Exposition du personnel des établissements de soin aux médicaments anticancéreux : de l'évaluation à la prévention

Drugs are chemicals widely used in health care. Although chemical European regulations do not take into account drugs, they have to be considered in risk assessment of healthcare workers. Among drugs, antineoplastic drugs are particularly studied for several years, because of their potential carcinogenic, mutagenic and/or reproductive effects on health. Knowledge on these drugs' hazard come both from studies in animals, studies in treated patients where the absorbed dose is more important than those of professionals, and from studies on healthcare workers whose some are now old. Observed human acute effects are due to high exposition levels, essentially occuring actually in accidental context. Occupational healthcare professionals draw their attention to carcinogenic and reproductive effects of these drugs. Exposition evaluations have to be conducted to assess professionals' risk. Thanks to environmental and biological monitoring of antineoplastic drugs in development since a few years, source and route of exposure are better identified. Contamination is possible at each step of drug manipulation and during contact with a treated patient or from contaminated environment. Prevention measures have to be applied. Although antineoplastic drugs' reconstitution is made in secured pharmacy units since about twenty years, it is necessary to provide prevention measures for all exposed activities in health care. International guidelines exist but are still sometimes unclear. This paper review available published data on this subject.