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Tang Y, Che X, Wang YL, Ye X, Cao WL, Wang Y. Evaluation of Closed System Transfer Devices in Preventing Chemotherapy Agents Contamination During Compounding Process-A Single and Comparative Study in China. Front Public Health 2022; 10:827835. [PMID: 35509509 PMCID: PMC9058097 DOI: 10.3389/fpubh.2022.827835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Aim We performed a comparative study to investigate the efficacy of closed system transfer devices (CSTDs) on the safe handling of injectable hazardous drugs (HDs). Methods The exposure assessments of cyclophosphamide and cytarabine were performed under traditional or CSTDs. For preparation activity, chemotherapy contamination samples on protective equipment (such as gloves and masks) were collected. The contamination analysis was performed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). A 6-item form was distributed monthly (form M1-M6, total 6 months) to assess the pharmacists' experience on ergonomics, encumbrance, and safety impression. Results Totally, 96 wiping samples were collected throughout the study. The numbers of contaminated cyclophosphamide samples reduced under CSTD were -37.8, -41.6, -67.7, -47.3, and -22.9% and cytarabine were -12.3, -12.1, -20.6, -69.6, and -56.7% for left countertop, right countertop, medial glass, air-intake vent and door handle, as compared to traditional devices. The reduction was similar to pharmacist devices, i.e., -48.2 and -50.0% for masks and gloves cyclophosphamide contamination, -18.0 and -42.4% for cytarabine. This novel system could improve contamination on dispensing table, transfer container, and dispensing basket by -16.6, -6.0, and -22.3% for cyclophosphamide and -28.5, -22.5, and -46.2% for cytarabine. A high level of satisfaction was consistently associated with ergonomics for CSTD during the compounding process. Meanwhile, a slightly decreased satisfaction on ergonomics, encumbrance, and safety impression was observed for the traditional system between M2 and M3. Conclusion Closed system transfer devices are offering progressively more effective alternatives to traditional ones and consequently decrease chemotherapy exposure risk on isolator surfaces.
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Affiliation(s)
| | | | | | | | | | - Yi Wang
- Department of Pharmacy, Huashan Hospital North, Fudan University, Shanghai, China
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2
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Leso V, Sottani C, Santocono C, Russo F, Grignani E, Iavicoli I. Exposure to Antineoplastic Drugs in Occupational Settings: A Systematic Review of Biological Monitoring Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3737. [PMID: 35329423 PMCID: PMC8952240 DOI: 10.3390/ijerph19063737] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 01/10/2023]
Abstract
The high toxicity of antineoplastic drugs (ADs) makes them dangerous not only for patients, but also for exposed workers. Therefore, the aim of this review was to provide an updated overview of the biological monitoring of occupational AD exposure in order to extrapolate information useful to improve risk assessment and management strategies in workplaces. Several studies demonstrated that remarkable portions of healthcare workers may have traces of these substances or their metabolites in biological fluids, although with some conflicting results. Nurses, directly engaged in AD handling, were the occupational category at higher risk of contamination, although, in some cases, personnel not involved in AD-related tasks also showed quantifiable internal doses. Overall, further research carried out on greater sample sizes appears necessary to gain deeper insight into the variability retrieved in the reported results. This may be important to understand the impact of the extent of ADs use, different handling, procedures, and cleaning practices, spill occurrence, training of the workforce, as well as the adoption of adequate collective and personal protective equipment in affecting the occupational exposure levels. This may support the achievement of the greatest clinical efficiency of such therapies while assuring the health and safety of involved workers.
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Affiliation(s)
- Veruscka Leso
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Cristina Sottani
- Environmental Research Center, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 10, 27100 Pavia, Italy; (C.S.); (E.G.)
| | - Carolina Santocono
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Francesco Russo
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
| | - Elena Grignani
- Environmental Research Center, Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 10, 27100 Pavia, Italy; (C.S.); (E.G.)
| | - Ivo Iavicoli
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (V.L.); (C.S.); (F.R.)
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3
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Ml H, T W, Jq Z, Yj S, Tj G, Lk Z, J L, Jf Y. Evaluation of external contamination on the vial surfaces of some hazardous drugs that commonly used in Chinese hospitals and comparison between environmental contamination generated during robotic compounding by IV: Dispensing robot vs. manual compounding in biological safety cabinet. J Oncol Pharm Pract 2021; 28:1487-1498. [PMID: 34162245 PMCID: PMC9465550 DOI: 10.1177/10781552211023571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The aims of the study were to evaluate the external contamination of
hazardous drug vials used in Chinese hospitals and to compare environmental
contamination generated by a robotic intelligent dispensing system (WEINAS)
and a manual compounding procedure using a biological safety cabinet
(BSC). Methods Cyclophosphamide, fluorouracil, and gemcitabine were selected as the
representative hazardous drugs to monitor surface contamination of vials. In
the comparative analysis of environmental contamination from manual and
robotic compounding, wipe samples were taken from infusion bags, gloves, and
the different locations of the BSC and the WEINAS robotic system. In this
study, high-performance liquid chromatography coupled with double mass
spectrometer (HPLC-MS/MS) was employed for sample analysis. Results (1) External contamination was measured on vials of all three hazardous
drugs. The contamination detected on fluorouracil vials was the highest with
an average amount up to 904.33 ng/vial, followed by cyclophosphamide
(43.51 ng/vial), and gemcitabine (unprotected vials of 5.92 ng/vial,
protected vials of 0.66 ng/vial); (2) overall, the environmental
contamination induced by WEINAS robotic compounding was significantly
reduced compared to that by manual compounding inside the BSC. Particularly,
compared with manual compounding, the surface contamination on the infusion
bags during robotic compounding was nearly nine times lower for
cyclophosphamide (10.62 ng/cm2 vs 90.43 ng/cm2), two
times lower for fluorouracil (3.47 vs 7.52 ng/cm2), and more than
23 times lower for gemcitabine (2.61 ng/cm2 vs
62.28 ng/cm2). Conclusions The external contamination occurred extensively on some hazardous drug vials
that commonly used in Chinese hospitals. Comparison analysis for both
compounding procedures revealed that robotic compounding can remarkably
reduce environmental contamination.
