How to protect environment and employees against cytotoxic agents, the UZ Ghent experience

Vandenbroucke, Johan; Robays, Hugo

doi:10.1177/107815520100600403

Cited by 56 publications

(38 citation statements)

References 13 publications

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“…Since the early 1990s, studies by a number of researchers have examined environmental contamination of areas where anticancer drugs are prepared and administered in healthcare facilities 18–31 . Using wipe samples, all investigators measured detectable levels of one or more anticancer drugs in various locations, such as surfaces in biological safety cabinets (BSCs), floors, countertops, storage areas, tables and chairs in patient treatment areas, and locations adjacent to drug‐handling areas.…”

Section: Sources For Workplace Exposuresmentioning

confidence: 99%

Hazardous Anticancer Drugs in Health Care

Connor

2006

Annals of the New York Academy of Sciences

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Exposure of healthcare workers to anticancer drugs became problematic in the 1970s. Shortly thereafter, studies began documenting exposure of healthcare workers to these drugs. Investigations employing biological markers, such as urine mutagenicity, chromosomal aberrations, sister chromatid exchanges, and micronuclei, demonstrated associations between occupational exposures and elevated marker levels. Other analytical methods emerged to monitor workplaces where drugs were handled. These contemporary studies uncovered widespread contamination of drugs on work surfaces, trace amounts in air samples, and their presence in the urine of workers. Vials containing these drugs are often contaminated with the drug when they are shipped. Most workplace surfaces are contaminated with the drugs being prepared and used in that area. Other anticancer/hazardous drugs would most likely be used in these areas. The interior surfaces of biological safety cabinets and isolators, floors, countertops, carts, storage bins, waste containers, treatment areas, tabletops, chairs, linen, and other items are all potential sources of exposure to anticancer drugs. Patient body fluids contain the drugs and/or metabolites, often more biologically active than the parent compounds. An exposure assessment of areas where anticancer/hazardous drugs are handled must consider every potential source and route of exposure. Data from surface contamination and inhalation studies suggest that dermal exposure is the primary route of exposure. Assessment of exposure is the first step in providing a safe work environment for these workers. However, because of the many drugs to which they are exposed, any assessment can only be an estimation of the overall exposure.

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Section: Sources For Workplace Exposuresmentioning

confidence: 99%

Hazardous Anticancer Drugs in Health Care

Connor

2006

Annals of the New York Academy of Sciences

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“…24 The disconnection procedure is a risk for exposure for nurses, and it is recommended that any remaining drug from the tubing be flushed before disconnecting the set without removing the tubing from the IV bag containing a cytotoxic drug. 16,[24][25][26] Despite this increased protection, personal protective equipment, including gown, gloves, and goggles if needed, must still be worn because there The system is closed and has luer-lock connectors.…”

Section: Journal Of Infusion Nursingmentioning

confidence: 99%

Evaluation of Safe Infusion Devices for Antineoplastic Administration

Lalande

Galy²,

Dussossoy³

et al. 2012

Journal of Infusion Nursing

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Nurses endure daily low-level exposure to cytotoxic drugs, which can lead to significant absorption with potential harmful consequences. New sterile medical devices called cytotoxic safe infusion systems (CSISs), intended by their manufacturers to improve safety and quality of cytotoxic drug infusions, have been made commercially available. CSISs from 3 manufacturers were tested in 2 cancer units and compared with standard infusion sets. The aim of this study is to evaluate the devices regarding occupational exposure, quality of the infusion, and economic aspects.

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“…Over the last 20 years, several studies have reported environmental contamination with hazardous drugs in hospital pharmacies (Castiglia et al 2008; Ensslin et al 1994; Hedmer et al 2008; McDevitt et al 1993; Sessink et al 1992; Sessink et al 1995; Sugiura et al 2011; Vandenbroucke and Robays 2001; Yoshida et al 2011). In addition, hazardous drugs were inadvertently absorbed, as determined by the presence of parent compounds and/or their metabolites in the urine of health care workers ( Ensslin et al 1997; Schreiber et al 2003; Sessink et al 1992;Sessink et al 1994; Sessink et al 1997).…”

Section: Introductionmentioning

confidence: 99%

“…However, we revealed that cyclophosphamide (CP) was still detected at the sites of the wipe tests as well as in urine samples from all pharmacists in charge of CP compounding ( Tanimura et al 2009 ). Several studies have shown nearly complete containment or reduction in surface contamination accompanying preparation and/or administration of hazardous drug ( Connor et al 2002 ; Vandenbroucke and Robays 2001 ; Wick et al 2003 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of closed-system drug transfer device on exposure of environment and healthcare provider to cyclophosphamide in Japanese hospital

et al. 2013

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In spite of current recommended safe handling procedures, the potential for the exposure of healthcare providers to hazardous drugs exists in the workplace. A reliance on biological safety cabinets to provide total protection against the exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimize cytotoxic drug exposure in healthcare providers. This study was conducted to compare surface contamination and personnel exposure to cyclophosphamide before and after the implementation of a closed-system drug transfer device, PhaSeal, under the influence of cleaning according to the Japanese guidelines. Personnel exposure was evaluated by collecting 24 h urine samples from 4 pharmacists. Surface contamination was assessed by the wiping test. Four of 6 wipe samples collected before PhaSeal indicated a detectable level of cyclophosphamide. About 7 months after the initiation of PhaSeal, only one of 6 wipe samples indicated a detectable level of cyclophosphamide. Although all 4 employees who provided urine samples had positive results for the urinary excretion of cyclophosphamide before PhaSeal, these levels returned to minimal levels in 2 pharmacists after PhaSeal. In combination with the biological safety cabinet and cleaning according to the Japanese guidelines, PhaSeal further reduces surface contamination and healthcare providers exposure to cyclophosphamide to almost undetectable levels.

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How to protect environment and employees against cytotoxic agents, the UZ Ghent experience

Cited by 56 publications

References 13 publications

Hazardous Anticancer Drugs in Health Care

Hazardous Anticancer Drugs in Health Care

Evaluation of Safe Infusion Devices for Antineoplastic Administration

Impact of closed-system drug transfer device on exposure of environment and healthcare provider to cyclophosphamide in Japanese hospital

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