1
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Sessink P, Tans B, Devolder D, Schrijvers R, Spriet I. Evaluation of environmental antibiotic contamination by surface wipe sampling in a large care centre. J Antimicrob Chemother 2024; 79:1637-1644. [PMID: 38828950 PMCID: PMC11215530 DOI: 10.1093/jac/dkae159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 04/13/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVES Exposure of healthcare workers to antibiotics may cause adverse health effects. Results of environmental contamination with antibiotics, obtained by taking surface wipe samples, can be used as an indicator for potential exposure to these sensitizing drugs. The objective was to describe the results of repeated measurements of contamination with antibiotics on multiple surfaces in hospital wards. Standardized needle and syringe preparation techniques and cleaning procedures were used. METHODS The preparation table and the floor around the waste bin in six wards were sampled and analysed for contamination with the antibiotics amoxicillin, benzylpenicillin, cefotaxime, ceftriaxone, flucloxacillin, meropenem, piperacillin and vancomycin. Sampling was performed in four trials during 8 months. Depending on the outcome of the trials, the cleaning procedure was adapted. Liquid chromatography with tandem mass spectrometry was used for the analysis of the drugs. RESULTS During the four trials, contamination with all eight antibiotics was omnipresent on all preparation tables and floors in the six wards. The highest contamination was found for amoxicillin (1291 ng/cm2). Changing the cleaning procedure did not reduce the level of contamination. CONCLUSIONS Surface contamination with the antibiotics was widespread and most probably caused by spillage during the preparation in combination with an ineffective cleaning procedure. Strategies should be developed and implemented by institutions for safe handling of antibiotics to reduce environmental contamination and potential exposure of healthcare workers to these sensitizing drugs.
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Affiliation(s)
- Paul Sessink
- Exposure Control Sweden AB, Bohus-Björkö, Sweden
| | - Birgit Tans
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - David Devolder
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology, and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
- Department General Internal Medicine-Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, University Leuven, Leuven, Belgium
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2
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Wilkinson AS, Walker KE, Ozolina L, Machníková R, Johnson AJ, Bhogal N, Pegg K. Integrity performance assessment of a closed system transfer device syringe adaptor lock as a terminal closure for Luer-Lock syringes. Eur J Hosp Pharm 2023; 31:50-56. [PMID: 35410874 PMCID: PMC10800267 DOI: 10.1136/ejhpharm-2021-003148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To investigate the container closure integrity of a closed system transfer device syringe adaptor lock in combination with disposable Luer-Lock syringes as the terminal closure device. The UK National Health Service (NHS) Pharmaceutical Quality Assurance Committee (PQAC) requires syringe integrity data for final storage devices of aseptic products such as chemotherapy drugs when prepared in advance and stored before use, as is standard practice for dose banded drugs. The assessment comprised both physical and microbial integrity testing of the combination closed system/Luer-Lock syringe containers at syringe sizes of 1 mL, 20 mL, and 50 mL. METHODS Integrity testing was performed as described in the NHS Pharmaceutical Quality Assurance Committee yellow cover document, second edition 2013 'Protocols for the Integrity Testing of Syringes', with Chemfort (Simplivia, IL) syringe adaptor lock (SAL) devices as replacement for sterile blind hubs. Microbiological integrity was assessed according to method 1 part 1.4 using Brevundimonas diminuta at 32°C for up to 14 days of contact time. Two positive control devices per syringe size were tested using a blind hub cap as closure which was loosened before the test. Physical integrity was assessed using method 3 of the yellow cover document which is a dye intrusion method. Dye intrusion was assessed both visually and using a validated ultraviolet-visible spectrophotometer method. For each size/batch of test articles a positive control device (n=1) was assessed using a wire wrapped around the syringe plunger tip deliberately compromising integrity. Negative controls for each size (n=1) consisted of devices not immersed in methylene blue dye. RESULTS Chemfort syringe adaptor lock/Luer-Lock syringe combinations were shown to be: (1) free of microbiological contamination after 14 days of contact time (n=60); and (2) free of dye intrusion at all syringe sizes tested (n=61 in total). The data demonstrate 100% closure integrity of the final container system when the Chemfort syringe adaptor lock replaces the syringe hub as the terminal closure device. All positive control devices demonstrated system suitability as container integrity was compromised in all positive control tests. All negative controls were negative for microbial and dye intrusion. CONCLUSIONS Syringe adaptor lock components complied with the NHS Pharmaceutical Quality Assurance Committee yellow cover document syringe integrity requirements when used as the terminal closure of Luer-Lock disposable syringes from 1 mL up to 50 mL. Therefore, syringe adaptor lock (Chemfort) can be used as the terminal closure system for pre-filled syringes of chemotherapeutic drug products prepared in advance in UK NHS pharmacy technical services.