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Affiliation(s)
- Hao Ml
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wang T
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China
| | - Zhu Jq
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China
| | - Song Yj
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China
| | - Gong Tj
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China
| | - Zou Lk
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Liu J
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Jf
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Personalized Drug Therapy Key Laboratory of Sichuan Province, Chengdu, China
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4
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Hilliquin D, Tanguay C, Bussières JF. External contamination of commercial containers by antineoplastic agents: a literature review. Eur J Hosp Pharm 2020; 27:313-314. [PMID: 32839267 DOI: 10.1136/ejhpharm-2018-001705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/12/2018] [Accepted: 12/12/2018] [Indexed: 11/03/2022] Open
Abstract
The aim of this study was to review the literature regarding the external contamination of commercial vials by antineoplastic drugs. A PubMed and CINAHL searches from 1 January 1990 to 1 May 2018 was performed with the terms: « antineoplastic agents », « environmental monitoring », « drug packaging », « vials » and « contamination ». Articles that presented results on the external contamination of commercial vials were included. Twenty-four articles were identified from 11 countries. A total of 4248 vials were sampled from 28 manufacturers. Traces were found on 56% (2379/4248) of vials. A maximum of 150 000 ng was measured on a glass vial of fluorouracil. This literature review showed that the exterior of the majority of commercial antineoplastic vials was contaminated. Manufacturers should limit this contamination. Centres are also encouraged to clean the vials on receipt. Personal protection equipment should be worn at all steps of the drug-use process.
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Affiliation(s)
- Delphine Hilliquin
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Cynthia Tanguay
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Jean-François Bussières
- Pharmacy Practice Research Unit, Pharmacy Department, CHU Sainte-Justine, Montréal, Québec, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
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5
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Hilliquin D, Bussières JF. External contamination of antineoplastic drug containers from a Canadian wholesaler. J Oncol Pharm Pract 2019; 26:423-427. [DOI: 10.1177/1078155219868525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Contamination of hospitals’ surfaces with antineoplastic drugs is documented despite safe handling practices. The exterior of commercial containers is often contaminated during the manufacturing process and can cross-contaminate hospitals’ surfaces. The aim was to investigate the contamination of the exterior of antineoplastic drug vials available in Canada in 2018. Methods Cross-sectional study. All available antineoplastic drugs vials from a single wholesaler were targeted. Containers were sampled upon their receipt by the pharmacy staff, before they were cleaned. One wipe was used to sample the external surface of five vials from a single batch from the same manufacturer. Nine antineoplastic drugs were quantified by ultra-performance liquid chromatography–tandem mass spectrometer: cyclophosphamide, docetaxel, 5-fluorouracil, gemcitabine, ifosfamide, irinotecan, methotrexate, paclitaxel, vinorelbine. Results Twenty-one samplings were done (105 containers from nine different manufacturers): cyclophosphamide = 2, docetaxel = 1, gemcitabine = 2, 5-fluorouracil = 2, ifosfamide = 2, irinotecan = 3, methotrexate = 6, paclitaxel = 2, vinorelbine = 1. One of these samplings was done on blister packaging, the remainder were done on glass vials. A total of 15/21 samples (71%) were positive to at least one drug (docetaxel, 5-fluorouracil, ifosfamide, and vinorelbine). A maximum of 272 ng/vial was quantified (gemcitabine). Cross contamination with other antineoplastic drugs was detected on 16/21 (76%) samples. Conclusion The majority of samples were positive to at least one antineoplastic drug, confirming that the exterior of antineoplastic drugs containers is still an important source of contamination. Manufacturers should reduce this contamination. Vials should be washed upon receipt, before they are stored in pharmacy. Gloves must be worn at all times to avoid occupational exposure.
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Affiliation(s)
- D Hilliquin
- Unité de recherche en pratique pharmaceutique, Département de pharmacie, CHU Sainte-Justine, Montréal, Québec, Canada
| | - JF 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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6
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Biological Monitoring of the Oncology Healthcare Staff Exposed to Cyclophosphamide in Two Hospitals in Tehran. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.86537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Smith AN, Klahn S, Phillips B, Parshley L, Bennett P, Flory A, Calderon R. ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice. J Vet Intern Med 2018; 32:904-913. [PMID: 29603372 PMCID: PMC5980460 DOI: 10.1111/jvim.15077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 01/22/2018] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this report is to offer a consensus opinion of ACVIM oncology diplomates and technicians on the safe use of cytotoxic chemotherapeutics in veterinary practice. The focus is on minimizing harm to the personnel exposed to the drugs: veterinary practitioners, veterinary technicians, veterinary staff, and pet owners. The safety of the patient receiving these drugs is also of paramount importance, but is not addressed in this statement. Much of the information presented is based on national recommendations by Occupational Safety and Health Administration, National Institute for Occupational Safety and Health, United States Pharmacopeia, and other published regulations. These directives reflect an abundance of caution to minimize exposure to medical personnel, but large-scale studies about the consequences of long-term occupational exposure are not available in veterinary medicine. Challenges in the delivery of optimal treatment safely and economically to veterinary patients in general practice without access to a veterinary oncologist or other specialist, because of costs or proximity, remain.
