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Yuan Z, Li Q, Tang T, Zhang M, Liu Y, Liu L. Studies on the optimization of decontamination protocol for surfaces contaminated with cytotoxic drugs in PIVAS. J Oncol Pharm Pract 2023; 29:1565-1573. [PMID: 36544379 DOI: 10.1177/10781552221138331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE The goal of this study was to create a cleaning procedure by comparing the performance of six different cleaning methods on the surfaces in pharmacy intravenous admixture service (PIVAS) work area. METHOD A stainless steel plate was simulating contaminated by gemcitabine, cyclophosphamide, epirubicin, etoposide, and paclitaxel, which was then dried and cleaned by per current cleaning protocols. The residues were collected and quantified by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Based on the most appropriate cleaning protocol, three cleaning variables were optimized: (1) use of dry gauze after cleaning agent application; (2) cleaning paths (inside-out vs. outside-in); (3) cleaning times (once or twice). Best conditions were tested with real samples from a hospital PIVAS. RESULTS This 10-2 M sodium dodecyl sulfate (SDS) and dry gauze cleaning protocol increases cleaning efficiency as well as saves time. Different from the traditional cleaning manner, we found that cleaning from outside to inside can not only improve the cleaning efficiency but also overcome the uneven distribution of drug residues caused by cleaning action. When simulating contamination at a high dose (4 mg/mL) level, it was found that the decontamination efficacy increased with repeating one more time. CONCLUSION The 10-2 M SDS and dry gauze cleaning protocol could obtain the best cleaning effect. The success of cytotoxic drug decontamination is determined not only by the cleaning solution, but also by the cleaning route and frequency. Compared with the traditional cleaning manner, there was a significant reduction in the contamination levels in the PIVAS work area after the cleaning protocol with 10-2 M SDS and dry gauze.
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Affiliation(s)
- Zhongzhen Yuan
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Qiaoqiao Li
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Tiantian Tang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Min Zhang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Yu Liu
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
| | - Ling Liu
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing, China
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Kato G, Mitome H, Teshima K, Tawa K, Hakuba Y, Tanabe T, Funahashi T, Hatae N, Koike Y, Hasebe M, Hidaka N, Tanaka M, Akira K. Study on the Use of Ozone Water as a Chemical Decontamination Agent for Antineoplastic Drugs in Clinical Settings. Ann Work Expo Health 2023; 67:241-251. [PMID: 36416483 DOI: 10.1093/annweh/wxac075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
The exposure of healthcare workers to antineoplastic drugs in hospitals has been recognized to be harmful. To minimize the risk of exposure, the removal of these drugs from work environments, such as compounding facilities, has been recommended. In our previous paper, the degradation and inactivation efficacy of ozone water, which is being introduced into Japanese hospitals as a chemical decontamination agent, was reported for its effects on typical antineoplastic drugs (gemcitabine, irinotecan, paclitaxel). This article aims to further investigate the efficacy of ozone water for eight antineoplastic drugs to clarify its application limitations. A small amount (medicinal ingredient: typically ca. 1.5 μmol) of formulation containing 5-fluorouracil, pemetrexed, cisplatin, oxaliplatin, cyclophosphamide, ifosfamide, doxorubicin, or docetaxel was mixed with 50 mL of ozone water (~8 mg/L), and the resulting solutions were analyzed by high-performance liquid chromatography over time to observe the degradation. Consequently, the ozonation was overall effective for the degradation of the drugs, however this varied depending on the chemical structures of the drugs and additives in their formulations. In addition, after the parent drugs were completely degraded by the ozonation, the degradation mixtures were