Health Care Workers Suffer Exposures to Antineoplastic Drugs

A recent study reveals that health care workers may be suffering from occupational exposure to chemotherapy drugs while treating cancer patients.

"Antineoplastic drugs are pharmaceuticals commonly used to treat cancer, which are generally referred to as 'chemotherapy'. Several studies have shown that exposure to antineoplastic drugs can cause toxic effects on reproduction as well as carcinogenic effects. Presence of these drugs in the urine of hospital personnel has been widely studied and dermal exposure has been suggested to be the main route of exposure. 

The main focus has been on handling the concentrated drug during preparation and administration of antineoplastic drugs and several approaches have been proposed on how to control those. Handling patient excreta has been considered to be potentially harmful to nurses working with cancer patients, since antineoplastic drugs are known to be present in patient excreta (e.g. urine, saliva, sweat, faeces, vomit), but this has not been studied in great detail in occupational exposure studies. 

The identification of occupational exposure to antineoplastic drugs in sectors outside the hospital environment (i.e. veterinary medicine, home care, nursing homes and industrial laundries) showed that the number of workers potentially exposed to antineoplastic drugs is larger than previously estimated. "

Click here to read the series of articles in The Annals of Occupational Hygiene

Exposure to Antineoplastic Drugs in Two UK Hospital Pharmacy Units 
H. J. Mason, S. Blair, C. Sams, K. Jones, S. J. Garfitt, M. J. Cuschieri, and P. J. Baxter 

A Pooled Analysis to Study Trends in Exposure to Antineoplastic Drugs among Nurses 
Wouter Fransman, Susan Peelen, Simone Hilhorst, Nel Roeleveld, Dick Heederik, and Hans Kromhout 

Occupational Dermal Exposure to Cyclophosphamide in Dutch Hospitals: A Pilot Study 
Wouter Fransman, Roel Vermeulen, And Hans Kromhout 

Postulating a dermal pathway for exposure to anti-neoplastic drugs among hospital workers 
Hans Kromhout, Fred Hoek, Ruud Uitterhoeve, Roel Huijbers, Roderik F. Overmars, Rob Anzion, and Roel Vermeulen 

Occupational Exposure Limits for Therapeutic Substances 
Raymond Agius 

Read more about "occupational exposures" and workers' compensation:

Workers' Compensation: OSHA Targets Occupational Exposure to ...

Jul 12, 2013

The Occupational Safety and Health Administration today announced a new National Emphasis Program to protect workers from the serious health effects from occupational exposure to isocyanates. OSHA develops national ...

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Workers' Compensation: Chemical Exposure: Devastating ...

Jun 03, 2013

Chemical exposure in the workplace can have an insidious--yet devasating--effect on a worker. In a wide-ranging article, the New York Times presented an in-depth view of chemical exposure at furniture factories in North ...

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Workers' Compensation: Occupational Safety and Health ...

Jul 19, 2013

Workers' compensation claims result from heat stress and exposure. As the Mid-West and Northeast heatwave is now soaring to records temperatures, workers should protect themselves from heat exposure. Today's post was ...

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The 6 Things You Need To Do If You Are Exposed To Mercury

Elemental mercury is a silver, odorless liquid.

Today's post comes from guest author Catherine Stanton from Pasternack Tilker Ziegler Walsh Stanton & Romano.

Irving J. Selikoff Center for Occupational & Environmental Medicine at Mount Sinai School of Medicine has released a guide to treatment for elemental mercury ((the pure form of the metal, when it is not combined with other chemicals) exposure. There are other forms of mercury, such as compounds found in contaminated fish, known as organic mercury and those are not covered by the guide.
Workers who experience a one-time sudden exposure to any chemical substance at work, should:

1. Gather as much information as you can about the type and amount of exposure, including labels, Material Safety Data Sheets (MSDS), and the medical emergency phone number on the MSDS. 
2. If you are feeling ill, seek medical attention at an emergency department (ED) immediately. It is best if a medical toxicologist is consulted as part of your visit to the ED. They can be reached for advice about treatment by having the healthcare professional contact the Poison Control Center at 1-800-222-1222. 
3. You can call the PCC independently for recommendations as well.
4. Once the urgent situation has been taken care of, you may contact the nearest occupational health clinic in the country for recommendations and follow-up.
5. This fact sheet is not a substitute for medical care. The purpose is to direct the exposed worker to the proper medical provider. 
6. Report any exposure to your employer immediately. Complete an incident or exposure form. If none is available, write a memo informing them of the exposure incident (date, time, location, what you were doing in the area, and for how long). Keep copies and insist that documents are placed in your personnel files.