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Affiliation(s)
- Annette N. Smith
- Department of Clinical SciencesAuburn University College of Veterinary MedicineAuburnAlabama
| | - Shawna Klahn
- Department of Small Animal Clinical SciencesVirginia–Maryland Regional College of Veterinary Medicine, Virginia TechBlacksburgVirginia
| | - Brenda Phillips
- Oncology Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
| | - Lisa Parshley
- Oncology Olympia Veterinary Cancer CenterOlympiaWashington
| | - Peter Bennett
- Oncology University Veterinary Teaching Hospital Sydney, University of SydneySydneyAustralia
| | - Andi Flory
- Oncology Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
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8
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Bartel SB, Tyler TG, Power LA. Multicenter evaluation of a new closed system drug-transfer device in reducing surface contamination by antineoplastic hazardous drugs. Am J Health Syst Pharm 2018; 75:199-211. [PMID: 29339374 DOI: 10.2146/ajhp160948] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a study to evaluate the effectiveness of a recently introduced closed system drug-transfer device (CSTD) in reducing surface contamination during compounding and simulated administration of antineoplastic hazardous drugs (AHDs) are reported. METHODS Wipe samples were collected from 6 predetermined surfaces in compounding and infusion areas of 13 U.S. cancer centers to establish preexisting levels of surface contamination by 2 marker AHDs (cyclophosphamide and fluorouracil). Stainless steel templates were placed over the 6 previously sampled surfaces, and the marker drugs were compounded and infused per a specific protocol using all components of the CSTD. Wipe samples were collected from the templates after completion of tasks and analyzed for both marker AHDs. RESULTS Aggregated results of wipe sampling to detect preexisting contamination at the 13 study sites showed that overall, 66.7% of samples (104 of 156) had detectable levels of at least 1 marker AHD; subsequent testing after CSTD use per protocol found a sample contamination rate of 5.8% (9 of 156 samples). In the administration areas alone, the rate of preexisting contamination was 78% (61 of 78 samples); with use of the CSTD protocol, the contamination rate was 2.6%. Twenty-six participants rated the CSTD for ease of use, with 100% indicating that they were satisfied or extremely satisfied. CONCLUSION A study involving a rigorous protocol and 13 cancer centers across the United States demonstrated that the CSTD reduced surface contamination by cyclophosphamide and fluorouracil during compounding and simulated administration. Participants reported that the CSTD was easy to use.
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Affiliation(s)
| | - Timothy G Tyler
- Comprehensive Cancer Center, Desert Regional Medical Center, Palm Springs, CA
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9
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Zamboni WC, Salch SA, Cox J, Eckel S. It takes a village to raise awareness of and to address surface contamination of hazardous drugs. J Oncol Pharm Pract 2017; 23:558-560. [DOI: 10.1177/1078155217724650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- William C Zamboni
- Eshelman School of Pharmacy, University of North Carolina (UNC), Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Carolina Center of Cancer Nanotechnology Excellence, University of North Carolina, Chapel Hill, NC, USA
- ChemoGLO, LLC, Chapel Hill, NC, USA
| | - Stephanie A Salch
- Eshelman School of Pharmacy, University of North Carolina (UNC), Chapel Hill, NC, USA
| | - Joshua Cox
- Dayton Physicians Network, Dayton, OH, USA
| | - Stephen Eckel
- Eshelman School of Pharmacy, University of North Carolina (UNC), Chapel Hill, NC, USA
- ChemoGLO, LLC, Chapel Hill, NC, USA
- University of North Carolina Hospitals, Chapel Hill, NC, USA
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10
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Azari M, Panahi D, Akbari ME, Mirzaei HR, Rezvani HR, Zendehdel R, Mehrabi Y, Bayatian M. Environmental Monitoring of Occupational Exposure to Cyclophosphamide Drug in Two Iranian Hospitals. IRANIAN JOURNAL OF CANCER PREVENTION 2016. [DOI: 10.17795/ijcp-7229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Fung V, Seneviratne M. Regulatory verification on safe use of cytotoxic drugs in veterinary clinics and animal hospitals. Aust Vet J 2016; 94:400-404. [PMID: 27785801 DOI: 10.1111/avj.12515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Veterinarians are increasingly being asked to provide chemotherapy for veterinary patients. However, chemotherapy agents have cytotoxic effects that can pose a health risk to workers from exposure. There are no published studies examining cytotoxic drug (CTD) contamination in veterinary practices in Australia. METHODS CTD use at 13 veterinary clinics and animal hospitals across New South Wales (NSW) was verified for compliance with Work, Health and Safety (WHS) legislation on the effectiveness of exposure control measures. Surface swab sampling was performed to detect the restricted carcinogen cyclophosphamide and seven other CTD. A total of 73 surface swab samples were collected from nine locations associated with CTD delivery, storage, treatment and waste disposal at four veterinary practices, with repeat sampling at two veterinary practices. RESULTS Compliance with WHS legislation for systematic chemical management, including procedures for safe use of carcinogens, in veterinary practices was high: 4 of the 10 key clauses in WHS chemical management were complied with at all 13 verified workplaces. Surface contamination was detected in three locations, with levels of CTD contaminants ranging from 3.54 to 89 ng per sample. DISCUSSION Results showed that, in general, there were safe systems in place to work with CTD in the veterinary practices that were verified in NSW. Areas for improvement were mainly in administrative measures related to hazardous chemical management. Particular attention should be given to raising awareness of the intrinsic hazards of CTD, through training and hazard information provision to staff.
