Efficacy of two intensive decontamination protocols and their effects after 30 days on environmental contamination by cyclophosphamide

Abstract

Objectives To evaluate the efficacy of two decontamination protocols on cyclophosphamide surface contamination and to explore its lasting effect 30 days later. Methods All sampling sites that were systematically contaminated with cyclophosphamide in 2017–2020 were included, from a convenience sample of centers. The first decontamination protocol consisted of four steps, each with 20 mL and a Wypall® wipe: detergent, sodium hypochlorite 2%, isopropyl alcohol 70% and water. The second decontamination protocol consisted of eight steps, each with 15 mL and a Micronsolo® microfibre wipe: detergent, sodium hypochlorite 2%, isopropyl alcohol 70%, water and then a second round with each of the four products. A first sampling was done at the end of a regular working day (T0), a second immediately following decontamination (T1) and a third 30 days later (T2) after regular operations. Cyclophosphamide was quantified by ultra-performance liquid chromatography – tandem mass spectrometry (limit of detection 0.001 ng/cm2). Results Seventeen sampling sites were included: six biological safety cabinet (BSC) front grilles, eight floors in front of BSCs and three cyclophosphamide storage shelves. The second protocol was more effective; however they both failed to completely remove all cyclophosphamide traces. BSCs and floors were found to be contaminated again 30 days later, at similar concentrations than at T0. A lasting effect was observed on the cyclophosphamide storage shelves that were less prone to be contaminated again. Conclusions Periodic decontamination with many cleaning steps is necessary on all surfaces, including those less frequently contaminated. Regular surface monitoring identifies systematically contaminated areas.

Knowledge and practices about safe handling regarding the risk of exposure to antineoplastic drugs for caregivers in compounding units and in operating rooms performing HIPEC/PIPAC

“…Many other studies in the literature have shown that ADs are still regularly detected on surfaces in healthcare centers despite the specific decontamination protocols implemented. 14,40,41 NIOSH alert 2004 recommended establishing some decontamination procedures, particularly for cleaning up spillage in cases of accidental exposure. 5 On this point, our study suggests that the procedures were insufficiently known by OR caregivers and not fully known by CU caregivers.…”

“…Despite the implementation of safety measures, recent studies have still reported residual contamination with ADs on surfaces and on caregivers’ hands. 13,14…”

“…Despite the implementation of safety measures, recent studies have still reported residual contamination with ADs on surfaces and on caregivers' hands. 13,14 Contamination was revealed in different hospital settings with different characteristics. Several contamination sources have been identified in pharmacies, especially during the compounding process.…”

Canadian monitoring program of the surface contamination with 11 antineoplastic drugs in 124 centers

“…Indeed, an intensive decontamination session proved to have a lasting effect on shelves, but biological safety cabinets and floors rapidly became contaminated again after typical daily drug preparation activities were resumed. 22 In addition, workers may be less prone to wearing their PPE in areas where the contamination risk is perceived as lower.…”