You can download a copy of the fact sheet by clicking here. It contains more information about the following topics:

Exposed to "Forever Chemicals": NJ Workers' Compensation for PFAS Illness

Per and polyfluoroalkyl substances (PFAS), also known as "forever chemicals," are a growing concern in the workplace. These man-made chemicals are nearly impossible to break down and can build up in the body over time. Unfortunately, some New Jersey workers are facing serious health consequences due to PFAS exposure.

Microplastics: Workplace Threat

Recent scientific studies and published articles have reported the dangers of microplastics and nanoplastics (MNPs) in the workplace and the consequences of occupational exposure to MNPs.

Hazards exist in the surface refinishing business

University of Iowa, College of Public health, recently reported the death of a bathtub refinishingt technician who died from the inhalation of paint stripper vapors.

In 2012, a 37-year-old female technician employed by a surface-refinishing business died from inhalation exposure to methylene chloride and methanol vapors while she used a chemical stripper to prep the surface of a bathtub for refinishing. The technician was working alone without respiratory protection or ventilation controls in a small bathroom of a rental apartment. When the technician did not pick up her children at the end of the day, her parents contacted her employer, who then called the apartment complex manager after determining the victim’s personal vehicle was still at the refinishing company’s parking lot.

The apartment complex manager went to the apartment unit where the employee had been working and called 911 upon finding the employee unresponsive, slumped over the bathtub. City Fire Department responders arrived within 4 minutes  of the 911 call. The apartment manager and first responders reported a strong chemical odor in the  second story apartment. There was an uncapped gallon can of Klean Strip Aircraft® Low Odor Paint  Remover (80-90% methylene chloride, 5-10% methanol) in the bathroom. The employee’s tools and knee pad were found in the tub, suggesting the employee had been kneeling and leaning over the tub wall to manually remove the loosened original bathtub finish coat.

The factors contributing to this lethal exposure include use of a highly concentrated methylene chloride chemical stripper having poor warning properties (“Low Odor”); working in a small room without local exhaust ventilation to remove chemical vapors or provide fresh air; and working without a respirator that could have protected the employee from exposure.

Read More about "occupational exposure"

Breast cancer risk in relation to occupations with exposure to ...

Nov 23, 2012

"Odds ratios (ORs) were increased for the usual risk factors for breast cancer and, adjusting for these, risks increased with occupational exposure to several agents, and were highest for exposures occurring before age 36 .

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The 6 Things You Need To Do If You Are Exposed To Mercury

Nov 26, 2012

"Odds ratios (ORs) were increased for the usual risk factors for breast cancer and, adjusting for these, risks increased with occupational exposure to several agents, and were highest for exposures occurring before age 36 .

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Occupational Exposure to Silica During Hydraulic Fracking

May 24, 2012

While focus has been on environmental concerns with the advent of fracking, a process to release oil and gas, a new concern has emerged over the potential occupational exposure to silica by workers who are involved in the ...

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Breast Cancer Linked to Occupational Exposures - Workers ...

May 29, 2010

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The Compensability of a Cellphone Radiation Exposure

A pending case in California may have significant impact on potential workers’ compensation claims throughout the country. The case involves the causal relationship of radio frequency [RF] radiation emitted by cellphones and human cancer. Cohen v. Apple, Inc., et. al, Case 5:19-cv-05322 (Filed 08/23/19) USDCT-North District California - San Jose Division.

Workers’ Compensation Benefits for Occupational Exposure to Cellphone Radiation

Last week, the French government requested that Apple stop selling the iPhone 12 model because of excessive radiation detected during recent tests. The Agence National des Fréquences [ANFR] stated that “…Apple must immediately take all measures to prevent the availability on the market of the phones concerned present in the supply chain. Regarding phones already sold, Apple must take corrective measures as soon as possible to make the phones concerned compliant. Otherwise, it will be up to Apple to recall them.”

Workplace Toxins: A Hidden Epidemic

In his groundbreaking new book, The Formula for Better Health: How to Save Millions of Lives—Including Your Own, former CDC Director Dr. Tom Frieden draws on decades of experience leading public health efforts to reveal how to defeat the world's deadliest diseases. While the book covers many health threats, its principles are particularly relevant to one of America's most overlooked crises: occupational exposure to toxic substances.

