Date of Award

6-2021

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Elpidoforos S. Soteriades

Second Advisor

Michal Grivna

Abstract

Introduction: Occupational exposure to cytotoxic drugs is associated with various unfavorable health outcomes. There is currently no safe level for occupational exposure to cytotoxic agents. Healthcare workers’ adherence to cytotoxics control measures is of primary importance to minimize the risk from exposure to these agents.

Aims: To develop a protocol for a systematic review and meta-analysis on environmental assessment of cytotoxic drugs in healthcare settings and conduct an environmental assessment study of cytotoxic drugs in two Oncology centers of Abu Dhabi, United Arab Emirates (UAE). In addition to evaluate pharmacists’ and nurses’ Knowledge, Attitudes, and Practices (KAP) towards handling of cytotoxic drugs.

Method: This research project comprised of three studies. The first study developed a protocol on environmental assessment of cytotoxic drugs in healthcare settings. The protocol was developed in line with PRISMA-P guidelines. The second study evaluated workplace contamination with 10 cytotoxic drugs by collecting 79 surface wipe samples from preparation and administration areas of two Abu Dhabi Oncology centers. The third study was a cross-sectional survey using an online self-administrated questionnaire to assess pharmacists’ and nurses’ KAP regarding the handling of cytotoxic drugs.

Results: In the first study, the protocol was registered (ID CRD42020162780) on The International Prospective Register of Systematic Reviews (PROSPERO). In the second study, a total of 79 surface samples were analyzed. Of these, 20 samples (25%) were positive for cytotoxic drug residues. Moreover, 10 samples (13%) indicated contamination by more than one cytotoxic drug, mainly in the oncology pharmacy department in both hospitals. The levels of contamination in the positive samples ranged from 0.003 to 50 ng/cm2. In the third study, 113 oncology healthcare professionals participated in the survey (23 Male and 90 Female). Most of them were aware of the potential hazards associated with handling of cytotoxic medications. The mean score of the participants’ knowledge was 74.04 out of 100. The majority of the participants reported high adherence levels to the use of personal protective equipment such as gloves, protective gown, and mask (98.14%, 97.22%, and 96.29%), respectively, while handling these agents. All the participants (100%) had received training on the safe handling of cytotoxic drugs during the past year.

Significant contributions: The findings of this research provide important baseline data about exposure and handling practices of healthcare professionals for cytotoxic drugs in the workplace environment. The findings may be used to develop programs about cytotoxic drugs handling that will help to minimize the risk of these agents. The results also point out that it is vital to healthcare facilities to assess environmental contamination with cytotoxics. Such initiatives will contribute to raise both knowledge and practices of healthcare professionals regarding the handling of cytotoxic drugs.

Gap filled: The environmental assessment study is the first study in the Middle East and North Africa (MENA) region, and in UAE in particular, that evaluated the potential environmental contamination with ten cytotoxic drugs in preparation and administration areas. Furthermore, the KAP study is also the first in the UAE to assess oncology healthcare professionals’ KAP towards handling of cytotoxic drugs.

Arabic Abstract

اﻟﻤﻘﺪﻣﺔ: ﯾﺮﺗﺒﻂ اﻟﺘﻌﺮض اﻟﻤﮭﻨﻲ ﻷدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﺑﺄﺛﺎر ﺻﺤﯿﺔ ﻋﺪﯾﺪة. ﺣﯿﺚ ﻻ ﯾﻮﺟﺪ ﺣﺎﻟﯿًﺎ ﻣﺴﺘﻮى آﻣﻦ ﻟﻠﺘﻌﺮض اﻟﻤﮭﻨﻲ ﻟﮭﺬه اﻷدوﯾﺔ. ﻛﻤﺎ ﯾﻌﺪ إﻟﺘﺰام ﻣﻤﺎرﺳﻲ اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ اﻟﻌﺎﻣﻠﯿﻦ ﻓﻲ ﻣﺮاﻛﺰ ﻋﻼج اﻷورام ﺑﺈﺟﺮاءات اﻟﺴﻼﻣﺔ واﻟﻮﻗﺎﯾﺔ اﻟﺨﺎﺻﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ ھﺬه اﻷدوﯾﺔ ذا أھﻤﯿﺔ ﻗﺼﻮى ﻟﺘﻘﻠﯿﻞ ﻣﺨﺎطﺮ اﻟﺘﻌﺮض ﻟﮭﺎ.

