Application and Assessment of a Regular Environmental Monitoring of the Antineoplastic Drug Contamination Level in Pharmacies - The MEWIP Project

Kiffmeyer, Thekla K.; Tuerk, Jochen; Hahn, Moritz; Stuetzer, Hartmut; Hadtstein, Claudia; Heinemann, André W.; Eickmann, Udo

doi:10.1093/annhyg/mes081

Cited by 50 publications

(55 citation statements)

References 19 publications

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“…USP Chapter <797> recommends an ‘action level’ of 1.0 ng/cm 2 for cyclophosphamide, but a recommendation to keep values as low as 0.1 ng/cm 2 would seem to be a reasonably achievable goal. (46,56) …”

Section: Discussionmentioning

confidence: 99%

“…Based on their observation, contamination values above the 75 th percentile were considered high and that handling procedures needed to be optimized. In another German report, Kiffmeyer et al (46) recommended the use of the 90 th percentile and suggested a guidance value of 0.1 ng/cm 2 based on their findings for 5-fluorouracil contamination. However, such an approach requires a large amount of wipe sampling data which is not available in the U.S and suggested values would not be based on a health outcome.…”

Section: Methodsmentioning

confidence: 99%

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Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations

Connor

Zock

Snow³

2016

Journal of Occupational and Environmental Hygiene

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Purpose Surface wipe sampling for various hazardous agents has been employed in many occupational settings over the years for various reasons such as evaluation of potential dermal exposure and health risk, source determination, quality or cleanliness, compliance, and others. Wipe sampling for surface residue of antineoplastic and other hazardous drugs in healthcare settings is currently the method of choice to determine surface contamination of the workplace with these drugs. The purpose of this article is to review published studies of wipe sampling for antineoplastic and other hazardous drugs, to summarize the methods in use by various organizations and researchers, and to provide some basic guidance for conducting surface wipe sampling for these drugs in healthcare settings. Methods Recommendations on wipe sampling methodology from several government agencies and organizations were reviewed. Published reports on wipe sampling for hazardous drugs in numerous studies were also examined. The critical elements of a wipe sampling program and related limitations were reviewed and summarized. Results Recommendations and guidance are presented concerning the purposes of wipe sampling for antineoplastic and other hazardous drugs in the healthcare setting, technical factors and variables, sampling strategy, materials required, and limitations. The reporting and interpretation of wipe sample results is also discussed. Conclusions It is recommended that all healthcare settings where antineoplastic and other hazardous drugs are handled consider wipe sampling as part of a comprehensive hazardous drug ‘safe handling’ program. Although no standards exist for acceptable or allowable surface concentrations for these drugs in the healthcare setting, wipe sampling may be used as a method to characterize potential occupational dermal exposure risk and to evaluate the effectiveness of implemented controls and the overall the safety program. A comprehensive safe-handling program for antineoplastic drugs may utilize wipe sampling as a screening tool to evaluate environmental contamination and strive to reduce contamination levels as much as possible, using the industrial hygiene hierarchy of controls.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations

Connor

Zock

Snow³

2016

Journal of Occupational and Environmental Hygiene

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“…For sampling we chose a day regarded as »normal« by the staff in terms of the number of treatments. Samples from the working and other surfaces were taken with wipes (24).…”

Section: Methodsmentioning

confidence: 99%

“…The risk of exposure is not limited to healthcare workers who prepare (pharmacists and pharmacy technicians) or administer (nurses) cytotoxic agents. Anyone in touch with contaminated air or objects or even patient excreta is at risk (12,(22)(23)(24)(25)(26). One Dutch study (25) identified home care, nursing homes, and laundry facilities as non-hospital occupational settings with higher exposure, which were all related to the care of cancer patients.…”

mentioning

confidence: 99%

Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Viegas

Oliveira

Carolino

et al. 2018

Archives of Industrial Hygiene and Toxicology

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Healthcare workers who prepare or administer cytotoxic agents run the risk of exposure, and the risks for health are real even at doses lower than those applied in cancer patients, because, in theory, no dose is safe. The most common and problematic route of exposure is through the skin, especially as work surfaces can remain contaminated even after cleaning. This pilot study aimed to demonstrate the importance of having an effective surface decontamination protocol by determining surface contamination with cyclophosphamide, 5-fluorouracil, and paclitaxel as the most common cytotoxic drugs in an oncology day service. Samples were collected before and after drug handling and analysed with high performance liquid chromatography with diode array detection (HPLC-DAD). Of the 29 samples collected before drug handling 23 were contaminated, five of which with more than one drug. Of the 30 samples collected after drug handling 25 were contaminated, eight of which with more than one drug. The two time points did not significantly differ, which evidences a widespread contamination and ineffective cleaning. This calls for revising the cleaning protocol and handling procedure to place contamination under control as much as possible.

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“…These workers include shipping and receiving personnel, pharmacists and pharmacy technicians, nursing personnel, and environmental services personnel (20). Workers employed in the synthesis and production of these products and staff involved in cleaning, transport, and disposal of hazardous drugs or contaminated material may all face health risks (20,36,(84)(85)(86). A study done by Meijster and colleagues (84) discussed the most important occupational settings outside hospitals in the Netherlands, where exposure to antineoplastic can also occur.…”

Section: Occupational Exposure To Antineoplastic Drugsmentioning

confidence: 99%

Forgotten public health impacts of cancer – an overview

Viegas

Ladeira

Veiga

et al. 2017

Archives of Industrial Hygiene and Toxicology

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Cancer is one of the diseases of greatest concern in developed countries and much effort has been invested in discovering and developing therapeutics for curing cancer. Despite the improvements in antineoplastic therapeutics in the last decades, cancer is still one of the most harmful diseases worldwide. The global burden of cancer also implies financial costs: these can be direct costs, such as those related to treatment, care, and rehabilitation and indirect, which include the loss of economic output due to missed work (morbidity costs) and premature death (mortality costs). There are also hidden costs such as health insurance premiums and nonmedical expenses that are worth noting. This paper intends to present an overview of the generally forgotten impacts that the increasing number of cancer cases can have on the environment, workers who handle antineoplastic drugs, and health services. The knowledge available of each of the impacts will be addressed and discussed regarding the expected development. Overall, lessons learnt reflect on the impact of cancer through aspects not commonly evidenced in the literature or even considered in socio-economic analysis, in part due to the fact that these are difficult to contemplate in direct and indirect cancer costs already defined. Attention may be drawn to the need of continuous investment in prevention to reduce the negative impact on the environment, and in the health of workers who handle antineoplastic drugs for patients' treatment. KEY WORDS: costs of cancer; global burden; occupational healthGlobally, cancer is a growing public health problem. It is the second cause of death (21 %) after cardiovascular diseases (48 %), followed by respiratory diseases (12 %) in the sector of non-communicable diseases or diseases caused by non-infectious and non-transmissible medical conditions (1). Important resources are mobilised in order to improve research on new therapeutics, and ultimately devise a cure for this particular disease. Despite the increase in the effectiveness and specificity of chemotherapeutic treatments, cancer still remains one of the most harmful diseases (2-4).In 2012, worldwide incidence of cancer rose to an estimated 14 million new cases per year, with an estimated 8.2 million cancer deaths. The most common cancers diagnosed were of lung (1.8 million cases, 13 %), breast (1.7 million, 11.9 %) and colon (1.4 million, 9.7 %) (1

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Application and Assessment of a Regular Environmental Monitoring of the Antineoplastic Drug Contamination Level in Pharmacies - The MEWIP Project

Cited by 50 publications

References 19 publications

Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations

Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations

Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure

Forgotten public health impacts of cancer – an overview

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