Hazardous Drug Contamination of Drug Preparation Devices and Staff: A Contamination Study Simulating the Use of Chemotherapy Drugs in a Clinical Setting

Using simulation to improve pharmacy operators' handling of cytotoxic spills

INTRODUCTION

International Society of Oncology Pharmacy Practitioners guidelines recommend having standard operating procedures (SOPs) and initial and yearly retraining programs on cytotoxic spill handling for pharmacy operators (POs). This study aimed to create a simulation-based training (SBT) program on this subject and evaluate its impact on POs' real-life performance.

METHODS

Randomly formed pairs of POs underwent a 2.5-hour training program, including two simulation exercises (a broken cytotoxic vial on the floor and a leaking cytotoxic bag) in a simulated pharmacy production unit. Each participant applied the cytotoxic spill handling SOPs. The PO and trainer-pharmacist did a debriefing after each exercise. Satisfaction was recorded on a 0-to-100% scale. A 20-item questionnaire assessed general knowledge about cytotoxic spill handling before and after the training. One month before and one month after the training, the POs underwent a real-life test when the trainer broke a fake cytotoxic vial in the cytotoxic storage area. Their performance in applying the SOPs was assessed on a 20-point checklist, and the time to handle the spill was recorded.

RESULTS

Twelve POs participated. Mean satisfaction score was 98.9%. Mean knowledge score improved from 10.8/20 (SD = 2.0) before training to 14.5/20 (SD = 1.6) after training (p < 0.05). Mean real-life SOP performance improved from 78.6% (SD = 7.4%) to 97.1% (SD = 5.2%) (p < 0.05). Mean time to handle cytotoxic spills decreased from 17.3 minutes (SD = 3.6 minutes) to 11.9 minutes (SD = 1.5 minutes) (p < 0.05).

CONCLUSION

POs improved their knowledge and real-life competencies for handling cytotoxic spills. This training will be included in POs' initial and continuing training programs.

Safe handling of hazardous drugs

Background: This evidence-based practice guideline was developed to update and address new issues in the handling of hazardous drugs including being compliant with NAPRA (National Association of Pharmacy Regulatory Authorities) and USP 800 (United States Pharmacopeia) standards, the use of personal protective equipment and treatment in diverse settings including in the home setting. Methods: This guideline was developed from an adaptation and endorsement of existing guidelines and from three systematic reviews. Prior to publication, this guideline underwent a series of peer, patient, methodological and external reviews to gather feedback. All comments were addressed and the guideline was amended when required. This guideline applies to and is intended for all health care workers who may come into contact with hazardous drugs at any point in the medication circuit. Results: The recommendations represent a reasonable and practical set of procedures that the intended users of this guideline should implement to minimize the opportunity for accidental exposure. These recommendations are not limited to just the point of care, but cover the entire chain of handling of cytotoxics from the time they enter the institution until they leave in the patient or as waste. Conclusions: Decreasing the likelihood of accidental exposure to cytotoxic agents within the medication circuit is the main objective of this evidenced-based guideline. The recommendations differ slightly from previous guidelines due to new evidence.

Evaluation of a novel C-Arm draping technique to minimize surgical field contamination and surgery time

BACKGROUND

The purpose of this study is to compare the sterility of three C-Arm draping techniques: the clip-drape, sterile pouch, and a novel drape tower method. We hypothesize that our novel technique will minimize floor contamination from reaching the surgical field while allowing the C-Arm machine to rotate between lateral and anterior-posterior positions more quickly.

METHODS

Five trials consisting of rotating the C-Arm and simulating surgeon movement were run using each technique. Ultraviolet light illuminating melamine powder was used to represent floor contamination. Measurements of melamine powder encroachment on the drapes were taken using the top of the C-Arm in lateral position as the reference point. The time needed to assemble, deploy, and retract the C-Arm was measured for each technique. The gown, gloves, and mayo stand were also examined after each trial for contamination.

RESULTS

Compared to the clip drape, the drape tower prevented contamination from reaching the C-Arm by an additional 30.5 cm (95% confidence interval (CI): 17.0-43.9, P < 0.001). The drape tower had faster deployment and retraction times than both the clip drape (P < 0.001 and P < 0.001, respectively) and sterile pouch (P = 0.011 and P < 0.001, respectively). The clip drape and sterile pouch exhibited glove contamination in two (40%) simulations, while the drape tower showed no instances of contamination (P = 0.255).

CONCLUSIONS

The novel drape tower technique limits the encroachment of floor contamination onto sterile drapes. It should be considered as an alternative draping method for lower extremity surgery.

Use of a closed-system drug transfer device reduces contamination with doxorubicin during bolus injection

BACKGROUND

Administration of doxorubicin via bolus injection may result in environmental contamination and a risk of nurses becoming exposed. Small spills are frequently observed by nurses when syringes are connected to, and disconnected from, infusion lines.

AIMS

The effect of a closed-system drug transfer device (CSTD) on the release of doxorubicin was studied during administration via bolus injections.

METHODS

10 administrations with the currently used technique and 10 administrations using the CSTD were compared by analysis of doxorubicin contamination on gauze pads, tissues and gloves.

FINDINGS

Using the current technique, contamination was found during nine administrations, which was mainly on the gauze pads and, to a lesser extent, on the tissues and gloves, indicating release of doxorubicin during administration. With use of the CSTD, contamination was found only on one pair of gloves.

CONCLUSION

Use of a CSTD significantly decreased the number of spills and level of contamination compared with the currently used technique and, consequently, the use of such devices offers a safer working environment for nurses.