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Affiliation(s)
- V Fung
- Hygiene & Toxicology Unit, Hazardous Chemical Services Team, SafeWork NSW, Level 1, 2 Burbank Place, Norwest, New South Wales, Australia.
| | - M Seneviratne
- Hygiene & Toxicology Unit, Hazardous Chemical Services Team, SafeWork NSW, Level 1, 2 Burbank Place, Norwest, New South Wales, Australia
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12
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Cox J, Speed V, O’Neal S, Hasselwander T, Sherwood C, Eckel SF, Zamboni WC. Development and evaluation of a novel product to remove surface contamination of hazardous drugs. J Oncol Pharm Pract 2016; 23:103-115. [DOI: 10.1177/1078155215621151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Even while following best practices, surface exposures of hazardous drugs (HDs) are high and numerous. Thus, it is important to develop new products to reduce the surface contamination of HDs. Hazardous Drug Clean (HDClean™) was developed to decontaminate and remove HDs from various types of surfaces and overcome the problems associated with other cleaning products. Methods HDClean was evaluated to remove mock surface exposures of HDs (docetaxel, paclitaxel, ifosfamide, cyclophosphamide, 5-FU, and cisplatin) from various types of surfaces. In two separate cancer centers, studies were performed to evaluate HDClean in reducing surface contamination of HDs in the pharmacy departments where no closed system transfer device (CSTD) was used. In a third cancer center, studies were performed comparing the effectiveness of a CSTD + Surface Safe compared with CSTD + HDClean to remove HDs. Results HDClean was able to completely remove mock exposures of a wide range of HDs from various surfaces (4 and 8 sq ft areas). Daily use of HDClean was equal to or more effective in reducing surface contamination of HDs in two pharmacies compared with a CSTD. HDClean was significantly more effective in removing HDs, especially cisplatin, compared with Surface Safe and does not have the problems associated with decontamination solutions that contain sodium hypochlorite. Conclusion These studies support HDClean as an effective decontaminating product, that HDClean is more effective than Surface Safe in removing HDs and is equal to or more effective than CSTD in controlling HD surface exposures.
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Affiliation(s)
- Joshua Cox
- Dayton Physicians Network, Dayton, OH, USA
| | - Vonni Speed
- James Graham Brown Cancer Center, Louisville, KY, USA
| | - Sara O’Neal
- University of North Carolina (UNC) Eshelman School of Pharmacy, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | | | - Candice Sherwood
- University of North Carolina (UNC) Eshelman School of Pharmacy, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Stephen F Eckel
- University of North Carolina (UNC) Eshelman School of Pharmacy, Chapel Hill, NC, USA
- University of North Carolina Hospitals, Chapel Hill, NC, USA
- ChemoGLO, LLC, Chapel Hill, NC, USA
| | - William C Zamboni
- University of North Carolina (UNC) Eshelman School of Pharmacy, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- ChemoGLO, LLC, Chapel Hill, NC, USA
- Carolina Center of Cancer Nanotechnology Excellence, University of North Carolina, Chapel Hill, NC, USA
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13
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Simon N, Vasseur M, Pinturaud M, Soichot M, Richeval C, Humbert L, Lebecque M, Sidikou O, Barthelemy C, Bonnabry P, Allorge D, Décaudin B, Odou P. Effectiveness of a Closed-System Transfer Device in Reducing Surface Contamination in a New Antineoplastic Drug-Compounding Unit: A Prospective, Controlled, Parallel Study. PLoS One 2016; 11:e0159052. [PMID: 27391697 PMCID: PMC4938267 DOI: 10.1371/journal.pone.0159052] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/27/2016] [Indexed: 11/18/2022] Open
Abstract
Background The objective of this randomized, prospective and controlled study was to investigate the ability of a closed-system transfer device (CSTD; BD-Phaseal) to reduce the occupational exposure of two isolators to 10 cytotoxic drugs and compare to standard compounding devices. Methods and Findings The 6-month study started with the opening of a new compounding unit. Two isolators were set up with 2 workstations each, one to compound with standard devices (needles and spikes) and the other using the Phaseal system. Drugs were alternatively compounded in each isolator. Sampling involved wiping three surfaces (gloves, window, worktop), before and after a cleaning process. Exposure to ten antineoplastic drugs (cyclophosphamide, ifosfamide, dacarbazine, 5-FU, methotrexate, gemcitabine, cytarabine, irinotecan, doxorubicine and ganciclovir) was assessed on wipes by LC-MS/MS analysis. Contamination rates were compared using a Chi2 test and drug amounts by a Mann-Whitney test. Significance was defined for p<0.05. Overall contamination was lower in the “Phaseal” isolator than in the “Standard” isolator (12.24% vs. 26.39%; p < 0.0001) although it differed according to drug. Indeed, the contamination rates of gemcitabine were 49.3 and 43.4% (NS) for the Standard and Phaseal isolators, respectively, whereas for ganciclovir, they were 54.2 and 2.8% (p<0.0001). Gemcitabine amounts were 220.6 and 283.6 ng for the Standard and Phaseal isolators (NS), and ganciclovir amounts were 179.9 and 2.4 ng (p<0.0001). Conclusion This study confirms that using a CSTD may significantly decrease the chemical contamination of barrier isolators compared to standard devices for some drugs, although it does not eliminate contamination totally.
