Evaluation of decontamination strategies for cyclophosphamide

Abstract

Purpose The main objective was to determine the efficacy of various types of cleaning equipment and products after deliberate contamination with cyclophosphamide. The secondary objective was to test various cleaning scenarios using these equipment and products. Methods The study had two phases: testing of cleaning equipment (wipe : woven microfibers – Hygen®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicronSolo®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicroMix®, simili-tissu (low filament production) – Tork® and, mop : woven microfibers – Hygen®, microfibre and viscose – MicroOne®) and products (disinfectant : quaternary ammonium – DR100®, chlorine 0.1% – Zochlor® – Brutab® – PCS® NPH, sodium hypochlorite 2%, cleaner : detergent – Nu- Action 3®, cleaner and disinfectant: sodium hypochlorite 0.6% + detergent – Aliflex® and water) in phase 1 and testing of various cleaning procedures in phase 2. Specific areas of a room with a laminar flow hood (class II/type B2) were contaminated with 10 mcg of cyclophosphamide. Different types of surfaces were cleaned with various scenarios and the remaining cyclophosphamide was measured by the Institut national de santé publique du Québec. All tests were performed in triplicate. Results A total of 189 samples were obtained: 42 negative controls and positive controls, 54 during phase 1 and 93 during phase 2. All products were more than 96.5% effective. The 0.1% chlorines were the most effective products. Cleaning procedures with two or three products had average cleaning efficacies of 99.94–99.99%. Efficacy increased with the number of successive cleanings. When two products were used, the average cleaning efficacy varied between 99.78% and 99.98%, depending on the surface. Conclusion All cleaning products tested reduced cyclophosphamide contamination by more than 96.58%. Cleaning efficacy increased with successive cleaning. No scenario was effective in removing 100% of traces. Additional studies with larger samples should be conducted to confirm these results.

Cross-Sectional Evaluation of Surface Contamination with Antineoplastic Drugs in Canadian Health Care Centres

“…Preliminary results have suggested that less concentrated solutions are equivalent in effectiveness, and using more dilute solutions would help to alleviate the disadvantages of sodium hypochlorite, notably its corrosive action on some surfaces and the unpleasant odour for workers and patients. 17 The other working practices that were evaluated led to results similar to those reported previously. 2 The centres that used more antineoplastic drugs had greater levels of surface contamination, but the other practices were not associated with significantly lower concentrations of cyclophosphamide.…”

Cross-sectional evaluation of surface contamination with 9 antineoplastic drugs in 93 Canadian healthcare centers: 2019 results

“…In addition, it may be more difficult to remove cyclophosphamide than 5-FU from contaminated surfaces, given the physicochemical characteristics of each molecule. Soubieux et al 23 and Ad e et al 24 have shown that it usually takes several successive cleanings to remove all traces of cyclophosphamide.…”

“…Soubieux et al. 23 and Adé et al. 24 have shown that it usually takes several successive cleanings to remove all traces of cyclophosphamide.…”

Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program

“…No single agent can entirely decontaminate a surface from all hazardous drugs 39 and many successive cleaning steps are necessary to remove all traces. 40 A vigorous mechanical action also allows for better results. 39 Further work is needed to better quantify this recurrence.…”