subjected to 1H nuclear magnetic resonance spectroscopy and evaluated for mutagenicity against Salmonella typhimurium strains and cytotoxicity against human cancer cells. The degradation mixtures of cisplatin and ifosfamide were mutagenic while those of the other drugs were non-mutagenic. Further, the ozonation resulted in clear decreases of cytotoxicity for 5-fluorouracil, oxaliplatin, and doxorubicin, but increases of cytotoxicity for pemetrexed, cisplatin, cyclophosphamide, and ifosfamide. These results suggest that the ozone water should be restrictedly used according to the situation of contamination in clinical settings because the ozonation enhances toxicity depending on the drug even if degradation is achieved.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Kenichiro Teshima
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Kanako Tawa
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Yui Hakuba
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Tomotaka Tanabe
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Tatsuya Funahashi
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
| | - Noriyuki Hatae
- Faculty of Pharmaceutical Sciences, Yokohama University of Pharmacy, 601 Matano, Totsuka-ku, Yokohama, Kanagawa 245-0066, Japan
| | - Yasumasa Koike
- Division of Pharmacy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Masafumi Hasebe
- Division of Pharmacy, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto-machi, Matsuyama, Ehime 791-0280, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, Matsuyama University, 4-2 Bunkyo-cho, Matsuyama, Ehime 790-8578, Japan
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Kato G, Mitome H, Shigematsu S, Utsunomiya A, Shimasaki M, Sasaki Y, Maki T, Yamamoto H, Tanabe T, Funahashi T, Hatae N, Hidaka N, Tanaka M, Akira K. Degradation and inactivation efficacy of ozone water for antineoplastic drugs in hospital settings. J Oncol Pharm Pract 2021; 28:1781-1789. [PMID: 34709082 DOI: 10.1177/10781552211042525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Occupational exposure to antineoplastic drugs in hospital settings is recognized to be hazardous, and as such environmental decontamination including degradation and inactivation of such drugs is recommended. To data, although various agents such as oxidants have been reported to be useful for decontamination, simpler, safer, and more convenient methods are required. In this study, the degradation and inactivation efficacy of ozone water, which has newly been introduced for decontamination of antineoplastic drugs in spills, was investigated for formulations of gemcitabine, irinotecan, and paclitaxel. METHODS Antineoplastic formulations (medicinal ingredient: ∼1.5 μmol) were mixed with 50 mL of ozone water (>4 mg/L). The reactions were monitored by high-performance liquid chromatography, and the degradation mixtures were analyzed by 1H nuclear magnetic resonance spectroscopy in order to obtain the structural information of the degradation products. The formulations of gemcitabine and irinotecan and those degradation mixtures were evaluated for their mutagenicity using the Ames test and cytotoxicity against human cancer cells. RESULTS gemcitabine and irinotecan were found to be readily degraded by the ozone treatment, and their active sites were suggested to be degraded. In contrast, paclitaxel was hard to be decomposed, possibly owing to the consumption of ozone by the polyoxyethylene castor oil added as a pharmaceutical additive of the formulation. No significant mutagenic changes of Salmonella typhimurium strains used for the Ames test were observed for the samples within the concentration ranges examined. The ozone treatment showed obvious increases in cell viability for gemcitabine formulation, and mild increases for irinotecan formulation. CONCLUSIONS Ozone water was shown to be effective as a decomposition agent for the antineoplastic drug formulations examined, although the efficacy depends on the chemical structures of the drugs and the pharmaceutical additives. It was also suggested that ozone treatment has a tendency to decrease the toxicity of the antineoplastic drug formulations. As such, further studies are required in order to clarify the effects and application limitations of ozone water.