اﻷھﺪاف: ﯾﮭﺪف ھﺬا اﻟﺒﺤﺚ إﻟﻰ ﺗﻄﻮﯾﺮ ﺑﺮﺗﻮﻛﻮل لـ(a systematic review and meta analysis) ﻟﻠﺘﻘﯿﯿﻢ اﻟﺒﯿﺌﻲ ﻟﻜﻤﯿﺔ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﻓﻲ اﻟﻤﻨﺸﺂت اﻟﺼﺤﯿﺔ، ودراﺳﺔ اﻟﺘﻘﯿﯿﻢ اﻟﺒﯿﺌﻲ ﻹﺣﺘﻤﺎل ﺗﻠﻮث ﻣﺮاﻛﺰ ﻋﻼج اﻷورام ﺑﺈﻣﺎرة أﺑﻮظﺒﻲ ﺑﺄدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ، ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ دراﺳﺔ ﻣﻌﺮﻓﺔ وﻣﻤﺎرﺳﺎت وﺗﺼﻮرات اﻟﺼﯿﺎدﻟﺔ واﻟﻤﻤﺮﺿﯿﻦ اﻟﻌﺎﻣﻠﯿﻦ ﻓﻲ ﺗﻠﻚ اﻟﻤﺮاﻛﺰ ﺗﺠﺎه اﻟﺘﻌﺎﻣﻞ ﻣﻊ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ.

اﻟﻄﺮﯾﻘﺔ: ﯾﺘﻀﻤﻦ ھﺬا اﻟﻤﺸﺮوع اﻟﺒﺤﺜﻲ 3 دراﺳﺎت، ﻣﻦ ﺧﻼل اﻟﺪراﺳﺔ اﻷوﻟﻰ ﺗﻢ ﺗﻄﻮﯾﺮ ﺑﺮوﺗﻜﻮل ﻟﻠﺘﻘﯿﯿﻢ اﻟﺒﯿﺌﻲ ﻟﻜﻤﯿﺔ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﻓﻲ اﻟﻤﻨﺸﺂت اﻟﺼﺤﯿﺔ، واﻟﺬي ﺗﻢ ﺗﻄﻮﯾﺮه وﻓﻘﺎً ﻟﺘﻮﺟﯿﮭﺎت (PRISMA-P)، ھﺬا وﻗﺪ ﻗﯿﻤﺖ اﻟﺪراﺳﺔ اﻟﺜﺎﻧﯿﺔ ﺗﻠﻮث أﻣﺎﻛﻦ اﻟﻌﻤﻞ ﻟﻌﺪد (10) أدوﯾﺔ ﺗﺴﺘﺨﺪم ﻟﻠﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﻣﻦ ﺧﻼل ﺟﻤﻊ (79) ﻋﯿﻨﺔ ﻣﺴﺢ ﻷﺳﻄﺢ وﺣﺪة اﻟﺼﯿﺪﻟﯿﺔ ووﺣﺪة ﻋﻼج اﻟﻤﺮﺿﻰ ﺑﻤﺮﻛﺰﯾﻦ ﻟﻸورام ﺑﺈﻣﺎرة أﺑﻮظﺒﻲ. أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﺪراﺳﺔ اﻟﺜﺎﻟﺜﺔ، ﻓﻘﺪ ﻛﺎﻧﺖ ﻋﺒﺎرة ﻋﻦ دراﺳﺔ ﻣﻘﻄﻌﯿﺔ ﺑﺈﺳﺘﺨﺪام اﺳﺘﺒﯿﺎن ﺗﻢ ﺗﻌﺒﺄﺗﮫ ذاﺗﯿﺎ ﻣﻦ ﻗﺒﻞ اﻟﻤﺸﺎرﻛﯿﻦ ﻓﻲ اﻟﺪراﺳﺔ، ﺑﮭﺪف ﺗﻘﯿﯿﻢ ﻣﻌﺮﻓﺘﮭﻢ وﺗﺼﻮراﺗﮭﻢ وﻣﻤﺎرﺳﺎﺗﮭﻢ ﺣﻮل اﻟﺘﻌﺎﻣﻞ ﻣﻊ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ.

