homes established by the US Environmental Protection Agency. Conclusions: This work suggests that take-home lead exposures are widespread and may be important sources of lead exposure among children. It also demonstrates the feasibility of a program for the identification of establishments whose employees may be susceptible to taking lead dust home with them and whose children may subsequently be targeted for blood lead monitoring.

Cocaine Detection by a Laser-Induced Immunofluorometric Biosensor

The trafficking of illegal drugs by criminal networks at borders, harbors, or airports is an increasing issue for public health as these routes ensure the main supply of illegal drugs. The prevention of drug smuggling, including the installation of scanners and other analytical devices to detect small traces of drugs within a reasonable time frame, remains a challenge. The presented immunosensor is based on a monolithic affinity column with a large excess of immobilized hapten, which traps fluorescently labeled antibodies as long as the analyte cocaine is absent. In the presence of the drug, some binding sites of the antibody will be blocked, which leads to an immediate breakthrough of the labeled protein, detectable by highly sensitive laser-induced fluorescence with the help of a Peltier-cooled complementary metal-oxide-semiconductor (CMOS) camera. Liquid handling is performed with high-precision syringe pumps and microfluidic chip-based mixing devices and flow cells. The biosensor achieved limits of detection of 7 ppt (23 pM) of cocaine with a response time of 90 s and a total assay time below 3 min. With surface wipe sampling, the biosensor was able to detect 300 pg of cocaine. This immunosensor belongs to the most sensitive and fastest detectors for cocaine and offers near-continuous analyte measurement.

An Improved LC–MS/MS Method for the Analysis of Thirteen Cytostatics on Workplace Surfaces

Cytostatics are drugs used in cancer treatment, which pose serious risks to healthcare workers. Dermal absorption via surface contamination is the key exposure route; thus, rapid, reliable, and validated analytical methods for multicomponent detection are crucial to identify the exposure risk. A surface-wipe-sampling technique compatible with hospitals’ safety requirements (gauze, 1 mL isopropanol) and a fast and simple extraction method (1 mL acetonitrile, 20 min ultrasonic bath, evaporation, reconstitution in 200 µL acetonitrile), coupled with liquid chromatography–tandem mass spectrometry analysis, were developed. It allowed identification and quantification of 13 cytostatics on surfaces: cyclophosphamide, doxorubicin, etoposide, ifosfamide, paclitaxel, bicalutamide, capecitabine, cyproterone, flutamide, imatinib, megestrol, mycophenolate mofetil, prednisone. Good linearity, sensitivity, and precision were achieved (R2 > 0.997, IDLs < 4.0 pg/cm2, average CV 16%, respectively). Accuracy for four model surfaces (melamine-coated wood, phenolic compact, steel 304, steel 316) was acceptable (80 ± 12%), except for capecitabine and doxorubicin. Global uncertainty is below 35% for concentrations above 100 pg/cm2 (except for capecitabine and doxorubicin)—a guidance value for relevant contamination. Method application in a Portuguese university hospital (28 samples) identified the presence of seven cytostatics, at concentrations below 100 pg/cm2, except for three samples. The widespread presence of cyclophosphamide evinces the necessity to review implemented procedures.

Cocaine Detection by a Laser-induced Immunofluorometric Biosensor

The trafficking of illegal drugs by criminal networks at borders, harbors, or airports is an increasing issue in public health as these routes ensure the main supply of illegal drugs. The prevention of drug smuggling, including the installation of scanners and other analytical devices to detect ultra-small traces of drugs within a reasonable time frame, remains a challenge. The presented immunosensor is based on a monolithic affinity column with a large excess of immobilized hapten, which traps fluorescently labeled antibodies as long as the analyte cocaine is absent. In the presence of the drug, some binding sites of the antibody will be blocked, which leads to an immediate breakthrough of the labeled protein, detectable by highly sensitive laser-induced fluorescence with the help of a Peltier-cooled complementary metal-oxide-semiconductor (CMOS) camera. Liquid handling is performed with high-precision syringe pumps and microfluidic chip-based mixing devices and flow cells. The biosensor achieved limits of detection of 23 pM (7 ppt) of cocaine with a response time of 90 seconds and a total assay time below 3 minutes. With surface wipe sampling, the biosensor was able to detect 300 pg of cocaine. This immunosensor belongs to the most sensitive and fastest detectors for cocaine and offers near-continuous analyte measurement.

Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy

Purpose Hyperthermic intrathoracic chemotherapy (HITOC) is an additive, intraoperative treatment for selected malignant pleural tumors. To improve local tumor control, the thoracic cavity is perfused with a cisplatin-containing solution after surgical cytoreduction. Since cisplatin is probably carcinogenic to humans, potential contamination of surfaces and pathways of exposure should be systematically investigated to enable risk assessments for medical staff and thus derive specific recommendations for occupational safety. Methods Wipe sampling was performed at pre-selected locations during and after ten HITOC procedures, including on the surgeon's gloves, for the quantitation of surface contaminations with cisplatin. After extraction of the samples with hydrochloric acid, platinum was determined as a marker for cisplatin by voltammetry. Results High median concentrations of cytostatic drugs were detected on the surgeons’ (1.73 pg Cis-Pt/cm2, IQR: 9.36 pg Cis-Pt/cm2) and perfusionists’ (0.69 pg Cis-Pt/cm2, IQR: 1.73 pg Cis-Pt/cm2) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm2 and thus could represent an origin of cross-contamination. In contrast, cisplatin levels on the floor surfaces in the area of the surgeon and the perfusion device or in the endobronchial tube were relatively low. Conclusion With a correct use of personal protective equipment and careful handling, intraoperative HITOC appears to be safe to perform with a low risk of occupational exposure to cisplatin.

Characterization and Separation of Platinum-Based Antineoplastic Drugs by Zwitterionic Hydrophilic Interaction Liquid Chromatography (HILIC)–Tandem Mass Spectrometry, and Its Application in Surface Wipe Sampling

Platinum-based antineoplastic drugs (PtADs) are among the most important and used families of chemotherapy drugs, which, even showing severe side effects and being hindered by drug resistance, are not likely to be replaced clinically any time soon. The growing interest in the occupational health community in antineoplastic drug (AD) surface contamination requires the development of increasingly fast and easy high-throughput monitoring methods, even considering the lack of harmonized legally binding regulation criteria. Thus, a wipe sampling method together with zwitterionic hydrophilic interaction liquid chromatography (HILIC-Z)–tandem mass spectrometry (MS/MS) analysis was developed for the simultaneous evaluation of oxaliplatin, cisplatin, and carboplatin surface contaminations. A design of experiments approach was used to optimize the chromatographic conditions. Limits of quantification ranging from 2 to 5 ng/mL were obtained from interday and intraday repetitions for oxaliplatin and carboplatin, and between 170 and 240 ng/mL for cisplatin. The wipe desorption procedure is equivalent to other AD sampling methods, enabling a fast sample preparation, with an LC-MS/MS analysis time of less than 7 min.

Effectiveness of a decontamination procedure in a pharmacy buffer room contaminated by 5 antineoplastic agents

Purpose Healthcare facilities are obligated to implement strategies to protect healthcare workers from exposure to hazardous drugs, including any real or potential risk from contaminated surfaces. Guidelines are broad and lack sufficient detail for healthcare facilities to establish clear effectiveness targets for their decontamination procedures. Our goal in this analysis was to measure the effectiveness of a decontamination procedure in a pharmacy buffer room contaminated with 5 antineoplastic drugs. Methods Six rounds of contamination, decontamination, and wipe sampling were performed in a pharmacy buffer room designated for hazardous drug (HD) compounding. Ten locations in the buffer room were contaminated with 5-fluorouracil, carboplatin, cyclophosphamide, paclitaxel, and doxorubicin. Pharmacy staff were blinded to contamination sites. After contamination, 3 pharmacy technicians following the same decontamination procedure decontaminated the buffer room. To assess the impact of decontamination, residual hazardous drug levels were assessed after contamination and after decontamination using a commercially available wipe sampling product. Results The mean (SD) residual contamination levels for the 239 wipe samples taken before and after decontamination were 63 (60) ng and 3.9 (8.2) ng, respectively, representing a 94% reduction in residual HD contamination. Residual contamination was not detectable (&lt;5 ng) in 221 (~93%) of the samples after decontamination. Conclusion The employed decontamination procedures effectively reduced residual HD surface contamination.