Surface Contamination from Cytotoxic Chemotherapy Following Preparation and Administration

Abstract

Background: Surface contamination with cytotoxic drug residue is a potential occupational health hazard to staff working in cytotoxic compounding areas and oncology wards. Aim: To identify surfaces contaminated with cytotoxic drug residue and to indicate the risk of exposure to health workers handling cytotoxic drug residue. Method: Wipe sampling was used to investigate surface contamination and occupational skin exposure to the marker cytotoxic drugs, fluorouracil (5-FU) and gemcitabine (GEM), in the pharmacy cytotoxic compounding section and oncology wards. Drug packaging, primary containers and gowns were also examined. Samples were analysed using a validated HPLC method. Repeat sampling was performed on selected surfaces to monitor any impact after implementing changes in practice. Results:The majority of surfaces tested were contaminated. The cytotoxic work room (5-FU 56.7-320 µg/m 2 ; GEM 75-370 µg/m 2 ) and oncology wards had similar levels of contamination. Cytotoxic drug residue was detected on original containers and drug vials (5-FU < 3-6 µg; GEM 7.8-7.9 µg/wipe sample) stored in the cytotoxic work room but not on containers delivered directly from the distributor, suggesting that accidental contamination by pharmacy personnel does occur. Contamination was also detected on sections of the gowns (GEM around 0.9 mg/m 2 ) worn by nurses in the oncology wards.

Benefits of Wipe Sampling: Evaluation of Long-Term 5-Fluorouracil and Platinum Monitoring Data

“…This has been supported by the results of many other studies [19,21,22,27,40,41], and is insofar critical as gloves are often not worn in areas where no contamination is expected [42]. Nevertheless, the present findings generally range in lower magnitudes than results from older studies [13,33,43,44] and also from more recent international studies [19,28,31,41,[45][46][47], indicating country-specific levels of contamination and pointing out the constant improvements in occupational hygiene practice in the participating pharmacies. The continuous improvement is likely to have benefitted from repeated and long-term monitoring.…”

Paclitaxel Exposure and its Effective Decontamination

“…Sodium hydroxide 0.03 M has been used for wetting surfaces/wipes and extracting cytotoxic drugs from samples after carrying out environmental monitoring. 7,11,12,19,20 Our study found that paclitaxel in sodium hydroxide 0.03 M degraded within 60 minutes. This has also been reported by the World Intellectual Property Organization and is not recommended as a wetting agent for environmental monitoring of paclitaxel; isopropanol 50% solution should be used instead.…”

Chemotherapy drug handling in first opinion small animal veterinary practices in the United Kingdom: results of a questionnaire survey

“…A large body of human evidence supports the use of PPE as exposure of workers to cytotoxic drugs has been a recognised health hazard in facilities where cytotoxic agents are being prepared, stored or handled (Sessink and others 1992, Mc Devitt and others 1993, Mason and others 2005). Cytotoxic residues have also been detected on the exterior of unopened vials and in wards distant from areas where antineoplastic agents were handled, causing concerns for personnel not directly involved in their preparation or administration (Nygren and others 2002, Lee and others 2007, Fleury-Souverain and others 2014, Janssens and others 2015). …”