Canadian monitoring program of the surface contamination with 11 antineoplastic drugs in 122 centers

Abstract

Introduction Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers’ health. Environmental monitoring is conducted once a year, as part of a Canadian monitoring program. The objective was to describe contamination with 11 antineoplastic drugs measured on surfaces. Methods Six standardized sites in oncology pharmacy and six in outpatient clinic were sampled in each hospital. Samples were analyzed by ultra-performance liquid chromatography coupled with tandem mass spectrometry (non-platinum drugs) and by inductively coupled plasma mass spectrometry (platinum-based drugs). The limits of detection (in ng/cm2) were: 0.0006 for cyclophosphamide; 0.001 for docetaxel; 0.04 for 5-fluorouracil; 0.0004 for gemcitabine; 0.0007 for irinotecan; 0.0009 for methotrexate; 0.004 for paclitaxel, 0.009 for vinorelbine, 0.02 for doxorubicine, 0.0037 for etoposide and 0.004 for the platinum. Sub-analyses were done with a Kolmogorov-Smirnov test Results 122 Canadian hospitals participated. Cyclophosphamide (451/1412, 32% of positive samples, 90th percentile of concentration 0.0160 ng/cm2) and gemcitabine (320/1412, 23%, 0.0036 ng/cm2) were most frequently measured on surfaces. The surfaces most frequently contaminated with at least one drug were the front grille inside the biological safety cabinet (97/121, 80%) and the armrest of patient treatment chair (92/118, 78%).The distribution of cyclophosphamide concentration was higher for centers that prepared ≥ 5000 antineoplastic drug preparations/year (p < 0.0001). Conclusions This monitoring program allowed centers to benchmark their contamination with pragmatic contamination thresholds derived from the Canadian 90th percentiles. Problematic areas need corrective measures such as decontamination. The program helps to increase the workers’ awareness.

Four-year follow-up of surface contamination by antineoplastic drugs in a compounding unit

“…Between 2012 and 2022, Bussières et al performed a long monitoring programme concerning surface contamination with ICADs (from 3 to 11), mainly cyclophosphamide, ifosfamide and methotrexate at six different locations in numerous Canadian hospitals (from 25 to 122 centres). These different studies revealed a large percentage of positive samples 16 23…”

“…Different ICADs usually used in hospitals were included as hazardous drugs. Several studies evaluating the occupational exposure to ICADs have been performed in a single compounding unit for shorter or longer periods of a few months including or not including care units 11 14–16. Others were carried out in different hospitals either in different care units or in compounding units 9 11 17–21.…”

Perception, knowledge, practices and training regarding the risk of exposure to antineoplastic drugs in three French compounding units

“…However, some studies have shown that the floor inside the biological safety cabinet is one of the most contaminated sites. 6,35 As an example, healthcare workers can be in contact with ADs when they manually remove overshoes that have been in contact with the contaminated floor in the CU; it can be a source of spreading ADs in other areas. Not all the respondents in CU were aware that the surface of a vial of ADs can be a source of contamination, as shown by several studies.…”

“…1 Acute and longterm toxicity can occur, such as genotoxic damage or adverse reproductive outcomes. 2,3 ADs are found at every stage of the hospital medication system 4 and on many surfaces in the pharmacy and in the outpatient clinic 5,6 but also on the workers' hands. 7 Traces of ADs are still found despite the implementation of decontamination measures.…”

Reporting environmental contamination results to healthcare workers could play a crucial role in decreasing the risk of occupational exposure to antineoplastic drugs

“…Regular monitoring of environmental contamination has been carried out for several years in German ( 23 ), Italian ( 24 ), Czechoslovakian ( 19 ), Canadian ( 20 ) or American hospitals ( 21 ). These monitoring have shown that the risk of healthcare exposure is not systematically related to the level of environmental contamination or to the activity of the chemotherapy process but more to the practices and awareness of healthcare workers.…”