Environmental Contamination with Cytotoxic Drugs in Healthcare Using Positive Air Pressure Isolators

Abstract

Occupational exposure to cytotoxic drugs of hospital personnel involved in their preparation and administration is a major issue: ever since the introduction of protective measures in recent decades, the handling of these drugs has always been referred to as an occupational health hazard. Isolator technology was one of the protective equipments aimed at providing safe handling, but it has not yet been studied regarding contamination. The present study evaluates surface contamination with four cytotoxic drugs [cyclophosphamide (CP), ifosfamide (IF), 5 fluorouracil (5FU) and methotrexate (MTX)] by wipe sampling in two hospital pharmacies. Wipe samples were taken from work surfaces both located inside and outside the isolators. In addition, working gloves, the surface of infusion bags filled with 5FU or CP, and gloves used in simulation of drug administration were analyzed. Contamination was routinely found inside the isolators but rarely outside the isolators, indicating that the isolator technology is offering good protection of the cytotoxic drug handlers as well as the environment during preparation. On the other hand, contamination was found on the surfaces of infusion bags and gloves in contact with infusion bags filled with cytotoxic drugs. Consequently, personal protective equipment is still recommended during the manipulation and administration of the drugs because of potentially contaminated drug vials and final products.

Occupational exposure of pharmacy technicians and cleaning staff to cytotoxic drugs in Dutch hospitals

“…Several previous studies have examined hand exposure to antineoplastic drugs, mainly cyclophosphamide. A previous trial from the Netherlands by Fransman et al (2007) found considerable actual hand exposure in nurses and in pharmacy technicians and cleaning personnel, which was later substantiated by Italian (Turci et al 2003), French (Crauste-Manciet et al 2005), and Canadian (Hon et al 2014) studies measuring contamination of used gloves or hands. Cleaning personnel, especially, could potentially be at risk, as several studies showed high levels of contamination on floors of both the pharmacy as well as wards and patient toilets (Hedmer et al 2008;Connor et al 2010;Fleury-Souverain et al 2015;Chauchat et al 2019).…”

A decontamination process adding a tensioactive agent and isopropanol to a closed-system drug transfer device for better control of isolator contamination. A prospective, parallel study

“…The risks associated with occupational exposure to antineoplastic drugs can be genotoxic effects or a decrease in reproductive functioning [ 3 , 4 ]. Several sources of contamination have been determined in hospital settings: in pharmacies, notably on the external surface of commercial vials [ 5 ], during the compounding process [ 6 ], inside isolators [ 7 ] and in medical wards (e.g. preparations coming from the pharmacy and patients’ excreta) [ 8 ].…”

Environmental Contamination and Occupational Exposure of Algerian Hospital Workers

“…For 5-FU, we found a maximum concentration of 2.15 ng/cm² on gloves. While some authors reported values well below this concentration (0.018-0.33 ng/cm²), others reported concentrations high above these values (449.3 and 11.4 ng/cm²) (26,27,36,41). In total, 10 samples were analyzed from PPE (masks and gloves).…”