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Affiliation(s)
- Nicolas Simon
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
- * E-mail:
| | - Michèle Vasseur
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | | | - Marion Soichot
- Laboratoire de Toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Richeval
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | - Luc Humbert
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | | | | | - Christine Barthelemy
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals and School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Delphine Allorge
- Unité Fonctionnelle de Toxicologie, Pôle de Biologie-Pathologie-Génétique, CHRU Lille, F-59037, Lille, France
| | - Bertrand Décaudin
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
| | - Pascal Odou
- EA 7365 –GRITA—Groupe de Recherche sur les formes Injectables et les Technologies Associées, F-59000, Lille, France
- CHU Lille, Institut de Pharmacie, F-59000, Lille, France
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Zare Sakhvidi MJ, Hajaghazadeh M, Mostaghaci M, Mehrparvar AH, Zare Sakhvidi F, Naghshineh E. Applicability of the comet assay in evaluation of DNA damage in healthcare providers' working with antineoplastic drugs: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:52-67. [PMID: 27110842 DOI: 10.1080/10773525.2015.1123380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Unintended occupational exposure to antineoplastic drugs (ANDs) may occur in medical personnel. Some ANDs are known human carcinogens and exposure can be monitored by genotoxic biomarkers. OBJECTIVE To evaluate the obstacles to obtaining conclusive results from a comet assay test to determine DNA damage among AND exposed healthcare workers. METHODS We systematically reviewed studies that used alkaline comet assay to determine the magnitude and significance of DNA damage among health care workers with potential AND exposure. Fifteen studies were eligible for review and 14 studies were used in the meta-analysis. RESULTS Under random effect assumption, the estimated standardized mean difference (SMD) in the DNA damage of health care workers was 1.93 (95% CI: 1.15-2.71, p < 0.0001). The resulting SMD was reduced to 1.756 (95% CI: 0.992-2.52, p < 0.0001) when the analysis only included nurses. In subgroup analyses based on gender and smoking, heterogeneity was observed. Only for studies reporting comet moment, I2 test results, as a measure of heterogeneity, dropped to zero. Heterogeneity analysis showed that date of study publication was a possible source of heterogeneity (B = -0.14; p < 0.0001). CONCLUSIONS A mixture of personal parameters, comet assay methodological variables, and exposure characteristics may be responsible for heterogenic data from comet assay studies and interfere with obtaining conclusive results. Lack of quantitative environmental exposure measures and variation in comet assay protocols across studies are important obstacles in generalization of results.
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Affiliation(s)
- Mohammad Javad Zare Sakhvidi
- a Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Mohammad Hajaghazadeh
- b Faculty of Health, Department of Occupational Health , Urmia University of Medical Sciences , Urmia , Iran
| | - Mehrdad Mostaghaci
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Amir Houshang Mehrparvar
- c Faculty of Medicine, Department of Occupational Medicine , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Fariba Zare Sakhvidi
- d Faculty of Health, Department of Occupational Health , Shahid Sadoughi University of Medical Sciences , Yazd , Iran
| | - Elham Naghshineh
- e Faculty of Medicine, Department of Obstetrics/Gynecology, Isfahan University of Medical Sciences , Isfahan , Iran
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da Conceição AV, Bernardo D, Lopes LV, Miguel F, Bessa F, Monteiro F, Santos C, Oliveira B, Santos LL. Oncology pharmacy units: a safety policy for handling hazardous drugs and related waste in low- and middle-income African countries-Angolan experience. Ecancermedicalscience 2015; 9:575. [PMID: 26557873 PMCID: PMC4631569 DOI: 10.3332/ecancer.2015.575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Indexed: 12/29/2022] Open
Abstract
In African countries, higher rates of late-stage cancers at the time of first diagnosis are a reality. In this context, hazardous drugs (HDs), such as chemotherapy, play an important role and have immense benefits for patients' treatment. HDs should be handled under specific conditions. At least a class 5 environment primary engineering control (PEC), physically located in an appropriate buffer area, is mandatory for sterile HDs compounding, as well as administrative control, personal protective equipment, work practices and other engineering and environmental controls, in order to protect the environment, patient, and worker. The aim of this study is to describe the Angolan experience regarding the development of oncology pharmacy units and discuss international evidence-based guidelines on handling HDs and related waste. Measures to incorporate modern and economical solutions to upgrade or build adequate and safe facilities and staff training, in order to comply with international guidelines in this area, are crucial tasks for African countries of low and middle income.