Protecting Healthcare Heroes: Pandemic Preparedness

The 2025 Global Preparedness Monitoring Board (GPMB) report, The New Face of Pandemic Preparedness, arrives with a sobering message: five years after COVID-19 began, the world remains dangerously unprepared for the next pandemic. But perhaps nowhere is this vulnerability more acute than among healthcare workers and first responders—the very people we depend on when crisis strikes.

Beryllium Exposure Standard Enforcement Delayed Until May 2018

The Trump Administration has yet again delayed the implementation of a stricter standard for occupational exposure to beryllium. The new date for enforcement is May 11, 2018.

Trump Administration May Bring a Surge in Occupational Disease Claims

Mesothelioma death rates remain high in the US even on the eve of an anticipated national ban of the asbestos fiber. Things may radically change for the worse as the Trump Administration goes forward with its announced intention to dismantle environmental regulation now in place and placed on-track for enactment during the former Obama Administration. With anticipated less EPA and OSHA regulation under the Trump administration, there is the potential for a serious surge of future occupational disease claims in the United States.

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Toxic Lead Exposure Results in OSHA Fines for NJ Company

Exposure to lead can cause serious medical problem in both children and adults. Strict safety precautions must be observed when working with lead.

Many initial occupational exposure claims in workers' compensation resulted from the

exposure to lead in factories. Lead pigment was used in paints for many years leading to a many serious blood disorders and neurological conditions.

The U.S. Department of Labor's Occupational Safety and Health Administration has cited Henry RAC Holding Corp. with four repeat and four serious safety and health violations, including workers exposed to lead hazards, at the company's Bayonne facility. The inspection was initiated in September 2012 after health hazards were discovered during an earlier OSHA safety inspection at the facility. Proposed penalties total $72,000.

EC Publishes Criteria to Diagnose Occupational Illness

The European Commission has published a listing of the criteria for diagnosis occupational disease. The 272 page report is available on-line. It reviews hundreds of established occupational medical conditions.

a) The clinical features must fit in with what is known about the health effects following  exposure to the specified agent. The symptoms and signs should fit, and this may be supported in some cases by suitable diagnostic tests.

b) There must be indication of sufficient occupational exposure. Evidence on exposure may be obtained through taking the occupational history, results of occupational hygiene measurements taken at the workplace, biological monitoring results, and/or records of incidents of over-exposure.

c) The time interval between exposure and effect must be consistent with what is known about the natural history and progress of the disease. Exposure must precede health effects. However, in some conditions such as occupational asthma, a past history of childhood asthma and/or asthmatic attacks occurring before occupational exposure, does notautomatically rule out the possibility of a workplace agent causing subsequent asthmatic attacks.

d) The differential diagnosis must be considered. There are non-occupational conditions that have similar clinical features as occupational diseases, and a physician will have to take this into account before diagnosing or excluding an occupational disease.


To read more about occupational exposures and workers' compensation.

Click here for more information on how Jon L Gelman can assist you in a claim for workers' Compensation claim benefits. You may e-mail Jon  Gelman or call 1-973-696-7900.

Analysis of US EPA's Draft Risk Evaluation for Formaldehyde and Worker Health

The U.S. Environmental Protection Agency's (EPA) draft risk evaluation of formaldehyde, released on March 15, 2024, raises significant concerns for worker health and worker compensation risk exposure.

NIOSH to Propose New Criteria for Diacetyl Exposure

The National Institute for Occupational Safety and Health (NIOSH) invites public comment on a draft document, "Criteria for a Recommended Standard: Occupational Exposure to Diacetyl and 2,3-pentanedione.”


For public review and comment, the draft document summarizes current scientific knowledge about the occupational safety and health implications of the food flavorings diacetyl and 2,3-pentanedione, and recommends occupational exposure limits and measures for controlling work related exposures to diacetyl and 2,3-pentanedione, based on the current state of knowledge.


The draft document is available athttp://www.cdc.gov/niosh/docket/review/docket245/default.html for written public comment until Oct. 14, 2011. NIOSH will also hold a public meeting to discuss and obtain comments on Aug. 26, 2011, in Washington D.C.


