醫院化學治療作業人員抗腫瘤藥劑暴露評估
癌症為我國人二十年來十大死因之首，治療癌症因而持續為醫療業務之大宗。然而工作者如藥劑、
護理人員，已被證實具有長期 ( 如生殖危害、基因損傷等 ) 、短期 ( 如皮膚刺激、嘔吐等 ) 暴露危 害。職業暴露危害與工作者認知有關。
本研究以立意取樣於國內某醫學中心，藥師、腫瘤專科 ( 病房及化治室 ) 護理、非腫瘤專科 ( 病房 及門診 ) 護理等五組人員為對象，以院內使用頻律最高的鉑離子製劑 ( 包含 Cisplatin, Carboplatin, O xaliplatin) 之總鉑量做為指標藥物，進行作業環境擦拭樣本、個人尿液偵測。鉑離子含量以感應耦 合電漿質譜儀 (ICP-MS) 定量 (LOD:0.69ppt, 0.405 pg/cm2) ；並以問卷瞭解作業人員危害認知 ( 如個 人作業規範了解、防護具佩戴習慣、衛生習慣等 ) 。利用環境汙染、體內暴露與個人危害認知等三 方資料，以單變項複迴歸進行相關性統計分析，評估作業者之暴露情形。
個人尿液鉑離子測出情形，工作前、後的測出率沒有呈現趨勢關係。在各單位中，測出率大多介於 0~10% ，然而非腫瘤門診測出率為 20% 為測出率最高單位。而測出濃度部份，工作前尿液樣本以 非腫瘤門診 (170.6ppt) 、化治室 (170.4ppt) 為最高。工作後尿液樣本以化治室 (23.66ppt) 為最高。
環測結果顯示，各單位中測出污染點主要為點滴架地板、點滴架、化療調配桌前地板等處。而非腫 瘤專科單位污染點測出率大於腫瘤專科單位。問卷結果顯示，作業規範認知與護具佩戴衛生分數，
均以非腫瘤門診護理人員最低分並顯著異於其他單位。顯示作業程序及規範有明顯不足。
生物測出率與環境測出率有顯著正相關、作業規範為顯著負相關 (p<0.05) ，表示環境汙染越多的情 形下會導致作業人員體內暴露情形越高，而越理解作業規範的工作者其體內暴露情形越低。護理人 員資料顯示，護具佩帶與衛生習慣分數也與生物偵測結果呈現顯著負相關，表示護具佩帶程度越高
，可降低體內暴露情形。
為降低化療作業人員暴露風險，建議應定期對環境進行清潔及環境偵測，並確實執行職業教育訓練
、提供完整個人防護具，以確保工作人員的健康與安全。
An Investigation of Chemotherapy Workers in Hospitals Exposed to Antineoplastic Agents
Several epidemiological studies found that exposure to antineoplastic agents were a ssociated with some reproductive and carcinogenic effects. Health care workers inv olving in chemotherapy were potentially exposed to these agents while handling an d administering drugs, or in procedures of caring patients.
One medical center in Taipei, Taiwan was selected as target hospital. Surface wipe samples were collected in the oncology wards, non-oncology wards and chemother apy pharmacy units. A self-administered questionnaire was used to collect demogra phic data, working practices, medical and contact history, and perceived work-relat ed symptoms of staff working in the wards, and pharmacy units. Urine samples of s ubjects were collected for exposure examinations. Platinum-containing drugs (Cispl atin, Carboplatin, Oxaliplatin) were used as indicator drugs in environmental and bi ological samples.
According to our results, antineoplastic agents were recovered (LODenv: 0.405 pg/
cm2) in nearly every sampling area, such as IV stands, the floor of IV stands. The p latinum concentrations were detectable (LODbio: 0.69ppt) in few urine samples.