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Affiliation(s)
- Alan Shaun Wilkinson
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Kate E Walker
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Laima Ozolina
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Romana Machníková
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Andrew J Johnson
- R&D, Biopharma Stability Testing Laboratory Ltd, Nottingham, Nottinghamshire, UK
| | - Navneet Bhogal
- QA Pharmacy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
| | - Kate Pegg
- QA Pharmacy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Derbyshire, UK
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3
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Simal I, Bauters T, Paepens C, Clottens N, Ramaut P, Kestens E. Developing a flowchart to evaluate the use of Closed System Drug-Transfer Devices with monoclonal antibodies: Focus on the clinical trial setting. J Oncol Pharm Pract 2023; 29:2014-2022. [PMID: 37680124 DOI: 10.1177/10781552231199412] [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: 09/09/2023]
Abstract
OBJECTIVE Available guidelines are ambiguous about safe handling monoclonal antibodies (MABs) and whether or not to use a Closed System Drug-Transfer Device (CSTD). In this article we want to describe a standardized working method on handling MABs in a clinical trial setting. DATA SOURCES The current workflow at the clinical trial unit of the Ghent University Hospital was critically analyzed, after which an extensive literature review was performed using the National Institute for Occupational Safety and Health Working Group guidelines and the database PubMed (Keywords: monoclonal antibodies, closed system transfer devices, safety guidelines, safe handling, management, administration, (bio)compatibility, volume loss, contamination, clinical trial unit. Period: 2020-2022). DATA SUMMARY Literature data are ambiguous. CSTDs can reduce cross-contamination and minimize exposure to potential hazardous drugs for healthcare professionals. However, in recent years more questions have been raised about their in-use compatibility and their impact on final product quality. This makes the debate on implementing CSTDs a hot topic in daily pharmacy practice and demands a holistic and standardized approach when deciding whether or not to use a CSTD when handling MABs. In a clinical trial setting, where safety data are frequently not available and the compatibility of CSTDs and investigational product is often unknown, this poses additional challenges that need to be taken into account. CONCLUSION We developed a flowchart which standardizes the use of a CSTD when handling MABs. It allows other healthcare professionals and clinical trial sponsors to define and evaluate the necessary criteria when standardizing the position of a CSTD in their safe handling procedures.
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Affiliation(s)
- Ine Simal
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
| | - Tiene Bauters
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
| | | | - Nele Clottens
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
| | - Pieter Ramaut
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
| | - Els Kestens
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
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4
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Clark C. Taking steps to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S4-S8. [PMID: 37219988 DOI: 10.12968/bjon.2023.32.10.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in March 2023 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.
