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

Abstract

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.

Cross-sectional evaluation of surface contamination with 9 antineoplastic drugs in 93 Canadian healthcare centers: 2019 results

“…In published studies, the proportion of cyclophosphamide-positive surface samples has ranged from 17.2% to 83%. 16,17,[19][20][21][22] Although cyclophosphamide was the third most commonly used drug in our study, the median amount of cyclophosphamide used by hospitals in our study was 6.7 times lower than the median amount for 5-FU (281 g vs. 1885 g). In terms of trace contamination, the proportion of cyclophosphamide-positive samples was higher than the proportion of 5-FU-positive samples (32.4% vs. 8.5%).…”

Evaluation of decontamination strategies for cyclophosphamide

“…No cleaning product was able to remove 100% of the cyclophosphamide applied, as reported by other groups. 6,8…”

“…These authors also pointed to contamination in areas regularly used by staff or patients (“high touch” areas). 8 It is therefore important to review procedures for cleaning contaminated areas, with emphasis on cleaning several times during the day and targeting areas at high risk of contamination.…”

Mycotoxins—Biomonitoring and Human Exposure

“…Exposure to mycotoxins does not always have to be related to food consumption. There are studies [14][15][16][17][18][19][20][21][22] that explored the occurrence of mycotoxins in working or living environments and the results showed that exposure to mycotoxins can be related to these places too. This will be further discussed in Section 2.…”