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Occupational Exposure to Cyclophosphamide in Nurses at a Single Center

Ramphal, Raveena MBChB, MPH; Bains, Tejinder BSc (Pharm); Vaillancourt, Régis B Pharm, Pharm D; Osmond, Martin H. MDCM; Barrowman, Nicholas PhD

Journal of Occupational and Environmental Medicine: March 2014 - Volume 56 - Issue 3 - p 304–312
doi: 10.1097/JOM.0000000000000097
Original Articles

Objective: To evaluate biological and environmental exposure to cyclophosphamide in nurses at a single institution.

Methods: Biological exposure to cyclophosphamide in nurses administering cyclophosphamide compared with two control groups: nononcology nurses not administering cyclophosphamide and community members without recent hospital exposure. Environmental exposure to chemotherapy was measured using surface wipes taken from oncology and nononcology areas in the hospital.

Results: More than one third of all nurses and no community controls tested positive for urinary cyclophosphamide. Oncology and nurse controls tested positive in equal numbers. Surface wipes were positive only in the oncology ward.

Conclusion: We have demonstrated elevated levels of cyclophosphamide in one third of all nurses and cyclophosphamide contamination of surfaces within the oncology patient environment. This suggests that environmental contamination plays a major role in biological exposure to cyclophosphamide.

From the Department of Pediatrics (Drs Ramphal and Osmond), University of Ottawa, Ottawa, Ontario, Canada; and Pharmacy Department (Ms Bains and Dr Vaillancourt) and Clinical Research Unit (Dr Osmond and Dr Barrowman), Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

Address correspondence to: Raveena Ramphal, MBChB, MPH, 2631-401 Smyth Rd, Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada (

The authors declare no conflicts of interest.

Copyright © 2014 by the American College of Occupational and Environmental Medicine