醫院化學治療作業工作安全衛生調查

An Investigation on the Hygiene Factors of Chemotherapy Works in Taiwan Hospital

10.7005/JOSH.200806.0164

熊映美(Yin-Mei Chiung)；陳秋蓉(Chiou-Jong Chen)；余孟庭(Men-Ting Yu)；嚴聿沛(Yu-Pei Yan)；陳文清(Wen-Ching Chen)

化學治療 ； 職業暴露 ； 藥劑室 ； 護理人員 ； 防治方法 ； Chemotherapy ； Occupational exposure ； Pharmacy ； Nursing ； Prevention measures

勞工安全衛生研究季刊

16卷2期（2008 / 06 / 01）

164 - 178

繁體中文

化學治療藥物具有細胞毒性，醫院工作人員在藥物處理流瀉、照護病人、處理廢棄物過程中，可能因為藥物外滲、揮發、飛沫、或接觸病患排泄物而造成職業暴露。長期暴露可能會影響工作人員健康率。 本研究於93年對台灣有化學治療的醫院進行工作防護狀況之調查，分別發送問卷給57家之安全衛生室、藥劑部與護理部，回收率各為52.6%、71.9%及54.3%。調查結果顯示，常用化療藥物超過50種，5-氟尿嘧啶為最常用的3種藥物之一，其次為順一雙氨雙氯鉑。藥劑部80%具負壓隔離艙，65%備有藥物之物質安全資料表。護理部在給藥地點及藥瓶上有警告標示者僅64.5%，對懷孕及哺乳期工作人員僅38.7%有特別保護措施。處理病患排泄物時，使用隔離衣及護目鏡者只有51.6% 綜合結果顯示護理人員與藥劑師均了解藥物的副作用，亦接受過配藥給藥之安全教育，常使用防護具，有定期健康檢查，但僅70%有特殊健康檢查。83.3%醫院有提供專業防護訓練，所用教材約70%為院方編寫。殘餘物及廢棄物委外處理者超過80%。所有受訪單位都發生過藥物洩漏事件，但備有緊急處理器材的僅有47.5%，事件後會就診者僅46.3%。 整體而言，暴露預防政策及化療藥物操作規範，各醫院無一致的作法。化療作業相關各部門，應採用同樣安全衛生管理措施，並應加強洩漏事件的後續補救與暴露危害追蹤。

Most anticancer drugs are cytotoxic, and healthcare workers may be exposed to these drugs via drug extravasation, volatilization, and while providing patient care. Long term exposure may result in harmful effects, including a carcinogenic risk for workers. In 2004, we conducted a survey to assess exposure prevention measures for chemotherapy workers in the divisions of health and safety, pharmacy, and nursing among 57 hospitals. The response rates were 52.6%, 71.9%, and 54.2%, respectively. Among over 50 chemotherapeutic drugs commonly used, 5-Fluoro-uracil was the most frequently prescribed, with Cisplatin the second most common. Approximately 80% of the hospitals were equipped with negative pressure clean rooms in the pharmacy divisions, and 65% provided Material Safety Data Sheets. Most nursing divisions posted warning posters at drug delivery locations. Only 64.5% of hospitals used warning labels on drug bottles and 38.5% provided additional protective measures for pregnant or postnatal nurses. Only 51.6% provided a safety apron and glasses to workers who disposed of patient excrements. All nurses and pharmacists received safety training concerning drug preparation and delivery, protective clothing, and annual health examinations. Only 70% provided special health examinations, and 83.3% provided workers with special training about occupational safety. Over 80% of the hospitals contracted with cleansing companies to dispose of chemotherapy waste. All hospitals experienced chemical leakages, but only 47.5% of them prepared proper drug-spill treatment packages and only 46.3% of related workers received medical attention after such events. Exposure prevention measures for handling anticancer drugs varied greatly among hospitals. Chemotherapy drug safety should be compromised among all divisions in hospitals, and follow-up actions for leakages and other types of exposure should be strengthened.

