Surveillance urinaire des professionnels de la santé exposés aux antinéoplasiques dans le cadre de leur travail : revue de la littérature de 2010 à 2015

RESUME Contexte : Il existe de plus en plus de donnees sur la presence de traces de medicaments dangereux dans l’urine des professionnels de la sante exposes a ces medicaments. Objectif : Presenter une revue de la litterature scientifique concernant la surveillance urinaire de professionnels de la sante exposes aux anti - neoplasiques dans le cadre de leur travail. Sources de donnees : Recherche sur PubMed avec les Medical Subject Headings (MeSH) « occupational exposure » et « antineoplastic agents » ainsi que sur Google Scholar avec les termes « antineoplastic », « urine » et « occupational exposure ». Selection des etudes et extraction des donnees : L’examen a porte sur tous les articles en anglais et en francais ayant trait aux professionnels de la sante exposes a des medicaments dangereux dans le cadre de leur travail, publies entre le 1er janvier 2010 et le 31 decembre 2015. Les articles ne comportant pas de resultats urinaires et ceux concernant les veterinaires ainsi que les revues de litterature, les editoriaux, les lettres a la redaction et les resumes de congres ont ete exclus. Synthese des donnees : Vingt-quatre articles ont ete retenus. Les etudes ont ete menees dans 52 etablissements de sante provenant de sept pays. Elles regroupaient 826 travailleurs exposes a des medicaments dangereux et 175 temoins, notamment des infirmiers ( n = 16 etudes), des pharmaciens ( n = 10), des assistants techniques en pharmacie ( n = 8), des medecins ( n = 7), des aides-soignants ( n = 2) et autres ( n = 8). Differentes methodes analytiques ont ete utilisees pour quantifier la presence de 13 medicaments dangereux, principalement le cyclophosphamide ( n = 16 etudes), les platines ( n = 7) et l’alpha-fluoro-beta-alanine, un metabolite urinaire du 5-fluorouracile ( n = 3). La proportion de travailleurs qui ont etes declares positifs s’etendait de 0 % ( n = 10 etudes) a 100 % ( n = 4). Si l’on ne retient que les etudes permettant de calculer le taux de travailleurs comportant au moins un prelevement urinaire positif ( n = 23), la proportion totale etait de 21 % (173/809 travailleurs, toutes methodes et tous medicaments confondus). Conclusion : Vingt-quatre etudes de surveillance urinaire ont ete realisees au sein de sept pays entre 2010 et 2015. Dans plusieurs etudes, aucune trace de medicaments n’a ete mesuree dans l’urine. ABSTRACT Background: There is increasing evidence that traces of hazardous drugs occur in the urine of health care professionals who are exposed to these drugs. Objective: To review the scientific literature regarding urinary monitoring of health care professionals exposed to antineoplastic drugs through their work. Data Sources: A search of PubMed using the Medical Subject Headings “occupational exposure” and “antineoplastic agents” and of Google Scholar using the terms “antineoplastic”, “urine”, and “occupational exposure”. Study Selection and Data Extraction: The analysis covered all articles in English or French pertaining to health care professionals exposed to hazardous drugs in the workplace, published from January 1, 2010, to December 31, 2015. Articles that did not discuss the results of urine tests and those concerning veterinarians, as well as literature reviews, editorials, letters to the editor, and conference abstracts, were excluded. Data Synthesis: Twenty-four articles were retained. The studies were conducted in 52 health care institutions in 7 countries. They included 826 workers exposed to hazardous drugs and 175 controls, specifically nurses ( n = 16 studies), pharmacists ( n = 10), pharmacy technicians ( n = 8), physicians ( n = 7), health care aides ( n = 2), and others ( n = 8). Various analytical methods were used to quantify the presence of 13 hazardous drugs, primarily yclophosphamide ( n = 16 studies), platinum based drugs ( n = 7), and alpha-fluoro-beta-alanine, a urine metabolite derived from 5-fluorouracil ( n = 3). The proportion of workers with positive results ranged from 0% ( n = 10 studies) to 100% ( n = 4). Considering only those studies that allowed calculation of the rate of workers with at least one positive urine sample ( n = 23), the total proportion was 21% (173/809 workers, for all methods and drugs combined). Conclusion: Twenty-four studies on urine monitoring were conducted in 7 countries between 2010 and 2015. In several studies, no traces of drugs were detected in urine.