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Affiliation(s)
- Ginjiro Kato
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Hidemichi Mitome
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Saki Shigematsu
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Aya Utsunomiya
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Miho Shimasaki
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Yuta Sasaki
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Tsuneo Maki
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Hiroshi Yamamoto
- Division of Pharmacy, 68286National Hospital Organization Shikoku Cancer Center Japan
| | - Tomotaka Tanabe
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Tatsuya Funahashi
- Laboratory of Hygienic Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
| | - Noriyuki Hatae
- Faculty of Pharmaceutical Sciences, 68348Yokohama University of Pharmacy, Japan
| | - Noriaki Hidaka
- Division of Pharmacy, 89456Ehime University Hospital, Japan
| | - Mamoru Tanaka
- Division of Pharmacy, 89456Ehime University Hospital, Japan
| | - Kazuki Akira
- Laboratory of Pharmaceutical Analytical Chemistry, College of Pharmaceutical Sciences, 12694Matsuyama University, Japan
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Bláhová L, Kuta J, Doležalová L, Kozáková Š, Krovová T, Bláha L. The efficiency of antineoplastic drug contamination removal by widely used disinfectants-laboratory and hospital studies. Int Arch Occup Environ Health 2021; 94:1687-1702. [PMID: 33738516 DOI: 10.1007/s00420-021-01671-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/12/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Antineoplastic drugs (ADs) pose risks to healthcare staff. Surface disinfectants are used in hospitals to prevent microbial contamination but the efficiency of disinfectants to degrade ADs is not known. We studied nine disinfectants on ten ADs in the standardized laboratory and realistic in situ hospital conditions. METHODS A survey in 43 hospitals prioritized nine most commonly used disinfections based on different ingredients. These were tested on inert stainless steel and in situ on contaminated hospital flooring. The effects against ten ADs were studied by LC-MS/MS (Cyclophosphamide CP; Ifosfamide IF; Capecitabine CAP; Sunitinib SUN; Methotrexate MET; Doxorubicin DOX; Irinotecan IRI; Paclitaxel PX; 5-Fluorouracil FU) and ICP-MS (Pt as a marker of platinum-based ADs). RESULTS Monitoring of the floor contamination in 26 hospitals showed that the most contaminated are the outpatient clinics that suffer from a large turnover of staff and patients and have limited preventive measures. The most frequent ADs were Pt, PX, FU and CP with maxima exceeding the recommended 1 ng/cm2 limit by up to 140 times. IRI, FU, MET, DOX and SUN were efficiently removed by hydrolysis in clean water and present thus lower occupational risk. Disinfectants based on hydrogen peroxide were efficient against PX and FU (> 70% degradation) but less against other ADs, such as carcinogenic CP or IF, IRI and CAP. The most efficient were the active chlorine and peracetic acid-based products, which however release irritating toxic vapors. The innovative in situ testing of ADs previously accumulated in hospital flooring showed highly problematic removal of carcinogenic CP and showed that alcohol-based disinfectants may mobilize persistent ADs contamination from deeper floor layers. CONCLUSION Agents based on hydrogen peroxide, peracetic acid, quaternary ammonium salts, glutaraldehyde, glucoprotamine or detergents can be recommended for daily use for both disinfection and AD decontamination. However, they have variable efficiencies and should be supplemented by periodic use of strong chlorine-based disinfectants efficient also against the carcinogenic and persistent CP.
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Affiliation(s)
- Lucie Bláhová
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Jan Kuta
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Lenka Doležalová
- Masaryk Memorial Cancer Institute, Žlutý kopec 7, 65653, Brno, Czech Republic
| | - Šárka Kozáková
- Masaryk Memorial Cancer Institute, Žlutý kopec 7, 65653, Brno, Czech Republic.,University Hospital Brno, Jihlavská 20, 62500, Brno, Czech Republic
| | - Tereza Krovová
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic
| | - Luděk Bláha
- Faculty of Science, Masaryk University, RECETOX, Kamenice 753/5, Building D29, 62500, Brno, Czech Republic.
