Chemotherapy Agent Exposure –

IAQ-EMF Consulting

Introduction

Cytotoxic chemotherapy agents can pose airborne and dermal exposure risks during HIPEC procedures and drug handling. IAQ‑EMF performed air and surface sampling to assess exposure levels.

Sampling & Methodology

During a HIPEC procedure at St. Vincent Hospital, we collected air and surface wipe samples around pharmacy staff, nurses, and surgeons using validated analytical protocols.

Key Findings

No detectable levels of Mitomycin C in air or surface samples.
Recommended exposure limit (0.05 μg/m³) was not exceeded during observation.
Double gloving and standard PPE practices prevented dermal exposure.

Health Implications & Controls

Even though OELs for chemotherapy drugs are limited, recommendations include using biological safety cabinets, closed-system drug transfer devices (CSTDs), and strict housekeeping to minimize exposure.

Occupational Hygiene Recommendations

We encourage healthcare facilities to adopt:

Routine environmental monitoring (see our industrial hygiene services page)
PPE and CSTD procedures
Training on safe drug handling and spill response

Conclusion

Our study confirms minimal exposure during HIPEC and drug handling with proper techniques. IAQ & industrial hygiene protocols remain critical for safeguarding healthcare staff.

Overview of the Operating Room Personnel

Surgeon with Hand Immersed in HIPEC Solution

Decontamination Technician at Sonic Bath

Decontamination Area

Mitomycin Sampling Results

Results for all samples are shown in detail in the attachment: “Laboratory Analysis Report…” and in the tables shown below.

Results indicate that none of the employees monitored had detectable level of exposure to Mitomycin via air or dermal routes and none exceeded the recommended airborne exposure guidelines for Mitomycin.

Surface Monitoring Results

Environmental sampling consisted of four air samples and six surface samples.

Six surface samples were taken for Mitomycin from numerous surfaces during the course of the HIPEC Procedure covering the preparation, use during surgery and post-surgical procedures.

The six surfaces sampled in the Operating Room were as follows: Surgeon – Dr Arregui’s Outer Glove, on the surface of his inner glove, on the surface of his bare hand; the Surgical Nurse – Shelly, on the surface of her inner glove, on the surface of her bare hand and finally the Decontamination Technician – Tina, on the surface of her outer glove. Mitomycin C, sampled on six surfaces, was not found on any of the surfaces tested.

Mitomycin Air Monitoring Results

Employees of the St. Vincent Hospital in Indianapolis, Indiana were monitored for Mitomycin exposure on February 17, 2009. Four air samples were taken in the breathing zone of key personnel during the HIPEC Procedure.

See tables below.

Mitomycin Air Samples on February 17, 2009
Sample ID	Job Function	Location	Analysis	Sample Location	Results micrograms per cubic meter	Interpretation
S101	Mark Schiess, Perfusionist	Operating Room	Mitomycin in Air	Operating Room	<0.22 per m3	Below Limit of Detection or Not Present
S102	Dr. Arregui, Chief Surgeon	Operating Room	Mitomycin in Air	Operating Room	<0.32 per m3	Below Limit of Detection or Not Present
S103	Nina, Scrub Nurse	Operating Room	Mitomycin in Air	Operating Room	<0.24 per m3	Below Limit of Detection or Not Present
S104	Tina, Decontamination Tech	Decontamination	Mitomycin in Air	Operating Room	<0.21 per m3	Below Limit of Detection or Not Present

Mitomycin Wipe Samples on February 17, 2009
Sample ID	Job Function	Location	Analysis	Sample Location	Results micrograms per 100 square centimeter	Interpretation
4806	Surgeon – Dr Arregui	Operating Room	Mitomycin on Surface	Outer Glove	< 0.50	Below Limit of Detection or Not Present
4714	Surgeon – Dr Arregui	Operating Room	Mitomycin on Surface	Inner Glove	< 0.50	Below Limit of Detection or Not Present
4813	Surgeon – Dr Arregui	Operating Room	Mitomycin on Surface	Bare Hand	< 0.50	Below Limit of Detection or Not Present
4709	Surgical Nurse – Shelly	Operating Room	Mitomycin on Surface	Inner Glove	< 0.50	Below Limit of Detection or Not Present
4803	Surgical Nurse – Shelly	Operating Room	Mitomycin on Surface	Bare Hand	< 0.50	Below Limit of Detection or Not Present
4739	Surgical Tech – Tina	Decontamination	Mitomycin on Surface	Outer Glove	< 0.50	Below Limit of Detection or Not Present

A similar study was done in February of 2007. As with the most recent study, no surface contamination was detected. Results are presented here.