اﻟﻨﺘﺎﺋﺞ: ﻣﻦ ﺧﻼل اﻟﺪراﺳﺔ اﻷوﻟﻰ، ﺗﻢ ﺗﺴﺠﯿﻞ اﻟﺒﺮوﺗﻜﻮل ﻓﻲ ﻣﻨﺼﺔ (PROSPERO) تحت رقم (CRD42020162780)، ﻛﻤﺎ وﺟﺪت اﻟﺪراﺳﺔ اﻟﺜﺎﻧﯿﺔ 20 ﻋﯿﻨﺔ (%25) ﻣﻠﻮﺛﺔ ﺑﺄدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ. ﻋﻼوة ﻋﻠﻰ ذﻟﻚ، ﺗﻠﻮث 10 ﻋﯿﻨﺎت (%13) ﺑﻌﺪد ﻣﻦ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ، ﺧﺎﺻﺔ ﻓﻲ وﺣﺪة ﺻﯿﺪﻟﯿﺔ اﻷورام ﻓﻲ اﻟﻤﺴﺘﺸﻔﯿﯿﻦ. ﺗﺮاوﺣﺖ ﻣﺴﺘﻮﯾﺎت اﻟﺘﻠﻮث ﻓﻲ اﻟﻌﯿﻨﺎت اﻹﯾﺠﺎﺑﯿﺔ ﻣﻦ 0.003 إﻟﻰ 50 ﻧﺎﻧﻮﻏﺮام/ ﺳﻨﺘﯿﻤﺘﺮ ﻣﺮﺑﻊ. أﻣﺎ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﺪراﺳﺔ اﻟﺜﺎﻟﺜﺔ، ﻓﻘﺪ ﺷﺎرك ﻓﯿﮭﺎ ﻋﺪد (113) ﻣﺸﺎرك ﻣﻦ اﻟﺼﯿﺎدﻟﺔ واﻟﻤﻤﺮﺿﯿﻦ اﻟﻌﺎﻣﻠﯿﻦ ﻓﻲ ﻣﺮاﻛﺰ ﻋﻼج اﻷورام (23 ذﻛﺮ و 90 أﻧﺜﻰ). ﺣﯿﺚ أﺷﺎرت اﻟﺪراﺳﺔ أن ﻣﻌﻈﻢ اﻟﻤﺸﺎرﻛﯿﻦ ﺑﺎﻟﺪراﺳﺔ ﻋﻠﻰ دراﯾﺔ ﺑﺎﻟﻤﺨﺎطﺮ اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﺘﻌﺎﻣﻞ ﻣﻊ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ. ﻛﻤﺎ ﻛﺎن ﻣﺘﻮﺳﻂ درﺟﺔ ﻣﻌﺮﻓﺔ اﻟﻤﺸﺎرﻛﯿﻦ 74.04 ﻣﻦ 100. ھﺬا وﻗﺪ أﺑﺪى ﻏﺎﻟﺒﯿﺔ اﻟﻤﺸﺎرﻛﯿﻦ اﻟﺘﺰاﻣﮭﻢ ﺑﻤﺴﺘﻮﯾﺎت ﻋﺎﻟﯿﺔ ﻻﺳﺘﺨﺪام ﻣﻌﺪات اﻟﺤﻤﺎﯾﺔ اﻟﺸﺨﺼﯿﺔ ﻣﺜﻞ اﻟﻘﻔﺎزات، وﻣﻼﺑﺲ اﻟﻮﻗﺎﯾﺔ وأﻗﻨﻌﺔ اﻟﺤﻤﺎﯾﺔ ﺑﻨﺴﺒﺔ (96.29%، 97.22%، 98.14%) ﻋﻠﻰ اﻟﺘﻮاﻟﻲ، أﺛﻨﺎء اﻟﺘﻌﺎﻣﻞ ﻣﻊ ھﺬه اﻷدوﯾﺔ. ھﺬا ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ ﺗﻠﻘﻰ ﺟﻤﯿﻊ اﻟﻤﺸﺎرﻛﯿﻦ (٪100) ﺗﺪرﯾﺒﺎت ﻣﺘﻌﻠﻘﺔ ﺑﺎﻟﺘﻌﺎﻣﻞ اﻵﻣﻦ ﻣﻊ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﺧﻼل اﻟﻌﺎم اﻟﻤﺎﺿﻲ.