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Palamini M, Floutier M, Gagné S, Caron N, Bussières JF. Evaluation of decontamination efficacy of four antineoplastics (ifosfamide, 5-fluorouracil, irinotecan, and methotrexate) after deliberate contamination. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:43-50. [PMID: 33357045 DOI: 10.1080/15459624.2020.1854458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The main objective was to determine the decontamination efficacy of quaternary ammonium, 0.1% sodium hypochlorite, and water after deliberate contamination with four antineoplastics (ifosfamide, 5-fluorouracil, irinotecan, methotrexate). A stainless-steel surface was deliberately contaminated with ifosfamide (15 µg), 5-fluorouracil (10 µg), irinotecan (1 µg), and methotrexate (1 µg). First, a single decontamination step with either water, quaternary ammonium, or 0.1% sodium hypochlorite was tested. Then, the effect of up to four successive decontamination steps with either quaternary ammonium or 0.1% sodium hypochlorite was tested. Commercial wipes consisting of two layers of non-woven microfibers with an inner layer of highly absorbent viscose fibers were used. Triplicate surface samples were obtained and tested by ultra-performance liquid chromatography tandem mass spectrometry. The limits of detection were 0.004 ng/cm2 for ifosfamide, 0.040 ng/cm2 for 5-fluorouracil, 0.003 ng/cm2 for irinotecan, and 0.002 ng/cm2 for methotrexate. After a single decontamination step, the 0.1% sodium hypochlorite eliminated 100% of contamination with 5-fluorouracil, irinotecan, and methotrexate and 99.6 ± 0.5% of ifosfamide contamination. Quaternary ammonium and water also removed 100% of the 5-fluorouracil, and 99.5% to 99.9% of the other three antineoplastics. For ifosfamide, irinotecan, and methotrexate, the decontamination efficacy increased with successive decontamination steps with quaternary ammonium. 5-fluorouracil was undetectable after a single decontamination step. Methotrexate was the only drug for which decontamination efficacy was less than 100% after four decontamination steps. 100% decontamination efficacy was achieved from the decontamination step with 0.1% sodium hypochlorite for 5-fluorouracil, irinotecan, and methotrexate. For ifosfamide, 100% efficacy was achieved only after the third decontamination step. It was possible to make all traces of antineoplastic undetectable after deliberate contamination with 5-fluorouracil, irinotecan, and methotrexate with a 0.1% chlorine solution; up to three decontamination steps were needed to make ifosfamide undetectable. Water or quaternary ammonium removed more than 99.5% of deliberate contamination. In several scenarios, it was necessary to repeat the decontamination to eliminate residual traces. More work is needed to identify the optimal decontamination approach for all of the antineoplastic drugs used.
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Affiliation(s)
- Marie Palamini
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Marine Floutier
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Sébastien Gagné
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Nicolas Caron
- Centre de Toxicologie du Québec, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Jean-François Bussières
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Québec, Canada
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
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Simon N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Chemical Decontamination of Hazardous Drugs: A Comparison of Solution Performances. Ann Work Expo Health 2021; 64:114-124. [PMID: 31848570 DOI: 10.1093/annweh/wxz093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/15/2019] [Accepted: 11/29/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Over the past 40 years, numerous actions have been undertaken to decrease the contamination of hospital facilities by intravenous conventional antineoplastic drugs (ICADs) such as centralizing compounding in pharmacies, using personal protective equipment, specific compounding, or infusion devices. As recently proposed in the <USP800> monograph, an additional specific decontamination step must be envisaged. A recent literature review analysed and discussed the different solutions tested in terms of decontamination efficacy. This article aims to discuss the performance of these solutions in the framework of aseptic compounding. METHODS The same dataset used in the previous literature review was reanalysed according to other parameters so as to select decontamination solutions: overall decontamination efficiency (EffQ), tested contaminants, and the risks of use in daily practice. RESULTS Using an EffQ threshold of 90% resulted in discarding 26 out of the 59 solutions. Solutions were tested differently: 8 on 1 contaminant, 11 on 2 contaminants, and 14 solutions on between 3 and 11 contaminants. Three risks were identified to help make choices in routine practice: the mutagenicity of degradation products, the safety of operators and facilities, and respect for the aseptic environment. CONCLUSIONS From the results, performance is discussed according to specific situations: a one-time incident or the basic chemical contamination due to daily practice. Accordingly, the decontamination solution selected then required a risk analysis and an evaluation before implementing it in the daily practice of a compounding unit.