Safety and Health at Work

Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency (산업안전보건연구원)
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Occupational Exposure during Intraperitoneal Pressurized Aerosol Chemotherapy Using Doxorubicin in a Pig Model

  • Wongeon Jung (Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University) ;
  • Mijin Park (Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University) ;
  • Soo Jin Park (Department of Obstetrics and Gynecology, Seoul National University Hospital) ;
  • Eun Ji Lee (Department of Obstetrics and Gynecology, Chung-Ang University Hospital) ;
  • Hee Seung Kim (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Sun Ho Chung ( Bio-Center, Gyeonggido Business & Science Accelerator (GBSA)) ;
  • Chungsik Yoon (Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University)
  • Received : 2022.09.06
  • Accepted : 2023.04.07
  • Published : 2023.06.30
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Abstract

Background: This study evaluated occupational exposure levels of doxorubicin in healthcare workers performing rotational intraperitoneal pressurized aerosol chemotherapy (PIPAC) procedures. Methods: All samples were collected during PIPAC procedures applying doxorubicin to an experimental animal model (pigs). All procedures were applied to seven pigs, each for approximately 44 min. Surface samples (n = 51) were obtained from substances contaminating the PIPAC devices, surrounding objects, and protective equipment. Airborne samples were also collected around the operating table (n = 39). All samples were analyzed using ultra-high performance liquid chromatography-mass spectrometry. Results: Among the surface samples, doxorubicin was detected in only five samples (9.8%) that were directly exposed to antineoplastic drug aerosols in the abdominal cavity originating from PIPAC devices. The telescopes showed concentrations of 0.48-5.44 ng/cm2 and the trocar showed 0.98 ng/cm2 in the region where the spraying nozzles were inserted. The syringe line connector showed a maximum concentration of 181.07 ng/cm2, following a leakage. Contamination was not detected on the surgeons' gloves or shoes. Objects surrounding the operating table, including tables, operating lights, entrance doors, and trocar holders, were found to be uncontaminated. All air samples collected at locations where healthcare workers performed procedures were found to be uncontaminated. Conclusions: Most air and surface samples were uncontaminated or showed very low doxorubicin concentrations during PIPAC procedures. However, there remains a potential for leakage, in which case dermal exposure may occur. Safety protocols related to leakage accidents, selection of appropriate protective equipment, and the use of disposable devices are necessary to prevent occupational exposure.

Keywords

Acknowledgement

The authors deeply appreciate Dreampac Corp. (WonjuGangwon, Republic of Korea) and Precision Medicine for Peritoneal Metastasis Corp. (WonjuGangwon, Republic of Korea) for their support in conducting rotational intraperitoneal pressurized aerosol chemotherapy. Moreover, the authors thank members of the Korean Rotational Intraperitoneal pressurized Aerosol chemotherapy (KoRIA) Trial Group, including Hee Su Lee, Junsik Kim (Interdisciplinary Program in Bioengineering, Seoul National University Graduate School, Seoul, Republic of Korea), Sunwoo Park (Department of Plant & Biomaterials science, Gyeongsang National University, Jinju, Republic of Korea), Jiyeon Ham, Gwonhwa Song (Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea), Ga Won Yim (Department of Obstetrics and Gynecology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea), Seung-Hyuk Shim (Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea), Beong-Cheol Kang (Department of Experimental Animal Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea) Suk Joon Chang (Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea), Whasun Lim (Department of Biological Sciences, Sungkyunkwan University, Suwon, Republic of Korea), Ji Won Park (Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea), and Jung Chan Lee (Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea).

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