Exposure to Carcinogenic, Mutagenic, and Reprotoxic Chemical Agents in Research Laboratories and the Healthcare Sector: A Systematic Review

Background: Carcinogenic, Mutagenic, and Reprotoxic (CMR) substances are among the most significant occupational health hazards in healthcare and research laboratories. Despite preventive measures and regulations, exposure assessment and risk management remain complex due to varied working practices, mixed exposures, and the lack of harmonized monitoring protocols. This systematic review investigates occupational exposure to CMR substances in laboratory and healthcare environments. Methods: Searches were conducted in PubMed, Scopus, and Web of Science up to February 2025 using tailored keyword strategies. Studies published between 2020 and 2025 reporting exposure assessment, monitoring, and/or risk management of CMR chemicals were included; non-English papers and irrelevant studies were excluded. Titles/abstracts and full texts were screened independently by two reviewers with arbitration by a third. Risk of bias was assessed by three authors who independently evaluated each study. A narrative synthesis with frequency tables was performed; no meta-analysis was conducted. Results: Of 446 screened records, 50 studies were included. Formaldehyde (25 studies) and antineoplastic drugs (18 studies) were most frequently examined. Healthcare settings—e.g., hospital pharmacies, oncology wards, and pathology laboratories—were predominant, while research laboratories were underrepresented. Inhalation was the main exposure route for formaldehyde, whereas dermal uptake and surface contamination predominated for antineoplastic drugs. Monitoring methods included air sampling, surface wipe testing, and biological assays; preventive strategies varied and were inconsistently applied. Most included studies involved environmental monitoring and did not report participant numbers, so a total number of participants cannot be aggregated; for the main outcomes, participant counts were often not available. Limitations of the evidence include marked heterogeneity across settings, matrices, analytical methods, and reporting units, which precluded meta-analysis, as well as imprecision and incomplete reporting in several studies. Conclusions: Findings reveal persistent gaps in harmonized exposure limits, monitoring standards, and long-term health surveillance, underscoring the need for comprehensive prevention strategies. This review was not registered and did not receive any external funding.