Reduction in Surface Contamination with Cyclophosphamide in 30 US Hospital Pharmacies following Implementation of a Closed-System Drug Transfer Device

Abstract

The CSTD significantly reduced, but did not totally eliminate, surface contamination with cyclophosphamide. In addition to other protective measures, increased usage of CSTDs should be employed to help protect health care workers from exposure to hazardous drugs.

Reproductive Health Risks Associated With Occupational Exposures to Antineoplastic Drugs in Health Care Settings

“…Some studies have shown an association between surface contamination and worker exposure 13–15 . Industrial hygiene studies suggest that work-place contamination with antineoplastic drugs in the United States has not changed considerably over the past decade or more, indicating that worker exposure probably has not changed considerably, despite efforts to reduce or eliminate environmental contamination 14,16–19 .…”

“…More recent attempts to reduce or eliminate workplace contamination have included using engineering controls such as compounding aseptic containment isolators (CACIs), robotic systems, and closed system drug transfer devices (CSTDs) 17–19, 21–23 . This research suggests that even when these controls are used in healthcare settings, the potential for exposure to antineoplastic drugs cannot be completely eliminated 12,14, 18,19,24–31 .…”

Environmental Contamination with Cyclophosphamide, Ifosfamide, and Methotrexate: A Study of 51 Canadian Centres

“…Similar sites were found to be highly contaminated in another recent large study involving 30 US hospitals. In that study, Sessink and others 16 found that 97% of samples from the front grille of the hood and 82% of those from the floor in front of the hood were positive for cyclophosphamide.…”

“…Even though numerous studies have shown that CSTDs can reduce contamination, their use does not completely eliminate contamination. For instance, Sessink and others 16 found a median of 1.69 ng/cm² (or 1690 pg/cm²) of cyclophosphamide on the front grille of the hood before CSTDs were in use and 0.39 ng/cm² (or 390 pg/cm²) after CSTDs were implemented. In the current study, the median concentration of cyclophosphamide on the front grille of the hood was 43 pg/cm² at hospitals not using a CSTD (n = 12) and 15 pg/cm² at hospitals that did use such devices (n = 37).…”

Analysis of a Questionnaire Survey regarding Current Conditions against Exposure to Anticancer Drugs and Reports of Cancer Chemotherapy at Outpatient Departments in Japan

“…The guidelines recommend the use of class II type B2 BSCs as opposed to type A2 BSCs in [13]. It also reduces the contamination of infusion lines by cyclophosphamide, ifosfamide, and fluorouracil [14] in BSCs, on the floor, and in workstations [15]. Since the use of CSTDs in all occasions is difficult, it is desirable to carry out back-priming, which is a way of bypassing the main infusion route.…”