职业暴露抗肿瘤药和其他危险药物对医务人员的危害及防护

危险药物是指具有致癌性、致畸性、生殖毒性、遗传毒性及低剂量致器官毒性的药物,包括抗肿瘤药、抗病毒药、激素、免疫抑制剂等。大量研究表明,配制和使用危险药物的医务人员面临职业暴露风险。危险药物暴露可发生于呼吸道吸入、皮肤接触吸收、消化道摄入等。吸入和皮肤接触吸收可能是危险药物暴露的主要途径。职业暴露危险药物可导致机体免疫力降低、发生肿瘤的危险性增加和潜在的生殖损害,常见的不良反应有头晕、乏力、脱发、咳嗽、恶心、呕吐、月经异常及皮疹等,长期接触还可能引起慢性肝损害。为了减少危险药物暴露对医务人员的风险,应采取以下安全防护措施：制定安全操作规程;对可能接触危险药物的医务人员加强安全教育和培训;设置专用配药场所;使用生物安全柜;穿戴个人防护装备包括手套、隔离衣、护目镜、面罩和呼吸罩;加强对废弃物处理的管理;急性危险药物暴露应及时处理。

Hazards and prevention of occupational exposure to antineoplastic and other hazardous drugs to healthcare workers

The term hazardous drugs refer to the drugs that have careinogenicity, teratogenicity, reproductive toxicity, genotoxicity, organ toxicity at low doses, including antineoplastic agents, antiviral agents, hormones, immunosuppressive agents, and so on. A large number of studies have showed that healtheare workers who prepare or administer hazardous drugs may have the risks for occupational exposure to these drugs. Exposures to hazardous drugs may occur through inhalation of respiratory tract, skin contact, skin absorption, ingestion of alimentary tract, and so on. Inhalation and skin contact/absorption are the most likely routes of exposure to hazardous drugs. Occupational exposure to hazardous drugs can lead to decrease in immunity, increase in risk for cancer occurring, and potential reproductive damage. The common adverse effects of hazardous drugs are dizziness, fatigue, alopeeia, cough, nausea, vomiting, abnormal menstruation, and skin rash. In addition, chronic liver damage may occur after long-term exposure to hazardous drugs. In order to diminish the risk of exposure to hazardous drugs to healtheare workers, the following safe protective procedures should be included： Good work practice should be formulated; The health care workers who have potential contact with these hazardous drugs should receive a safety education and training; Preparation should be carried out in designated area; Use of biological safety cabinets; Personnel protective equipment （including gloves, isolation gowns, safety glasses, face shields, and respirators） should be worn; Adequate care should be taken in the disposal of waste material; Acute exposure to hazardous drugs should be managed promptly.