Re-evaluation of urine mutagenicity of pharmacy personnel exposed to antineoplastic agents

Connor, Thomas H.; Theiss, Jeffrey C.; Anderson, Roger W.; Puckett, William H.; Matney, Thomas S.

doi:10.1093/ajhp/43.5.1236

Cited by 9 publications

(4 citation statements)

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“…The adoption of improved handling techniques, and in particular the use of cytotoxic drug safety cabinets, has reduced the exposure to cytotoxic drugs in health workers to levels that could not be detected at that time. [16][17][18] Studies from Europe using improved detection methods have demonstrated measurable levels of contamination in the healthcare setting. [19][20][21][22] Cyclophosphamide, doxorubicin, fluorouracil, ifosfamide and methotrexate were detected in the air, on work surfaces and in manufacturing and preparation areas even though the drugs were prepared in biological safety cabinets.…”

Section: Introductionmentioning

confidence: 99%

Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments

Siderov

Kirsa

McLauchlan

2009

Pharmacy Practice and Res

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Background Studies from Europe, the US and Australia have shown measurable levels of cytotoxic contamination in health facilities. Cytotoxic drug residue has been detected in the air and on surfaces in preparation areas even though work was undertaken in biological safety cabinets. Several studies have found substantial levels of surface contamination in pharmacy drug preparation and administration areas. At the time this study was conducted there were no published Australian studies investigating surface contamination when cytotoxic drug safety cabinets are in use. Aim To determine if surface contamination with cytotoxic drugs occurs when cytotoxic drug safety cabinets are used by pharmacy personnel to prepare cytotoxic chemotherapy. Method A multicentre study conducted at 10 hospital pharmacy departments in metropolitan Melbourne. All sites were tested to measure the amount of cytotoxic contamination present using cyclophosphamide as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified locations within the cytotoxic suites. Results Cyclophosphamide contamination was detected in 78% of samples taken within the cytotoxic drug safety cabinet, with 100% contamination detected in the sump. Positive results were also found in 89% of floor samples (cleanroom and anteroom) and 67% of checking benches. Conclusion Cytotoxic drug contamination was detected on a variety of surfaces in the cytotoxic drug preparation areas that used cytotoxic drug safety cabinets. The potential risk of exposure to cytotoxic drugs exists in the workplace despite adherence to the recommended safe handling guidelines.

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Section: Introductionmentioning

confidence: 99%

Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments

Siderov

Kirsa

McLauchlan

2009

Pharmacy Practice and Res

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“…The occupational exposure associated with drugs manipulation has been known for 4 decades [19][20][21][22][23][24]. The possible risk for health professionals, related to drugs, is determined by the inherent toxicity of the active principle, but the level of risk is also determined by the process or manipulation that must be carried out with the drug.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive tackling to the safe handling of hazardous drugs: a multidisciplinary approach to clinical practice

Vuelta-Arce¹,

Chiapella-Micó²,

Mestre-Prad³

et al. 2020

Int J Occup Med Environ Health

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The aim of this study is to present the adaptation and implementation of the recommendations of the National Institute for Safety and Health at Work (Instituto Nacional de Seguridad y Salud en el Trabajo-INSHT) in the authors' hospital to achieve a safer handling of hazardous drugs. Material and Methods: In 2016, INSHT published the first document on hazardous drugs in Spain. In the authors' center, a project was developed to implement the recommendations presented in that document in 2 phases: 1) analysis: to identify drugs and processes susceptible to not being handled as hazardous, and to search for safer alternatives and preventive measures; and 2) development: to ensure information, training, the adaptation of standardized work procedures, the minimization of risks associated with handling, safety devices, personal protective equipment (PPE), as well as health monitoring. Results: The authors detected 80 commercial presentations manipulated without adhering to safety conditions, mainly oral (74%) from lists 1 (7.5%), 2 (37.5%) and 3 (55%) of the National Institute for Occupational Safety and Health. The following measures were envisaged to reduce the risk: introducing new presentations (4 lower doses, 1 liquid dose) and centralizing new preparations in the pharmacy service (11 oral formulas, 6 parenteral drugs). Management, spillage and exposure procedures were adapted. Safety measures were included in the prescription and administration applications, and there were some indications of risks in the storage. Overall, 48 referents and 690 nurses were trained. Each unit was provided with PPE and safety devices (e.g., closed systems, RX CRUSH ®). The steps prior to the administration were moved to the patient's bedside to align patient and professional safety. During the first 6 months after the implementation, 22 cases of pregnancy (64% among the nursing staff), 4 cases of lactation, and 1 case of conceiving problems were reported. In the cases of oxytocin and the repackaging of list 3, risk management was applied. Conclusions: The multidisciplinary approach has allowed to achieve a global and safer control of hazardous drugs with a minimal impact on the center. It is important to continuously evaluate the effects of these measures, and to take into account the data of this analysis and any possible new evidence.

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“…The class II biological safety cabinet offers effective personnel protection from airborne particulates and, at the same time, provides product protection. Several reports in the literature discuss the use of class II safety cabinets in the "medication preparation environment" (10,37,46). The term medication preparation environment is used because, although many anticancer drugs are prepared by pharmacy personnel in hospitals, most doses are prepared by nursing and technical personnel in physicians' offices, clinics, and home care settings.…”

Section: Safety Cabinets In Pharmacy and Medicinementioning

confidence: 99%

Biological safety cabinetry.

Kruse¹,

Puckett²,

Richardson³

1991

Clinical Microbiology Reviews

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tively, not divine origin, induced disease. In 1546, Fracastorius described the agent of communicable disease as a living contagium vivum that spread by direct contact, by intermediary fomites, or through the air and postulated that these living seeds, passed from one infected animal, produced the same disease in an animal that received them. In 1676, Leeuwenhoek discovered and described bacteria, but bacteriology as a science dates from the middle of the 19th century, a result of the scientific studies of Louis Pasteur. Microbiologists are cognizant of his study disproving the theory of spontaneous generation and his work with cultures and the propagation of bacteria; however, because all of the media were fluid, these methods were not applicable for isolating a single microorganism from mixed cultures. Robert Koch's studies with nutrient gelatin and, later, solid 207

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Re-evaluation of urine mutagenicity of pharmacy personnel exposed to antineoplastic agents

Cited by 9 publications

References 0 publications

Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments

Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments

Comprehensive tackling to the safe handling of hazardous drugs: a multidisciplinary approach to clinical practice

Biological safety cabinetry.

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