Purpose The aim of this study was to monitor environmental contamination by 10 antineoplastic drugs in Canadian oncology pharmacy and patient care areas. The secondary objective was to explore the impact of factors that may explain contamination. Methods Twelve standardized sites were sampled in each center (six in the pharmacy and six in patient care areas). Each sample was prepared to allow quantification of seven antineoplastic drugs (cyclophosphamide, ifosfamide, methotrexate, cytarabine, gemcitabine, 5-fluorouracil, irinotecan) by UPLC-MS-MS. Docetaxel, paclitaxel and vinorelbine were also detected, but not quantified due to sensibility limitations. The impact of some factors was evaluated compared with a Kolmogorov-Smirnov test for independent samples. Results Eighty-three Canadian centers were recruited in 2017. A total of 953 surfaces were sampled, 495 in pharmacy and 458 in patient care areas. Cyclophosphamide was most often found on surfaces (36% of samples positive, 75th percentile 0.0040 ng/cm). The arm rest (81.7% of samples positive for at least one antineoplastic drug), the front grille inside the hood (78.3%) and the floor in front of the hood (61.4%) were more frequently contaminated. Centers who prepared more antineoplastic drugs per year had higher concentration on different surfaces ( p < 0.0001). Conclusion Despite growing awareness and implementation of new safe handling guidelines, healthcare centers' surfaces remain contaminated with traces of many antineoplastic drugs. The use of personal protective equipment remains indisputable. Performing an annual monitoring remains a good indicator to monitor trends over time and to compare with similar centers.
<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Several studies have compared cleaning procedures for decontaminating surfaces exposed to antineoplastic drugs. All of the cleaning products tested were successful in reducing most of the antineoplastic drug quantities spilled on surfaces, but none of them completely<br />removed residual traces.</p><p><strong>Objective:</strong> To assess the efficacy of various cleaning solutions for decontaminating a biological safety cabinet workbench exposed to a defined amount of cyclophosphamide.</p><p><strong>Methods:</strong> In this pilot study, specific areas of 2 biological safety cabinets (class II, type B2) were deliberately contaminated with a defined quantity of cyclophosphamide (10 μg or 107 pg). Three cleaning solutions were tested: quaternary ammonium, sodium hypochlorite 0.02%, and sodium hypochlorite 2%. After cleaning, the cyclophosphamide remaining on the areas was quantified by wipe sampling. Each cleaning solution was tested 3 times, with cleaning and wipe sampling being performed 5 times for each test.</p><p><strong>Results:</strong> A total of 57 wipe samples were collected and analyzed. The average recovery efficiency was 121.690% (standard deviation 5.058%). The decontamination efficacy increased with the number of successive cleaning sessions: from 98.710% after session 1 to 99.997% after session 5 for quaternary ammonium; from 97.027% to 99.997% for sodium hypochlorite 0.02%; and from 98.008% to 100% for sodium hypochlorite 2%. Five additional cleaning sessions performed after the main study (with detergent and sodium hypochlorite 2%) were effective to complete the decontamination, leaving no detectable traces of the drug.</p><p><strong>Conclusions:</strong> All of the cleaning solutions reduced contamination of biological safety cabinet workbenches exposed to a defined amount of cyclophosphamide. Quaternary ammonium and sodium hypochlorite (0.02% and 2%) had mean efficacy greater than 97% for removal of the initial quantity of the drug (107 pg) after the first cleaning session. When sodium hypochlorite 2% was used, fewer cleaning sessions were required to complete decontamination. Further studies should be conducted to identify optimal cleaning strategies to fully eliminate traces of hazardous drugs.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> Bon nombre d’études ont comparé les méthodes de nettoyage pour décontaminer les surfaces exposées aux antinéoplasiques. Toutes les solutions de nettoyage évaluées permettaient d’enlever la majeure partie des quantités d’antinéoplasiques renversés sur les surfaces, mais aucune n’arrivait à éliminer les traces résiduelles.</p><p><strong>Objectif :</strong> Évaluer l’efficacité de différentes solutions de nettoyage servant à décontaminer une enceinte de sécurité biologique exposée à une quantité précise de cyclophosphamide.</p><p><strong>Méthodes :</strong> Dans la présente étude pilote, des zones déterminées de deux enceintes biologiques (classe II, type B2) ont été délibérément contaminées avec une quantité précise de cyclophosphamide (10 μg ou 107 pg). Trois solutions de nettoyage ont été évaluées : l’ammonium quaternaire, l’hypochlorite de sodium à 0,02 % et l’hypochlorite de sodium à 2 %. Après nettoyage, le cyclophosphamide toujours présent sur les surfaces était quantifié à l’aide de prélèvements par lingette. Chaque solution de nettoyage a été évaluée trois fois, tandis que le nettoyage et le prélèvement par lingette ont été répétés cinq fois pour chaque test.</p><p><strong>Résultats :</strong> Au total, on a recueilli et analysé 57 lingettes ayant servi à l’échantillonnage. Le taux moyen d’efficacité de récupération était de 121,690 % (écart-type de 5,058 %). L’efficacité de la décontamination augmentait en fonction du nombre de séances successives de nettoyage : de 98,710 % après le premier nettoyage à 99,997 % après le cinquième nettoyage pour l’ammonium quaternaire; de 97,027 % à 99,997 % pour l’hypochlorite de sodium à 0,02 %; et de 98,008 % à 100 % pour l’hypochlorite de sodium à 2 %. Après l’étude principale, cinq séances de nettoyage supplémentaires (avec détergent et hypochlorite de sodium à 2%) ont permis de terminer la décontamination, ne laissant aucune trace détectable du médicament.</p><p><strong>Conclusions :</strong> Toutes les solutions de nettoyage réduisaient la contamination d’une enceinte de sécurité biologique exposée à une quantité précise de cyclophosphamide. L’efficacité moyenne de l’ammonium quaternaire et de l’hypochlorite de sodium (à 0,02 % et à 2 %) pour éliminer la quantité initiale de 107 pg du médicament s’élevait à plus de 97 % après la première séance de nettoyage. Lorsque l’hypochlorite de sodium à 2 % était employé, un moins grand nombre de séances de nettoyage était nécessaire pour terminer la décontamination. De plus amples études sont nécessaires afin de pouvoir trouver des stratégies de nettoyage optimales permettant d’éliminer entièrement les traces de médicaments dangereux.</p>
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