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Affiliation(s)
| | - Dora Bernardo
- Pharmacy Department of Portuguese Institute of Oncology, Rua Dr António Bernardino de Almeida – 4200–072, Porto, Portugal
| | - Lygia Vieira Lopes
- Cancer Unit of Sagrada Esperança Clinic, Av Murtala Mohammed, Luanda, Angola
| | - Fernando Miguel
- Angolan Institute of Cancer Control, Rua Amilcar Cabral, Luanda, Angola
| | - Fernanda Bessa
- Pharmacy Department of Portuguese Institute of Oncology, Rua Dr António Bernardino de Almeida – 4200–072, Porto, Portugal
| | - Fernando Monteiro
- Nurse Department of Portuguese Institute of Oncology, Rua Dr António Bernardino de Almeida – 4200–072, Porto, Portugal
| | - Cristina Santos
- ONCOCIR - Education and Care in Oncology, Marçal, Luanda, Angola
| | | | - Lúcio Lara Santos
- ONCOCIR - Education and Care in Oncology, Marçal, Luanda, Angola
- Experimental Pathology and Therapeutics Group and Surgical Oncology Department, Portuguese Institute of Oncology, Rua Dr António Bernardino de Almeida – 4200–072, Porto, Portugal
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Meade E. Use of closed-system drug transfer devices in the handling and administration of MABs. ACTA ACUST UNITED AC 2015; 24:S21-7. [DOI: 10.12968/bjon.2015.24.sup16a.s21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Meade
- Registered Advanced Nurse Practitioner in Oncology, HSE Dublin Mid Leinster, Midland Regional Hospital Tullamore, County Offaly, Republic of Ireland
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17
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Hon CY, Barzan C, Astrakianakis G. Identification of Knowledge Gaps Regarding Healthcare Workers' Exposure to Antineoplastic Drugs: Review of Literature, North America versus Europe. Saf Health Work 2014; 5:169-74. [PMID: 25516807 PMCID: PMC4266773 DOI: 10.1016/j.shaw.2014.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 01/20/2023] Open
Abstract
We have been examining the issue of healthcare workers' exposure to antineoplastic drugs for nearly a decade and have observed that there appears to be more publications on the subject matter originating from Europe than from North America. The concern is that findings from Europe may not be generalizable to North America because of differences in handling practices, regulatory requirements, and training. Our objective was to perform a literature review to confirm our observation and, in turn, identify gaps in knowledge that warrants addressing in North America. Using select keywords, we searched for publications in PubMed and Web of Science. All papers were initially classified according to the originating continent and then categorized into one or more subject categories (analytical methods, biological monitoring, occupational exposure, surface contamination, and probability of risk/exposure). Our review identified 16 papers originating from North America and 55 papers from Europe with surface contamination being the subject matter most often studied overall. Based on our results, we are of the opinion that North American researchers need to further conduct dermal and/or urinary drug contamination studies as well as assess the exposure risk faced by healthcare workers who handle antineoplastic drugs. Trends in exposure levels should also be explored.
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Affiliation(s)
- Chun-Yip Hon
- School of Occupational and Public Health, Ryerson University, Toronto, Ontario, Canada ; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cris Barzan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada ; Prevention Division, WorkSafeBC, Vancouver, British Columbia, Canada
| | - George Astrakianakis
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Umemura M, Itoh A, Ando Y, Yamada K, Wakiya Y, Nabeshima T. Effects of outside air temperature on the preparation of antineoplastic drug solutions in biological safety cabinets. J Oncol Pharm Pract 2014; 21:243-8. [PMID: 24714128 DOI: 10.1177/1078155214530176] [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: 11/17/2022]
Abstract
PURPOSE In Japan, biological safety cabinets are commonly used by medical staff to prepare antineoplastic agents. At the Division of Chemotherapy for Outpatients, Nagoya University Hospital, a class II B2 biological safety cabinet is used. The temperature inside this biological safety cabinet decreases in winter. In this study, we investigated the effect of low outside air temperature on the biological safety cabinet temperature, time required to admix antineoplastic agents, and accuracy of epirubicin weight measurement. METHODS Studies were conducted from 1 January to 31 March 2008 (winter). The outside air temperature near the biological safety cabinet intake nozzle was compared with the biological safety cabinet temperature. The correlation between the outside air temperature and the biological safety cabinet temperature, time for cyclophosphamide and gemcitabine solubilization, and accuracy of epirubicin weight measurement were investigated at low and high biological safety cabinet temperatures. RESULT The biological safety cabinet temperature correlated with the outside air temperature of 5-20℃ (p < 0.0001). Compared to cyclophosphamide and gemcitabine solubilization in the biological safety cabinet at 25℃, solubilization at 10℃ was significantly delayed (p < 0.01 and p < 0.0001, respectively). Measurement of epirubicin weight by using a syringe lacked accuracy because of epirubicin's high viscosity at low temperatures (p < 0.01). CONCLUSION These results suggest that the biological safety cabinet temperature decreases when cool winter air is drawn into the biological safety cabinet, affecting the solubilization of antineoplastic agents. We suggest that a decrease in biological safety cabinet temperature may increase the time required to admix antineoplastic agents, thereby increasing the time for which outpatients must wait for chemotherapy.