Table III-Mitomycin C Surface Sample Results on February 27, 2007
Sample ID	Job Function	Sample Location	Sample Surface Area Tested cm2	Analysis	Results micrograms per 100 square centimeter	Interpretation
W102	Surgeon Dr B–	Outer glove Dr. B	100 cm2	Mitomycin C on Surface	not detected	Below Limit of Detection or Not Present
W196	Surgeon Dr B–	Bare hand Dr. B	100 cm2	Mitomycin C on Surface	not detected	Below Limit of Detection or Not Present
W176	Perfusionist Mark Schiess	Outer gloves Mark S	100 cm2	Mitomycin C on Surface	not detected	Below Limit of Detection or Not Present
W182	Perfusionist Mark Schiess	Bare hand Mark S	100 cm2	Mitomycin C on Surface	not detected	Below Limit of Detection or Not Present
W103	na	Floor near table	14641 cm2	Mitomycin C on Surface	not detected	Below Limit of Detection or Not Present

Discussion of Results

Results are based on the data gathered from two separate HIPEC procedures approximately two years apart. Air monitoring results indicate that none of the employees monitored during the procedure on February 17, 2009 had detectable levels of Mitomycin in the four air samples or on the six surfaces tested, including the gloves and bare skin (palm) of surgical personnel. As well, none of the surfaces tested in February 2007, including the palm, had detectable quantities of Mitomycin. The recommended exposure limit (REL), 0.05 micrograms per cubic meter of Mitomycin was not exceeded.

Mitomycin

Results indicate that no detectable quantities of surface or airborne of Mitomycin were found in the operating room during this procedure. Mitomycin in its purest form is a solid powder cake. As a solid material at room temperature, it has an infinitesimally low vapor pressure, so in essence it will not evaporate. In its aqueous dextrose solution (dissolved solid) as used in HIPEC, it has not been known to aerosolize during its normal and routine application. Thus it is very unlikely to be inhaled in any form. The need for any local exhaust ventilation (such as portable smoke evacuators) is superfluous and unnecessary and may take up valuable floor space.

LCMS

The laboratory used a method of analysis known as liquid chromatography-mass spectrometry (LCMS).[5] This method has a limit of detection (LOD) for Mitomycin that ranged from 2.20 micrograms per cubic meter to 0.22 micrograms per cubic meter based on sampling times ranging from 24 minutes to 4 hours and 4 minutes. Any quantity below the limit of detection would be reported as “not detected” though in theory it may be present. At this time there are no readily available analytical methods known to this researcher with a lower level of detection.

On surfaces in close proximity to the operating table, Mitomycin was not detected. Additionally, no “breakthrough” of Mitomycin was seen during the use of the Biogel™ gloves. They appear to offer adequate protection of the skin surface.

About IAQ-EMF Consulting Inc.

IAQ-EMF Consulting Inc. is a full service consulting firm in the areas of environmental health and safety testing and remediation. The Indiana firm was incorporated in 1998. Stuart Bagley is a senior consultant from IAQ-EMF Consulting Inc. He is a Certified Industrial Hygienist (CIH) and a Certified Safety Professional (CSP). He has a Master of Science degree in Occupational and Environmental Health from Wayne State University and a Bachelor of Science degree in Biology from the University of Michigan. Mr. Bagley’s field experience includes serving as a Compliance Safety and Health Officer for US Dept. of Labor-Occupational Safety and Health Admin (OSHA), working in corporate safety management, and as a senior consultant for IAQ-EMF Consulting Inc., a total of 30 years.

Thank you for your assistance during this vital work at St. Vincent Hospital of Indianapolis.

Sincerely,

Stuart D. Bagley, MS, CIH, CSP