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland.,Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, EA 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Simon N, Guichard N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Efficiency of four solutions in removing 23 conventional antineoplastic drugs from contaminated surfaces. PLoS One 2020; 15:e0235131. [PMID: 32569333 PMCID: PMC7307753 DOI: 10.1371/journal.pone.0235131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Residual contamination by intravenous conventional antineoplastic drugs (ICAD) is still a daily issue in hospital facilities. This study aimed to compare the efficiency (EffQ) of 4 different solutions to remove 23 widely used ICADs from surfaces. METHOD AND FINDINGS A solution containing 23 ICADs (4 alkylating agents, 8 antimetabolites, 2 topo-I inhibitors, 6 topo-II inhibitors and 3 spindle poisons) was spread over 100 cm2 stainless steel. After drying, decontamination was carried out using 10×10 cm wipes moistened with 300 μL of one of the following solutions: 70% isopropanol (S1); ethanol-hydrogen peroxide 91.6-50.0 mg/g (S2); 10-2 M sodium dodecyl sulphate/isopropanol 80/20 (S3) or 0.5% sodium hypochlorite (S4). Six tests were performed for each decontamination solution. Two modalities were tested: a single wipe motion from top to bottom or vigorous wiping (n = 6 for each modality). Residual contamination was measured with a validated liquid chromatography with tandem mass spectrometry detection method. Solution efficiency (in %) was computed as follows: EffQ = 1-(quantity after decontamination/quantity before decontamination), as median (min-max) for the 23 ICADs. The overall decontamination efficiency (EffQ) of the 4 solutions was compared by a Kruskall-Wallis test. Decontamination modalities were compared for each solution and per ICAD with a Mann-Whitney test (p<0.05). EffQ were significantly different from one solution to the next for single wipe motion decontamination: 79.9% (69.3-100), 86.5% (13.0-100), 85.4% (56.5-100) and 100% (52.9-100) for S1, S2, S3 and S4 (p<0.0001), respectively. Differences were also significant for vigorous decontamination: EffQ of 84.3% (66.0-100), 92.3% (68.7-100), 99.6% (84.8-100) and 100% (82.9-100) for S1, S2, S3 and S4, respectively (p<0.0001). Generally, vigorous decontamination increased EffQ for all tested solutions and more significantly for the surfactant. CONCLUSION Decontamination efficiency depended on the solution used but also on the application modality. An SDS admixture seems to be a good alternative to sodium hypochlorite, notably after vigorous chemical decontamination with no hazard either to materials or workers.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Nicolas Guichard
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Pascal Odou
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, ULR 7365 –GRITA–Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
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Soubieux A, Palamini M, Tanguay C, Bussières JF. Evaluation of decontamination strategies for cyclophosphamide. J Oncol Pharm Pract 2019; 26:413-422. [DOI: 10.1177/1078155219865931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Annaelle Soubieux
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Côte-Sainte-Catherine, Montréal, Canada
| | - Marie Palamini
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Côte-Sainte-Catherine, Montréal, Canada
| | - Cynthia Tanguay
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Côte-Sainte-Catherine, Montréal, Canada
| | - Jean-François Bussières
- Unité de Recherche en Pratique Pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Côte-Sainte-Catherine, Montréal, Canada
- Faculté de pharmacie, Université de Montréal, Montréal, Canada
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Simon N, Odou P, Decaudin B, Bonnabry P, Fleury-Souverain S. Efficiency of degradation or desorption methods in antineoplastic drug decontamination: A critical review. J Oncol Pharm Pract 2019; 25:929-946. [DOI: 10.1177/1078155219831427] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although considerable efforts have been made over the last 40 years, occupational exposure to antineoplastic drugs is still a daily concern, since eradicating such contamination from workplaces seems unattainable. Considerable data are currently available on the risks associated with their use at work. Hospital facilities are often cleaned with marketed antimicrobials whose chemical decontamination efficacy certainly differs but remains unknown. To keep compounding facilities sterile, alcohol-based solutions are frequently used but with very limited efficiency. It would be particularly useful if a decontamination method could be added to the means already available so that all conventional antineoplastic drug contamination could be removed. Several degradation methods or desorption methods have previously been experimented, with varying success. They have never been compared or discussed in terms either of efficiency or usability. This review aims to analyse and discuss the results of each degradation or decontamination procedure and to compare them. This should facilitate selection of the method to be implemented in daily practice.