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Affiliation(s)
- Masayuki Umemura
- Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Akio Itoh
- Department of Pharmacy Practice and Sciences, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Yuichi Ando
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Japan
| | - Kiyofumi Yamada
- Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshifumi Wakiya
- Department of Pharmacy Practice and Sciences, School of Pharmacy, Aichi Gakuin University, Nagoya, Japan
| | - Toshitaka Nabeshima
- Department of Regional Pharmaceutical Care & Sciences, School of Pharmacy, Meijo University, Nagoya, Japan
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Savry A, Correard F, Bennis Y, Roubaud S, Gauthier-Villano L, Pisano P, Pourroy B. Aseptic simulation test for cytotoxic drug production in isolators. Am J Health Syst Pharm 2014; 71:476-81. [PMID: 24589539 DOI: 10.2146/ajhp130343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The results of a media-fill test (MFT) study to validate processes for cytotoxic drug preparation inside and outside aseptic compounding isolators are presented. METHODS Using an MFT protocol adapted to institution-specific production conditions, the pharmacy team at a hospital in France performed a series of tests to verify the efficacy of decontamination and sterile compounding procedures, as required by French compendial standards, while assessing the performance of its team of 12 isolator operators; all operators were tested on three occasions, producing 10 MFT samples per test for a total of 30 samples per operator. The team also tested alternative compounding systems (i.e., two closed-system transfer devices and a classic spike system) for use during power outages or other emergencies precluding drug preparation within isolators. MFTs were performed using a standard tryptone soy broth-based test kit under worst-case conditions. RESULTS The hospital's facilities for cytotoxic drug preparation were found to be in conformance with applicable sterility standards. Bacterial growth was not detected in any of the MFT samples produced by isolator operators during the study (total n = 360). In one instance, an MFT sample prepared using a closed-system transfer device was found to be contaminated due to improper cleaning of the medication vial, highlighting the importance of strict adherence to proper decontamination procedures. CONCLUSION A hospital's practices for preparation of sterile products according to applicable good manufacturing guidelines, as well as emergency procedures for cytotoxic drug preparation outside isolators, were validated by the results of an MFT study.
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Affiliation(s)
- Amandine Savry
- Amandine Savry, Pharm.D., Ph.D., is Pharmacist; Florian Correard, is Pharmacy Intern; and Youssef Bennis, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital, Marseille, France. Sophie Roubaud, Pharm.D., is Pharmacist, Plein Ciel Clinic, Mougins, France. Laurence Gauthier-Villano, Pharm.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital. Pascale Pisano, Pharm.D., Ph.D., is Pharmacist, Pharmacology Laboratory, Faculty of Pharmacy, Aix Marseille University, Marseille. Bertrand Pourroy, Pharm.D., Ph.D., is Pharmacist, Oncopharma Unit, Pharmacy Department, La Timone University Teaching Hospital
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20
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Sessink PJM, Trahan J, Coyne JW. Reduction in Surface Contamination With Cyclophosphamide in 30 US Hospital Pharmacies Following Implementation of a Closed-System Drug Transfer Device. Hosp Pharm 2014; 48:204-12. [PMID: 24421463 DOI: 10.1310/hpj4803-204] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE In a follow-up to a previous study, surface contamination with the antineoplastic drug cyclophosphamide was compared in 30 US hospital pharmacies from 2004 to 2010 following preparation with standard drug preparation techniques or the PhaSeal closed system drug transfer device (CSTD). METHODS Wipe samples were taken from biological safety cabinet (BSC) surfaces, BSC airfoils (the front leading edge of the BSC), floors in front of BSCs, and countertops in the pharmacy, and they were analyzed for contamination with cyclophosphamide. Contamination was reassessed after a minimum of 6 months following the implementation of the CSTD. Surface contamination (ng/cm(2)) was compared between the 2 techniques and between the previous and current test periods and evaluated with the Kruskal-Wallis test. RESULTS With the use of CSTD compared to the standard preparation techniques, a significant reduction in levels of contamination with cyclophosphamide was observed (P < .0001). Median values for surface contamination with cyclophosphamide were reduced by 86% compared to 95% in the previous study. CONCLUSIONS The CSTD significantly reduced, but did not totally eliminate, surface contamination with cyclophosphamide. In addition to other protective measures, increased usage of CSTDs should be employed to help protect health care workers from exposure to hazardous drugs.
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Affiliation(s)
- Paul J M Sessink
- Chemist and President, Exposure Control Sweden AB, Bohus-Björkö, Sweden
| | - Jason Trahan
- Manager of Clinical Pharmacy Services, Baylor All Saints Medical Center, Fort Worth, Texas
| | - Joseph W Coyne
- Vice President of Pharmacy Services, Cancer Treatment Centers of America, Schaumburg, Illinois. Corresponding author: Dr. Paul J.M. Sessink, Exposure Control Sweden AB, Backsippevägen 2, SE - 475 37 Bohus-Björkö, Sweden; phone: (46) 702 692260; e-mail:
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21
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Guillemette A, Langlois H, Voisine M, Merger D, Therrien R, Mercier G, Lebel D, Bussières JF. Impact and appreciation of two methods aiming at reducing hazardous drug environmental contamination: The centralization of the priming of IV tubing in the pharmacy and use of a closed-system transfer device. J Oncol Pharm Pract 2014; 20:426-32. [PMID: 24395542 DOI: 10.1177/1078155213517127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The main objective was to evaluate the impact of two methods aiming at reducing hazardous drug environmental contamination: the centralization of the priming of IV tubing in the pharmacy and the use of a closed-system transfer device. The secondary objective was to evaluate the satisfaction of pharmacy technicians using a survey. METHODS Sites in the hematology-oncology satellite pharmacy and care unit were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate before and after the centralization of the priming of IV tubing in the pharmacy and before and after using a closed-system transfer device. The limits of detection for cyclophosphamide, ifosfamide and methotrexate were, respectively, of 0.0015 ng/cm(2), 0.0012 ng/cm(2) and 0.0060 ng/cm(2). The pharmacy technician satisfaction was evaluated using a questionnaire. RESULTS A total of 225 samples was quantified. After the centralization of priming in the pharmacy, no significant difference was found in the proportion of positive samples for cyclophosphamide, ifosfamide and methotrexate. Traces of cyclophosphamide found on the floor in patient care areas was significantly reduced (median[min-max] 0.08[0.06-0.09]ng/cm(2) vs. 0.03[0.02-0.05], p < 0.0001). After using a closed-system transfer device, a significant difference was found for the proportion of cyclophosphamide positive samples (15/45(33%) vs. 0/45(0%), p < 0.0001), but no significant difference was found for ifosfamide (12/45(27%) vs. 5/45(11%), p = 0.059) and methotrexate (1/45(2%) vs. 2/45(4%), p = 0.557). Pharmacy technicians raised issues following the centralization of priming (e.g. workload) and the use of closed-system transfer devices (e.g. spills, particles, workload and handling difficulties). CONCLUSION The centralization of the priming of IV tubing in the pharmacy reduced floor contamination in patient care areas without increasing surface contamination in the pharmacy. Closed-system transfer devices reduced contamination in pharmacy, but handling issues were raised by pharmacy technicians.
