Workplace Contamination with Antineoplastic Agents in a New Cancer Hospital Using a Closed-System Drug Transfer Device

Abstract

Objective To determine levels of environmental chemotherapy contamination in a new cancer hospital that has exclusively used a closed-system drug transfer device (PhaSeal) for preparing and administering all compatible antineoplastics. Methods After 6 months of operation, surface samples were collected from pharmacy and nursing areas to determine levels of contamination with cyclophosphamide and ifosfamide. In addition, urine samples were collected from pharmacists, pharmacy technicians, and nurses to determine employee exposure to these agents. All samples were analyzed using liquid chromatography/tandem mass spectrometry. Results Twenty-one percent (7/34) of surface samples collected tested positive for cyclophosphamide contamination. Twelve percent (4/34) of surface samples tested positive for ifosfamide. To place this into perspective, historical data collected at our outpatient oncology infusion clinic 6 months after converting to PhaSeal from conventional methods of antineoplastic preparation showed 33% (7/21) and 71% (15/21) of samples tested positive for cyclophosphamide and ifosfamide, respectively. The level of ifosfamide contamination found in samples that tested positive at our new hospital also appeared to be lower than in positive samples at the outpatient infusion clinic. In the current study, the urine of one participant (1/11), a pharmacy technician, tested positive for low levels of cyclophosphamide and ifosfamide. To compare, 71% and 0% of participants tested at the outpatient infusion clinic had positive urine samples prior to and 6 months after implementation of PhaSeal, respectively. Conclusions: Compared with historical levels of contamination in our outpatient oncology infusion clinic, levels of chemotherapy contamination appeared lower. However, some contamination was still present in our new cancer hospital where PhaSeal had been used exclusively.

Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device

“…4,26,28,66,71 In addition two similar studies have been published in Europe. 19,25 Connor et al measured surface contamination for six months at 28 day intervals following implementation in a newly renovated pharmacy area.…”

“…71 Twenty-one percent of cyclophosphamide and 12% of ifosfamide have levels of drug above the limit of detection. The authors conclude these values were below their historical controls for other sites.…”

Safe handling of cytotoxics: guideline recommendations

“…There is evidence from studies [21][22][23][24][25][26] that closed-drug transfer systems can reduce contamination during preparation. Further emerging evidence suggests that when these devices are not used as specified, they could become open to the environment.…”

Occupational Exposure to Chemotherapy of Pharmacy Personnel at a Single Centre

“…11-31 However, only a few studies in North America, most with small sample sizes, have concurrently investigated both environmental contamination and biological exposure to chemotherapy agents in health care workers, 27,30,31 and none of these studies looked exclusively at pharmacy personnel. Only one of these studies, in which pharmacy personnel constituted a minority of participants, used a control group consisting of health care workers who did not handle chemotherapy agents.…”