Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments

Abstract

Background Studies from Europe, the US and Australia have shown measurable levels of cytotoxic contamination in health facilities. Cytotoxic drug residue has been detected in the air and on surfaces in preparation areas even though work was undertaken in biological safety cabinets. Several studies have found substantial levels of surface contamination in pharmacy drug preparation and administration areas. At the time this study was conducted there were no published Australian studies investigating surface contamination when cytotoxic drug safety cabinets are in use. Aim To determine if surface contamination with cytotoxic drugs occurs when cytotoxic drug safety cabinets are used by pharmacy personnel to prepare cytotoxic chemotherapy. Method A multicentre study conducted at 10 hospital pharmacy departments in metropolitan Melbourne. All sites were tested to measure the amount of cytotoxic contamination present using cyclophosphamide as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified locations within the cytotoxic suites. Results Cyclophosphamide contamination was detected in 78% of samples taken within the cytotoxic drug safety cabinet, with 100% contamination detected in the sump. Positive results were also found in 89% of floor samples (cleanroom and anteroom) and 67% of checking benches. Conclusion Cytotoxic drug contamination was detected on a variety of surfaces in the cytotoxic drug preparation areas that used cytotoxic drug safety cabinets. The potential risk of exposure to cytotoxic drugs exists in the workplace despite adherence to the recommended safe handling guidelines.

Cleaning Efficiencies of Three Cleaning Agents on Four Different Surfaces after Contamination by Gemcitabine and 5-fluorouracile

“…Biomonitoring has shown incorporation and adverse health effects in pharmacy and nurse staff despite improved technologic solutions and personal protective equipment. (1)(2)(3)(4)(5) Drug residues are still found on various surfaces in and around the drug preparation area of (hospital) pharmacies and oncology wards, even on assumedly "clean" surfaces (6)(7)(8)(9)(10)(11)(12)(13)(14) and on the outside of vials. (15)(16)(17)(18)(19)(20)(21)(22)(23) Dermal contact followed by transdermal absorption is suggested to be the major route of incorporation in occupational settings.…”

The assessment of environmental and external cross-contamination in preparing ready-to-administer cytotoxic drugs: a comparison between a robotic system and conventional manual production

“…Our results imply smaller contamination rates for both manual and robotic compounding than previous research did. Earlier studies suggested that variability in surface contamination could be associated with different methods of drug preparation, which can influence work techniques, that is proximity of the storage area relative to the preparation area, as well as the size of the compounding area where drugs are handled.…”

“…In the manual compounding group, lower contamination rates were found compared to other studies, including studies with closed‐system devices. This suggests that the use of these spikes does not result in a positive bias for the robotic procedure …”

“…Theoretically, other cytotoxic drugs could vaporize more easily. However, these two drugs are commonly used in studies investigating contamination and are therefore appropriate for comparison with results from other studies …”

ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice

“…A CSTD will decrease aerosolization of a parenteral drug during preparation and administration and prevent accidents during administration. Multiple studies have shown a decrease in environmental contamination with the use of CSTD [52][53][54][55][56][57][58][59]. A CSTD is not a substitute for the use of PPE or preparation in a ventilated cabinet 40,47,60.…”