Association of Surface Contamination by Antineoplastic Drugs With Different Working Conditions in Hospital Pharmacies

Abstract

This study investigates the surface contamination levels of cyclophosphamide and platinum (a marker of platinum-containing drugs) in storage and preparation areas of hospital pharmacies and their relationship to working conditions surveyed by questionnaire. In total, 259 wipe samples were collected in 13 hospital pharmacies over 4 sampling campaigns. After sample extraction with acetate buffer, cyclophosphamide and platinum were determined using high-performance liquid chromatography-tandem mass spectroscopy (HPLC-MS/MS) and inductively coupled plasma mass spectrometry (ICP-MS). Depending on the sampling spot and campaign, median concentrations ranged from <2 to 61 pg/cm(2) and from <0.2 to 6.9 pg/cm(2) for cyclophosphamide and platinum, respectively. Statistical evaluation of monitoring data revealed that the contamination level was significantly influenced by laboratory throughput (expressed as number of chemotherapies prepared per week), personnel expertise (ie, participation of pharmacists with academic education in drug admixture activities), and surface material.

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.…”

“…However, amounts of handled drugs were not recorded in this study. Various studies stated that number and amount of processed ADs did not correlate to the level of contamination in pharmacy areas, but conclusions of a potential relationship are inconsistent in published literature [11,21,22,[26][27][28][29]. We are aware that data are heterogenic due to the different frequency of monitoring per pharmacy, the individual temporal distance between the samplings and due to the range in the number of wipe samples influenced by the free choice of sampling locations.…”

“…Only few studies had comparable LODs for FU or PT [22,26,28] of which Brouwers et al reported also a high percentage of 94 % positive PTsamples in hospital pharmacies. Sensitive analytical methods are an important premise as reliable evaluation is only possible when sufficient numbers of sample concentrations are quantifiable.…”

“…A time trend has also been reported in Canadian hospitals for other ADs with a substantial (4-5-times) decrease of the 75th percentile of contamination concentration over several years [14,48] while the proportion of positive results remained approximately constant. Likewise, European studies described a reduction in surface contamination over time for various ADs [27,28,31,49]. This is most likely related to the increased awareness of the health hazard of occupational exposure to ADs and to the implementation of international and national guidelines.…”

Antineoplastic drugs determination by HPLC‐HRMSn to monitor occupational exposure

“…Thus, sensitive and reliable analytical methods are needed to determine the lowest degree of environmental contamination (e.g. the Odraska's group gave 7 pg/cm 2 as limit of quantification (LOQ) for cyclophosphamide in wipes). Presently the most sensitive analytical methods are based on mass spectrometry techniques …”