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Affiliation(s)
| | | | | | - Delphine Merger
- Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada
| | | | | | - Denis Lebel
- Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada
| | - Jean-François Bussières
- Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada Faculty of Pharmacy, University of Montreal, Canada
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De Ausen L, DeFreitas EF, Littleton L, Lustik M. Leakage from closed-system transfer devices as detected by a radioactive tracer. Am J Health Syst Pharm 2013; 70:619-23. [PMID: 23515515 DOI: 10.2146/ajhp110678] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE A study of leakage from selected closed-system transfer devices (CSTDs) under experimental conditions is described. METHODS Three CSTDs (the ChemoClave, OnGuard, and PhaSeal systems) were tested. Nine manufacturer-trained oncology pharmacists and pharmacy technicians volunteered to participate in an experiment to determine the degree of leakage of a liquid test agent (a radioactive technetium isotope [(99m)Tc] diluted in normal saline) during CSTD-assisted transfer of liquid from vials to syringes per standard practices. After such transfers, alcohol prep pads (n = 135 for each system) were used to wipe CSTD points of entry and assessed for the presence of (99m)Tc. Comparisons among participants and devices were conducted via analysis of variance (ANOVA), with the a priori level of significance set at 0.05. RESULTS ANOVA results indicated significant differences among devices in leakage of the test solution, with the PhaSeal device having the lowest geometric mean leakage (0.1 nL; 95% confidence interval [CI], 0-0.2 nL), followed by the OnGuard (1.5 nL; 95% CI, 1.1-1.9 nL) and ChemoClave (35.6 nL; 95% CI, 29.1-43.6 nL) devices; each pairwise comparison was significant (p < 0.001). Despite several major limitations, the research supports the use of CSTDs to help protect health care workers, as recommended by federal authorities and professional groups including the American Society of Health-System Pharmacists. CONCLUSION The volume of leakage was significantly less with PhaSeal than with OnGuard and ChemoClave when pharmacists and pharmacy technicians used the three CSTDs and (99m)Tc as a tracer.
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Affiliation(s)
- Lorena De Ausen
- Department of Pharmacy, Tripler Army Medical Center, Honolulu, HI, USA
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Clark BA, Sessink PJM. Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents. J Oncol Pharm Pract 2013; 19:99-104. [PMID: 23292973 DOI: 10.1177/1078155212468367] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of a closed system drug-transfer device, EquaShield®, at reducing surface contamination with antineoplastic agents throughout an ambulatory cancer chemotherapy infusion center. METHODS Surfaces throughout the cancer center were sampled three times. The first samples were obtained in June 2010 without prior cleaning to measure baseline levels of contamination of the current technique (Chemo Dispensing Pin, B. Braun Medical Inc.). The second samples were obtained in August 2010 after the implementation of the closed system drug-transfer device and cleaning to evaluate if the contamination was removed. The third samples were obtained in August 2011. Wipe samples were taken from five positions in the pharmacy and from five positions in the infusion suite. Wipe samples were also collected from two positions in office areas. Samples were analyzed for cyclophosphamide and 5-fluorouracil. RESULTS The results from the first two sets of samples showed contamination with cyclophosphamide on about half of the positions at all locations during both collection periods. However, levels of contamination were very low and mostly just above the detection limit of the analytical method. The highest level of contamination was found on the door and handle in the pharmacy. Contamination with 5-fluorouracil was only observed on the dispensing counter in the pharmacy during the second collection period. The results from the third and final collection period showed no contamination with cyclophosphamide or 5-fluorouracil in the pharmacy, the infusion suite or in offices of the cancer center. CONCLUSION Implementation of the closed system drug-transfer device for preparing and administering chemotherapy eliminated surface contamination with cytotoxic agents at the ambulatory cancer chemotherapy infusion center.
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Affiliation(s)
- Bernadette A Clark
- Oncology, Cleveland Clinic Cancer Center, Fairview Hospital, OH 44111, USA.
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Robot-assisted preparation of oncology drugs: The role of nurses. Int J Pharm 2012; 439:286-8. [DOI: 10.1016/j.ijpharm.2012.09.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 09/05/2012] [Accepted: 09/08/2012] [Indexed: 11/21/2022]
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