Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program

Abstract

Introduction Healthcare workers exposure to antineoplastic drugs can lead to adverse health effects. Guidelines promote the safe handling of antineoplastic drugs, but no safe exposure limit was determined. Regular surface sampling contributes to ensuring workers safety. Methods A cross-sectional monitoring is conducted once a year with voluntary Canadian centers, since 2010. Twelve standardized sampling sites were sampled. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng/cm2) were: 0.001 for cyclophosphamide and gemcitabine; 0.3 for docetaxel and ifosfamide; 0.04 for 5-fluorouracil and paclitaxel; 0.003 for irinotecan; 0.002 for methotrexate; 0.01 for vinorelbine. Results The surfaces from 109 centers were sampled between 01/01/2020–18/06/2020. Twenty-six centers delayed their participation because of the COVID-19 pandemic. 1217 samples were analyzed. Surfaces were frequently contaminated with cyclophosphamide (34% positive, 75th percentile 0.00165 ng/cm2) and gemcitabine (16% and <0.001 ng/cm2). The armrest of patient treatment chairs (84% to at least one drug), the front grille inside the biological safety cabinet (BSC) (73%) and the floor in front of the BSC (55%) were frequently contaminated. Centers that prepared ≥5000 antineoplastic drugs annually had higher concentration of cyclophosphamide on their surfaces (p < 0.0001). Contamination measured on the surfaces was reduced from 2010 to 2020. Conclusions This large-scale study showed reproducible long term follow up of the contamination of standardized sites of Canadian centers and a reduction in surface contamination from 2010 to 2020. Periodic surface sampling help centers meet their continuous improvements goals to reduce exposure as much as possible. The COVID-19 pandemic had a limited impact on the program.

Levels and risks of surface contamination by thirteen antineoplastic drugs in the Czech and Slovak hospitals and pharmacies

“…Similar conclusions were also published by (Schierl et al 2009) from 102 German hospitals. On the contrary, a recent study by Canadian authors (Chabut et al 2021) based on 1217 samples from 109 centers showed that workplaces with the annual number of ADs preparations above 5 000 (i.e., above 400 monthly preparations to compare with our study; cf Table 1) had higher surface concentrations of CP. Similarly, Palamini et al (2020) concluded that higher numbers of CP preparations result in higher CP surface contamination, and the correlation with numbers of AD preparations was also reported in a study of 24 Swiss hospital pharmacies (Fleury-Souverain et al 2015).…”

“…On the other hand, the pharmacy areas outside the preparation (dispatch areas or storage rooms) were more contaminated in SK compared to the CZ. This confirms that a significant reduction in contamination in the CZ can be achieved through the implementation of complex management measures including regular monitoring (Chabut et al 2021;Kiffmeyer et al 2013;Yoshida et al 2013), preventive and corrective measures such as the use of zones, adjusted cleaning procedures (Odraska et al 2013), regular training of pharmaceutical staff (Odraska et al 2014;Ozakin et al 2019), or using of closed drug transfer devices (Siderov et al 2010).…”

“…In the CZ, AD contamination has been assessed since 2009, and the systematic monitoring together with subsequent corrective actions significantly contributed to the decrease of exposures (Blahova et al 2020;Odraska et al 2013). On the other hand, Slovak workplaces were first monitored in 2018 as captured in the present study, and future improvements can be expected in the case of sustained periodic monitoring followed by the measures taken for a safe handling of ADs (Chabut et al 2021;Odraska et al 2013;Yoshida et al 2013).…”

“…In addition to the three major ADs, Pt, CP, and FU, that have been extensively studied before (Odraska et al 2013;Schierl et al 2009;Acampora et al 2005), ten new ADs were included in the present study. To cover a broader range of ADs in monitoring is recommended due to heterogeneity of physical and chemical properties of ADs (Fabrizi et al 2016), and recent studies from Canada brought some first information on contamination profiles (Chabut et al 2021;Palamini et al 2020).…”

“…Monitoring of ADs indoor contamination in hospitals and pharmacies has been established as an important element in the overall management of AD occupational risks (Chabut et al 2021;Palamini et al 2020). In particular, analyses of surface contamination through the collection of wipe samples are among the main methods of monitoring (Colombo et al 2017;Connor et al 2016;Jeronimo et al 2015), also because dermal contact is considered the most common pathway for occupational exposure to ADs (Kromhout et al 2000).…”