1. The globally harmonized system of classification and labelling of chemicals
2. (1996).Taiwan Clinical Pharmacy Association.Discussion on tumor chemotherapy.
3. (2003).APEC Meeting of Chemical Dialogue, Globally Harmonized System (GHS) Symposium.Taipei:
4. (2005).Occupational Health and Safety (OHS) Regulation Guideline.
5. NIH Recommendations for the Safe Handling of Cytotoxic Drugs
6. Anwar WA,Salama SI,el Serafy MM,Hemida SA,Hafez AS.(1994).Chromosomal aberrations and micronucleus frequency in nurses occupationally exposed to cytotoxic drugs.Mutagenesis,9,315-317.
7. Barton-Burke M,Wilkes GM,Ingwersen KC.(2001).Cancer chemotherapy: a nursing process approach.Sudbury (MA):Jones and Bartlett.
8. Bos RP,Sessink PJ.(1997).Biomonitoring of occupational exposures to cytostatic anticancer drugs.Rev Environ Health,12,43-58.
9. Chen CJ,Chiung YM,Chen ZY(2007).An investigation of exposure and health evaluation of chemotherapy workers in hospitals.IOSH.
10. Chen CJ,Gu CH,Liu SS.(2003).Occupational hazards of waste anesthetic gases in medical workers.IOSH.
11. Chiung YM(2005).An Investigation on the hygiene Factors in the hospitals enviornment of Chemotherapy.IOSH.
12. Connor TH,McDiarmid MA.(2006).Preventing occupational exposures to antineoplastic drugs in health care settings.CA Cancer J Clin,56,354-365.
13. Fischer DS,Knobf MT,Durivage HJ,Beaulieu NJ.(2003).The cancer chemotherapy handbook.Mosby.
14. Huang RW,Chen CJ,Lin RS.(2000).Estimate the health effect of the workers and industry hygiene in the pesticide factories.IOSH.
15. IARC.(2000).Some antiviral and antineoplastic drugs and other pharmaceutical agents, summary of data reported and evaluation.monographs on the evaluation of carcinogenic risks to humans 2000,76
16. Ishii N,Dakeishi M,Sasaki M,Murata K.(2005).Safety awareness of anticancer drug handling among Japanese nurses.Nippon Koshu Eisei Zasshi,52,727-735.
17. Katzung BG,Katzung BG, (editor.)(2004).Basic and clinical pharmacology.Lange-Medical McGRAW-HILL Companies.
18. Lanza A,Robustelli della Cuna FS,Zibera C,Pedrazzoli P,Robustelli della Cuna G.(1999).Somatic mutations at the T-cell antigen receptor in antineoplastic drug-exposed populations: comparison with sister chromatid exchange frequency.Int Arch Occup Environ Health,72,315-322.
19. McDiarmid MA,Gurley HT,Arrington D.(1991).Pharmaceuticals as hospital hazards: managing the risks.J Occup Med,33,155-158.
20. McKeon CM,Fogarty GJ,Hegney DG.(2006).Organizational factors: impact on administration violations in rural nursing.J Adv Nurs,55,115-123.
21. Newman MA,Valanis BG,Schoeny RS,Hee SQ.(1994).Urinary biological monitoring markers of anticancer drug exposure in oncology nurses.Am J Public Health,84,852-855.
22. NIOSH ALERT(2004).Antineoplastic agents-occupational hazards in hospitals.
23. NIOSH ALERT.(2004).Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings.
24. OSHA Technical Manual.(1999).OSHA Directive TED.
25. Parillo VL.(1994).Documentation forms for monitoring occupational surveillance of healthcare workers who handle cytotoxic drugs.Oncol Nurs Forum,21,115-120.
26. Peters BG.(1995).Technical considerations in the preparation and dispensing of chemotherapy.Top Hosp Pharm Manage,14,78-88.
27. Rubino FM,Verduci C,Buratti M,Fustinoni S,Campo L,Omodeo-Salè E(2006).Assay of urinary alpha-fluoro-beta-alanine by gas chromatography-mass spectrometry for the biological monitoring of occupational exposure to 5-fluorouracil in oncology nurses and pharmacy technicians.Biomed Chromatogr,20,257-266.
28. Sorsa M,Anderson D.(1996).Monitoring of occupational exposure to cytostatic anticancer agents Mutat Res,355,253-261.
29. Sorsa M,Pyy L,Salomaa S,Nylund L,Yager JW.(1988).Biological and environmental monitoring of occupational exposure to cyclophosphamide in industry and hospitals.Mutat Res,204,465-479.
30. Tiziani AP.(2006).Havard`s nursing guide to drugs.Mosby.
31. White SK,Stephens AD,Dowjat B,Sugarbaker PH.(1996).Safety constiderations in the use of intraoperative intraperitoneal chemotherapy.Cancer Treat Res,82,311-316.
32. Yodaiken RE,Bennett D.(1986).OSHA Work-practice guidelines for personnel dealing with cytotoxic (antineoplastic) drugs.Am J Hospital Pharm,43,1193-1204.
33. Zheng HJ,Liao CW,Chang LW.(2004).Discussions about the safety on the preparation of antineoplastic drugs.Chang Gung J Pharmacy,11,1-5.

1. 蔡宜蓁,楊雅涵,張嘉蘋,胡彩華,邱苡瑄,呂簪婷,江素維,朱奕蓉(2018)。降低護理師抗癌化學藥物給藥執行錯誤率。新臺北護理期刊，20(2)，75-87。
2. 蔡爭岳,劉世淼,柴康偉(2021)。從職災預防觀點看醫院護理師工作。工業安全衛生，380，56-62。
3. 盧士一、蔡忠融、陳美蓮、徐儆暉、徐雅媛、毛鏡琪、毛義方(2011)。我國醫院員工超工時與輪班研究。勞工安全衛生研究季刊，19(2)，223-246。