Health Surveillance Protocol for Healthcare Workers Occupationally Exposed to Cytostatic Drugs
Synopsis
Cytostatic drugs are classified as hazardous medicinal products due to their carcinogenic, mutagenic, and reproductive toxicity. Healthcare workers may be occupationally exposed throughout the drug circuit, raising concerns regarding long-term health effects. Objectives: To describe occupational exposure pathways to cytostatic drugs in hospital settings and to systematise a structured health surveillance protocol for exposed healthcare workers. Methodology: A review of international guidelines, regulatory frameworks, and scientific literature was conducted, supporting the development of a health surveillance protocol adapted to hospital occupational health practice. Results: Occupational exposure occurs predominantly via the dermal route while respiratory exposure represents a less relevant route under routine conditions, although it may become significant during specific tasks. Digestive exposure may occur secondarily. Exposure affects multiple professional groups, including pharmacists, nurses, physicians, operational assistants, and cleaning staff. Environmental and biological monitoring present methodological limitations, reinforcing the need for preventive strategies based on the as low as reasonably achievable principle (ALARA). A structured surveillance programme was defined, with specific criteria for fitness for work criteria for vulnerable workers. Conclusions: Health surveillance programmes should be risk-based and integrated with preventive measures to ensure effective exposure control and early detection of adverse health effects.