"Occupational exposure to diacetyl has been associated with severe obstructive lung disease, bronchiolitis obliterans, and decrease in lung function," said NIOSH Director John Howard, M.D. "NIOSH has provided over a decade of research and leadership in this important scientific area. In addition to the recommended exposure limits (RELs), this draft document provides for public comment a comprehensive review of scientific literature, a quantitative risk assessment, and valuable guidance to reduce occupational exposures to diacetyl and 2,3-pentanedione. We invite public comment on the draft Criteria Document to help us develop final recommendations."

The draft document includes, for comment:
For Diacetyl, a recommended exposure limit (REL) of 5 parts per billion (ppb) as an eight-hour, time-weighted average, (TWA) during a 40-hour work week. To further protect against effects of short-term exposures, NIOSH recommends in the draft document a short-term exposure limit (STEL) for diacetyl of 25 ppb for a 15-minute time period.


For 2,3-pentanedione, a recommended exposure limit (REL) of 9.3 parts per billion (ppb) as an eight-hour, time-weighted average, (TWA) during a 40-hour work week. The REL for 2,3-pentanedione in the draft document is based upon the lowest level at which the substance reliably can be detected using the existing analytical method, and should not be misconstrued to imply that 2,3-pentanedione is of lower toxicity than diacetyl. Further, NIOSH recommends a STEL of 31 ppb to limit peak exposures for 2,3-pentanedione on the same basis of analytic method limitation.

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Biden Administration Targets Occupational Exposure to PFAS

The Biden-Harris Administration announced accelerated efforts to protect American workers from per- and polyfluoroalkyl substances (PFAS), which can cause severe health problems and persist in the environment once released, posing a severe threat across rural, suburban, and urban areas. 

Employee Allowed to Sue Employer for Negligence Resulting From an Occupational Exposure

Guest Blog by John R. Boyd

A Court of Appeals in Missouri has ruled that an employee, who became ill as a result of an occupational exposure to asbestos fiber, may sue his employer for negligence. The Court ruled that the limitations on recovery of the Workers' Compensation Act did not bar a claim where an occupational exposure occurred.

On September 13, 2011, the Court of Appeals for the Western District of Missouri issued a very rare en banc opinion on a writ of prohibition allowing the employee's claim to go forward. The ill worker was exposed to asbestos, a known cancer causing agent, while working for KCP&L Greater Missouri Operations Company (KCP&L)  from 1954 to 1988 and was diagnosed with mesothelioma in 2010. Mesothelioma is a rare, but fatal, asbestos related disease.

His claims against his employer, KCP&L,  relied upon premises liability and negligence theories. The employee alleged that KCP&L had a duty to exercise "reasonable care" in preventing an "unreasonable risk of injury."   KCP&L argued that the Missouri Workers' Compensation Act was his exclusive remedy, and sought summary judgment, which was ultimately denied by the trial court.

The Appeals Court held in its 7-2 opinion, that a strict reading of the  Missouri Statutes §287.020.2 and §287.120 defeated KCP&L's argument that the claimant's occupational disease was covered by the Act, and that workers' compensation was the employee's exclusive remedy available. The Court reasoned that the 2005 amendments to the Missouri Workers' Compensation Act required a "strict construction" of the Act. 

The exposure at work was deemed not to be a specific accident, but rather a continuous occupational exposure over 34 years. The Appeals Court differentiated the occupational exposure to asbestos from a specific accident that is defined as "an unexpected traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift."

The Court's ruling opened the door for this worker and others who have been exposed in such a fashion to pursue a lawsuit against his or her employer directly, and not be constrained by the limited economic bounds of the Workers' Compensation Act.

This change in the law came about as a result of previous aggressive actions by business and industry to modify the Missouri Workers' Compensation Act in an to attempt to eliminate claims. The ultimate lesson to be learned is that when a pro-business Legislature deforms the law, and attempts to carve-out certain types of injuries from being compensable, they force such cases into the civil arena. Be careful what you ask for----you just might get what you deserve.

Following the Appeals Court's  ruling, an Application for Transfer to the Missouri Supreme Court was filed by counsel for the appellant's on 9/27/11. No ruling on the transfer request has been made by the Missouri Supreme Court.

State ex rel KCP&L Greater Missouri Operations Company v. Hon. Jacqueline Cook WD73642 2011 WL 4031146 (Mo.App. W.D.) (September 13, 2011)

John R. Boyd  is President of the Workers' Injury Law and Advocacy Group (WILG). He is the managing partner of Boyd & Kenter, P.C., Kansas City, MO, and is licensed to practice in Missouri, the United States Court of Appeals for the Eighth Circuit; and the United States District Court for the Western District of Missouri. He is currently a member of the Missouri Bar Association, the Kansas City Metropolitan Bar Association (Chairman of the Workers' Compensation Committee 2000-2001), the Missouri Association of Trial Attorneys (MATA), and the American Association for Justice. 

