Evaluation of surface contamination with cyclophosphamide following simulated hazardous drug preparation activities using two closed-system products

Abstract

Purpose. A preliminary investigation was conducted to evaluate and compare the effectiveness of two closed-system products in preventing contamination of typical pharmacy workplace surfaces with cyclophosphamide during simulated hazardous drug preparation activities in a controlled laboratory setting.Methods. Two separate trials simulating hazardous drug compounding using cyclophosphamide were performed with two different closed-system products. Prior to each trial, work area surfaces of the biological safety cabinet (BSC) workbench, the BSC airfoil and front grill, and the floor below the BSC were cleaned, and wipe samples were collected and analyzed to determine, if present, levels of cyclophosphamide. Following each trial, wipe samples were collected from the work area surfaces to determine the hazardous drug containment effectiveness of each closed-system product.Results. Cyclophosphamide was not detected on work area surfaces prior to each trial. Low levels were detected on the BSC workbench surface following both trials.Discussion. Based on the limited number of samples obtained during this preliminary study and the determination of the presence of the chemical of interest on the drug vials, no statistical evaluation was performed to compare the relative effectiveness of the two systems tested. Work practices and procedures regarding product operation may affect hazardous drug containment and worker safety. Further study and statistical analyses are needed.

Oncology pharmacy units: a safety policy for handling hazardous drugs and related waste in low- and middle-income African countries—Angolan experience

“…Several articles identified surface contamination by chemotherapy drugs in the pharmacies and patient care areas [18, 19, 20]. …”

Environmental Monitoring of Occupational Exposure to Cyclophosphamide Drug in Two Iranian Hospitals

“…According to the results of this and other recent studies (11,21,32,35), safe work practice training for oncology staff is essential and environmental and biological monitoring of cytotoxic drugs should be periodically carried out as part of a comprehensive cytotoxic drug safe handling program and monitoring of effectiveness of preventive and protective measures.…”

“…Several guidelines have been published by agencies like the NIOSH and American Society of HealthSystem Pharmacists (ASHP) on the safe handling of these drugs (6,7). The advantages of closed systems in minimizing cytotoxic drug surface contamination when compared to common preparation methods in the hospital setting have been shown in some studies (8)(9)(10)(11).…”

“…Contamination with cyclophosphamide has been detected in work environment at hospitals. Dermal and wipe samplings were reported to be used to monitor occupational exposure assessment of drugs and wipe sampling methods are used for quantification of dermal and surface contamination with cyclophosphamide (11,(17)(18)(19)(20)(21).…”

Aseptic simulation test for cytotoxic drug production in isolators

“…6 As these two devices have demonstrated efficacy in preventing both chemical and microbiological contaminations, an evaluation to determine the best device for a given institution, from the perspectives of both patients and technicians, might focus on factors such as ease of use, adaptability for use with small vials, compatibility with drugs, and fingerstick risks. 15,16 …”