Risk Assessment Of Health Effect On Nurse Occupationally Exposed To Antineoplastic Drugs In Shenzhen Hospital

Objective(1)To understand the occupational status and health status of nurses due to occupational exposure to ADs in different departments in a hospital of Shenzhen,for exploring the relationship between ADs exposure level and immune function or genetic toxicity to these nurses in terms of their occupational characteristics,and evaluating the accuracy of the relevant monitoring indicators to assess the degree of damage.(2)To examine the possible environmental risk factors in occupational exposure to anticancer drug nurses in this hospital by analyzing the correlation between exposure index and immune function or genetic toxicity of ADs in nurses with different demographic characteristics,so as to set the foundation for effective intervention for reducing the damage level via occupational exposure.Methods A total of 84 eligible nurses from different departments in a hospital of Shenzhen were selected in this study.The control group was consisted of 99 nurses without contract with ADs.First,a questionnaire survey was conducted to understand the different demographic characteristics of all these nurses,and their symptoms in occupational exposure to ADs,their protective knowledge and self-conscious behaviors,and environmental risk factors.According to this survey,an exposure index was created.Second,the three following assays were performed to build the relationship between the exposure index and hematological immune function and genetic toxicity.(1)Peripheral lymphocyte cytokinesis cloning micronucleus test: Micronucleus rate,nuclear bridge rate,nucleation rate,and abnormal value of peripheral lymphocytes were measured.According to the normal range provided by Shenzhen City Occupational Disease Prevention and Treatment Institute,the relationship of exposure index and genetic toxicity were studied.(2)Peripheral lymphocyte comet assay: Morphologies of lymphocyte cells(comet cell percentage),distance index(comet length and its tail length),intensity index(DNA percentages of coma and comet tail),and the moment index(moments of tail and Olive tail)were investigated.Migration length and cell tail rate,primary DNA damage and injury were quantitatively or qualitatively evaluated.The relationship between genetic toxicity and ADs exposure level of nurses with different demographic characteristics was further explored.(3)Serum immunoglobulin assay: The serum immunoglobulin(Ig G,Ig M,and Ig A)levels in 183 nurses were measured by an immuno-turbidimetric assay.Along with different demographic characteristics and ADs exposure index based on a questionnaire,the correlation of the exposure index and the serum immunoglobulin level was analyzed.Results(1)Self-made questionnaire and behavioral assessment scale survey results:Among 8 demographic characteristics,the serum immunoglobulin levels were affected by the department,age,length of service,and staff professional level(P<0.05).in ADs exposure indexes only statistical significance appeared in terms of exposure time(P<0.05).(2)Micronucleus test results: The abnormal rates of micronucleus cell(>15‰),cell micronucleus(>15‰),nuclear bridge(>5‰),germination(>5‰)were 2.4%,3.6%,0.0%,and 1.2% respectively,all lied in normal reference range without obvious occupational injury.There was no significant correlation between demographic characteristics and ADs exposure index and genotoxicity(P>0.05).(3)Peripheral lymphocyte comet test results:The differences of lymphocytic head DNA percentage and tail DNA percentage to departments were obvious(P<0.05),except the moment index(tail moment,Olive tail moment).(4)Serum levels of immunoglobulin: The abnormal rate of Ig G(7.0~16.0 g/L),Ig M(0.4~2.3 g/L)and Ig A(0.7~1)were 7.14%,3.57% and 11.90% respectively.The WBC abnormal rate and Carcinoembryonic antigen were 5.9% and 13.10% respectively in staff files.ADs exposure level of nurse was correlated with Ig A(r=-0.184,P>0.05),Ig M(r=-0.216,P<0.05)and Ig G(r=-0.253,P<0.05),and exhibited a characteristic that the higher the exposure index,the lower the serum immunoglobulin level.The differences of ADs exposure indexes in various department,ages,length of service and title levels were obvious(P<0.05),in which ADs exposure index of nurse working in digestion and hematology arrived at highest level.Conclusions Because of insecure factors,the occupational status and health status of the nurses in the hospital should be monitored regularly and improved continuously.Training and managing ADs exposure nurse are necessary.