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OSHA To Focus on Infections in the Workplace

OSHA schedules meetings to
discuss occupational exposure to infectious diseases

The Occupational Safety and Health Administration has scheduled two informal stakeholder meetings to solicit comments on exposure to infectious diseases in the workplace. OSHA will use information gathered during these meetings to explore the possible development of a proposed rule to protect workers from occupational exposure to infectious agents in healthcare settings where direct patient care is provided and other settings where workers perform tasks with occupational exposure. Both meetings are scheduled for July 29 in Washington, D.C.

On May 6, 2010, OSHA published a Request for Information on Infectious Diseases. OSHA wanted to gather comments on strategies that are currently used to reduce the risk of workplace exposure to infectious agents, and to more accurately distinguish the nature and extent of occupationally-acquired infectious diseases. Based on responses received and an ongoing review of literature on this subject, OSHA is considering development of a proposed program standard to control worker exposures to infectious agents.

"We know that workers in healthcare and related facilities may be exposed to infectious agents, and they deserve to be protected," said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. "Information gained from these meetings will help us determine the best approach to assure that workers don’t put themselves at risk while caring for patients and doing their job. After all, a good job is a healthy and safe job."

The two meetings will be held July 29, from 9 a.m. to noon and from 1:30 p.m. to 4:30 p.m., at the U.S. Department of Labor, 200 Constitution Ave., N.W., Room N-4437, Washington, DC 20210. To participate in one of the stakeholder meetings, or be a nonparticipating observer, individuals must submit a notice of intent electronically, by facsimile or by hard copy no later than July 22. See the Federal Register notice for details.

Meeting discussions will focus on issues including the advantages and disadvantages of using a program standard to limit occupational exposure to infectious diseases; whether and to what extent an OSHA standard should require employers to develop a written worker infection control plan that documents how employers will implement infection control measures to protect workers; and whether and to what extent OSHA should take alternative approaches to rulemaking to improve compliance with current infection control guidelines issued by the Centers for Disease Control and Prevention, the National Institutes of Health, and other authoritative agencies.

Under the Occupational Safety and Health Act of 1970, employers are responsible for providing safe and healthful workplaces for their employees. OSHA’s role is to ensure these conditions for America’s working men and women by setting and enforcing standards, and providing training, education and assistance. For more information, visit http://www.osha.gov.

For over 3 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.

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Increased in risk of specific NHL subtypes associated with occupational exposure to TCE

Trichloroethylene

Study published linking trichloroethylene exposure to cancer.

The chemical compound trichloroethylene (C2HCl3) is a chlorinated hydrocarbon commonly used as an industrial solvent. It is a clear non-flammable liquid with a sweet smell.

"Objectives We evaluated the association between occupational exposure to trichloroethylene (TCE) and risk of non-Hodgkin lymphoma (NHL) in a pooled 

analysis of four international case-control studies.

Methods Overall, the pooled study population included 3788 NHL cases and 4279 controls. Risk of NHL and its major subtypes associated with TCE exposure was calculated with unconditional logistic regression and polytomous regression analysis, adjusting by age, gender and study.

Results Risk of follicular lymphoma (FL), but not NHL overall or other subtypes, increased by probability (p=0.02) and intensity level (p=0.04), and with the combined analysis of four exposure metrics assumed as independent (p=0.004). After restricting the analysis to the most likely exposed study subjects, risk of NHL overall, FL and chronic lymphocytic leukaemia (CLL) were elevated and increased by duration of exposure (p=0.009, p=0.04 and p=0.01, respectively) and with the combined analysis of duration, frequency and intensity of exposure (p=0.004, p=0.015 and p=0.005, respectively). Although based on small numbers of exposed, risk of all the major NHL subtypes, namely diffuse large B-cell lymphoma, FL and CLL, showed increases in risk ranging 2–3.2-fold in the highest category of exposure intensity. No significant heterogeneity in risk was detected by major NHL subtypes or by study.

Conclusions Our pooled analysis apparently supports the hypothesis of an increase in risk of specific NHL subtypes associated with occupational exposure to TCE.

Found on

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