اﻟﻤﺴﺎھﻤﺎت اﻹﺿﺎﻓﯿﺔ اﻟﻤﻤﯿﺰة ﻟﻠﺪراﺳﺔ: ﺗﻮﻓﺮ ﻧﺘﺎﺋﺞ ھﺬا اﻟﺒﺤﺚ ﺑﯿﺎﻧﺎت أﺳﺎﺳﯿﺔ ﻣﮭﻤﺔ ﺣﻮل ﻣﺪى ﺗﻌﺮض ﻣﻤﺎرﺳﻲ اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ ﻷدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﻓﻲ ﺑﯿﺌﺔ اﻟﻌﻤﻞ وﻣﻤﺎرﺳﺎت ﺗﻌﺎﻣﻠﮭﻢ ﻣﻊ ھﺬه اﻷدوﯾﺔ. ﻛﻤﺎ ﯾﻤﻜﻦ اﺳﺘﺨﺪام ﻧﺘﺎﺋﺞ ھﺬا اﻟﺒﺤﺚ ﻟﺘﻄﻮﯾﺮ ﺑﺮاﻣﺞ ﺣﻮل اﻟﺘﻌﺎﻣﻞ اﻵﻣﻦ ﻣﻊ أدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ، واﻟﺘﻲ ﻣﻦ ﺷﺄﻧﮭﺎ أن ﺗﺴﺎھﻢ ﻓﻲ اﻟﺤﺪ ﻣﻦ ﻣﺨﺎطﺮ اﻟﺘﻌﺮض اﻟﻤﮭﻨﻲ ﻟﮭﺬه اﻷدوﯾﺔ. ﻛﻤﺎ ﺗﺸﯿﺮ اﻟﻨﺘﺎﺋﺞ أﯾﻀﺎً إﻟﻰ أھﻤﯿﺔ ﻋﻤﻞ اﻟﻤﻨﺸﺂت اﻟﺼﺤﯿﺔ ﻟﺘﻘﯿﯿﻢ ﺑﯿﺌﻲ ﻷدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ﻓﻲ ﻣﻨﺸﺂﺗﮭﺎ، واﻟﺬي ﺳﯿﺴﺎھﻢ إﻟﻰ رﻓﻊ ﻣﺴﺘﻮى ﻛﻼً ﻣﻦ ﻣﻌﺮﻓﺔ وﻣﻤﺎرﺳﺎت ﻣﻤﺎرﺳﻲ اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ اﻟﻌﺎﻣﻠﯿﻦ ﻓﻲ ﻣﺮاﻛﺰ اﻷورام ﺑﮭﺬا اﻟﻤﻮﺿﻮع.

اﻟﻔﺠﻮات اﻟﻤﻌﺮﻓﯿﺔ اﻟﺘﻲ أﻏﻠﻘﺘﮭﺎ اﻟﺪراﺳﺔ: دراﺳﺔ اﻟﺘﻘﯿﯿﻢ اﻟﺒﯿﺌﻲ ﻹﺣﺘﻤﺎل ﺗﻠﻮث ﺑﯿﺌﺔ اﻟﻌﻤﻞ ﺑﺄدوﯾﺔ اﻟﻌﻼج اﻟﻜﯿﻤﯿﺎﺋﻲ ھﻲ اﻟﺪراﺳﺔ اﻷوﻟﻰ ﻓﻲ ﻣﻨﻄﻘﺔ اﻟﺸﺮق اﻷوﺳﻂ وﺷﻤﺎل إﻓﺮﯾﻘﯿﺎ (MENA)، وﻓﻲ دوﻟﺔ اﻹﻣﺎرات اﻟﻌﺮﺑﯿﺔ اﻟﻤﺘﺤﺪة ﻋﻠﻰ وﺟﮫ اﻟﺨﺼﻮص، واﻟﺘﻲ ﻗﯿﻤﺖ اﻟﺘﻠﻮث اﻟﺒﯿﺌﻲ اﻟﻤﺤﺘﻤﻞ ﻟﻌﺸﺮة أدوﯾﺔ ﻋﻼج ﻛﯿﻤﯿﺎﺋﻲ ﻓﻲ وﺣﺪات اﻟﺼﯿﺪﻟﯿﺎت وﻋﻼج اﻟﻤﺮﺿﻰ ﻓﻲ ﻣﺮاﻛﺰ ﻋﻼج اﻷورام. ھﺬا ﺑﺎﻹﺿﺎﻓﺔ، إﻟﻰ أن دراﺳﺔ اﻟﻤﻌﺮﻓﺔ واﻟﺘﺼﻮرات واﻟﻤﻤﺎرﺳﺎت (KAP) ھﻲ اﻟﺪراﺳﺔ اﻷوﻟﻰ ﻓﻲ دوﻟﺔ اﻹﻣﺎرات اﻟﻌﺮﺑﯿﺔ اﻟﻤﺘﺤﺪة، واﻟﺘﻲ ﻗﯿﻤﺖ ﻣﺴﺘﻮى ﻣﻌﺮﻓﺔ وﺗﺼﻮرات وﻣﻤﺎرﺳﺎت ﻣﻤﺎرﺳﻲ اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ اﻟﻌﺎﻣﻠﯿﻦ ﻓﻲ ﻣﺮاﻛﺰ ﻋﻼج اﻷورام ﺗﺠﺎه اﻟﺘﻌﺎﻣﻞ ﻣﻊ ھﺬه اﻷدوﯾﺔ.

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