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Affiliation(s)
- Nicolas Simon
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Odou
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Bertrand Decaudin
- Univ. Lille, CHU Lille, EA 7365 – GRITA – Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
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Roland C, Adé A, Ouellette-Frève JF, Gagné S, Caron N, Bussières JF. Pilot Study Evaluating the Efficacy of Four Cleaning Solutions and Two Types of Mops in Delimited Areas of a Floor Contaminated with Cyclophosphamide. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2017. [DOI: 10.1515/pthp-2017-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractBackgroundHazardous drugs (HD) traces are measured in most hospitals that perform environmental surveillance. Uncertainties exist regarding the cleaning agents and procedures needed to completely remove HD contamination The objective was to evaluate the efficacy of four cleaning solutions and two types of mops in reducing contamination on a floor contaminated with a predetermined amount of cyclophosphamide (CP).MethodsThis pilot study was divided into three steps: 1) the voluntary contamination of a pre-delimited area on the floor (3600cmResultsThe average decontamination efficacy of the four cleaning products used was: 99.53%±0.41 % for the detergent, 99.74%±0.15 % for quaternary ammonium, 99.86%±0.11 % for sodium hypochlorite, 99.75%±0.15 %, for hydrogen peroxide. The average decontamination efficacy for disposable mops was 99.58%±0.28 % and 99.86%±0.09 % for non-disposable mops.ConclusionSodium hypochlorite, hydrogen peroxide, quaternary ammonium and a detergent applied with a disposable or a non-disposable mop were efficient to reduce the CP concentration on the floor contaminated with a predetermined quantity of CP. However, no cleaning scenarios was able to remove 100 % of CP after one cleaning session. Further studies are required to identify an optimal strategy.
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Anastasi M, Rudaz S, Queruau Lamerie T, Odou P, Bonnabry P, Fleury-Souverain S. Efficacy of Two Cleaning Solutions for the Decontamination of 10 Antineoplastic Agents in the Biosafety Cabinets of a Hospital Pharmacy. ANNALS OF OCCUPATIONAL HYGIENE 2015; 59:895-908. [PMID: 25979920 DOI: 10.1093/annhyg/mev031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 03/05/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to evaluate two cleaning solutions for the chemical decontamination of antineoplastic agents on the surfaces of two biosafety cabinets routinely used for chemotherapy preparation in a hospital pharmacy. METHODS For almost 1 year (49 weeks), two different solutions were used for the weekly cleaning of two biosafety cabinets in a hospital pharmacy's centralized cytotoxic preparation unit. The solutions evaluated were a commercial solution of isopropyl alcohol (IPA) and water (70:30, vol:vol), and a detergent solution constituted by 10(-2)M of sodium dodecyl sulfate (SDS) with 20% IPA. Seven areas in each biosafety cabinet were wiped 14 times throughout the year, before and after the weekly cleaning process, according to a validated procedure. Samples were analyzed using a validated method of high-performance liquid chromatography coupled to mass spectrometry. The decontamination efficacy of these two solutions was tested for 10 antineoplastic agents: cytarabine, gemcitabine, methotrexate, etoposide phosphate, irinotecan, cyclophosphamide, ifosfamide, doxorubicin, epirubicin, and vincristine. RESULTS Overall decontamination efficacies observed were 82±6% and 49±11% for SDS solution and IPA, respectively. Higher contamination levels were distributed on areas frequently touched by the pharmacy technicians-such as sleeves and airlock handles-than on scale plates, gravimetric control hardware, and work benches. Detected contaminations of cyclophosphamide, ifosfamide, gemcitabine, and cytarabine were higher than those of the others agents. SDS solution was almost 20% more efficient than IPA on eight of the antineoplastic agents. CONCLUSION Both cleaning solutions were able to reduce contamination levels in the biosafety cabinets. The efficacy of the solution containing an anionic detergent agent (SDS) was shown to be generally higher than that of IPA and, after the SDS cleaning procedure, biosafety cabinets demonstrated acceptable contamination levels.
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Affiliation(s)
- Marco Anastasi
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Serge Rudaz
- 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Thomas Queruau Lamerie
- 3.Department of Pharmacy, Dunkerque Hospital, 130, avenue Louis Herbeaux, BP 6 367, 59385 Dunkerque, France
| | - Pascal Odou
- 3.Department of Pharmacy, Dunkerque Hospital, 130, avenue Louis Herbeaux, BP 6 367, 59385 Dunkerque, France 4.Biopharmacy, Galenic and Hospital Pharmacy Department (EA 4481, IFR114), UFR Pharmacie, Université Lille Nord de France, 1 Rue Lefèvre, 59000 Lille, France
| | - Pascal Bonnabry
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland 2.School of Pharmaceutical Sciences, University of Geneva/University of Lausanne, 30, quai Ernest-Ansermet, 1211 Geneva, Switzerland
| | - Sandrine Fleury-Souverain
- 1.Department of Pharmacy, Geneva University Hospitals, Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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