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5
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Kennedy K, Vu K, Coakley N, Daley-Morris J, Forbes L, Hartzell R, Lessels D. Safe handling of hazardous drugs. J Oncol Pharm Pract 2023; 29:401-412. [PMID: 36373754 PMCID: PMC9900183 DOI: 10.1177/10781552221135121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Kardi Kennedy
- Cancer Services, Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Kathy Vu
- Safety Initiatives Systemic Treatment Program, Ontario Health,
Cancer Care Ontario, Toronto, Ontario, Canada,Teaching Stream, Leslie Dan Faculty of Pharmacy, University of
Toronto, Toronto, Ontario, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto,
Ontario, Canada
| | - Nadia Coakley
- Department of Oncology, McMaster University, Hamilton, Ontario,
Canada,Ontario Health's Cancer Care Ontario's Program in Evidence-Based
Care, McMaster University, Hamilton, Ontario, Canada,Nadia Coakley, Department of Oncology,
McMaster University, Hamilton, ON, Canada; Ontario Health's Cancer Care
Ontario's Program in Evidence-based care, McMaster University, Juravinski Site
G-227, 1280 Main St W, Hamilton, Ontario, Canada L8N 3Z5.
| | - Jennifer Daley-Morris
- Oncology Pharmacy & Systemic Therapy Suite, Southlake Regional Health
Centre, Newmarket, Ontario Canada
| | - Leta Forbes
- Systemic Treatment Program Ontario Health, Cancer Care Ontario,
Durham Regional Cancer Center, Oshawa, Ontario, Canada
| | - Renee Hartzell
- Kingston Health Sciences
Centre, Kingston, Ontario, Canada
| | - Darrilyn Lessels
- Lakeridge Health, Durham Regional Cancer Center, Oshawa, Ontario,
Canada
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6
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Clark C. The need to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S10. [PMID: 36149419 DOI: 10.12968/bjon.2022.31.17.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in May 2022 as part of a series on the risks of exposure to hazardous drugs for nurses working in oncology.
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7
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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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8
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Luiz MT, Dutra JAP, Di Filippo LD, Junior AGT, Tofani LB, Marchetti JM, Chorilli M. Epirubicin: Biological Properties, Analytical Methods, and Drug Delivery Nanosystems. Crit Rev Anal Chem 2021; 53:1080-1093. [PMID: 34818953 DOI: 10.1080/10408347.2021.2007469] [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: 07/21/2023]
Abstract
Epirubicin (EPI) is a chemotherapeutic agent belonging to the anthracycline drug class indicated for treating several tumors. It acts by suppressing the DNA and RNA synthesis by intercalating between their base pair. However, several side effects are associated with this therapy, including cardiotoxicity and myelosuppression. Therefore, EPI delivery in nanosystems has been an interesting strategy to overcome these limitations and improve the safety and efficacy of EPI. Thus, analytical methods have been used to understand and characterize these nanosystems, including spectrophotometric, spectrofluorimetric, and chromatography. Spectrophotometric and spectrofluorimetric methods have been used to quantify EPI in less complex matrices due to their efficiency, low cost, and green chemistry character. By contrast, high-performance liquid chromatography is a suitable method for detecting EPI in more complex matrices (e.g., plasm and urine) owing to its high sensitivity. This review summarizes physicochemical and pharmacokinetic properties of EPI, its application in drug delivery nanosystems, and the analytical methods employed in its quantification in different matrices, including blood, plasm, urine, and drug delivery nanosystems.
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Affiliation(s)
- Marcela Tavares Luiz
- School of Pharmaceutical Science of Ribeirao Preto, University of São Paulo (USP), Ribeirao Preto, São Paulo, Brazil
| | | | | | | | - Larissa Bueno Tofani
- School of Pharmaceutical Science of Ribeirao Preto, University of São Paulo (USP), Ribeirao Preto, São Paulo, Brazil
| | - Juliana Maldonado Marchetti
- School of Pharmaceutical Science of Ribeirao Preto, University of São Paulo (USP), Ribeirao Preto, São Paulo, Brazil
| | - Marlus Chorilli
- School of Pharmaceutical Science of São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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9
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Doepke A, Streicher RP. Source apportionment and quantification of liquid and headspace leaks from closed system drug-transfer devices via Selected Ion Flow Tube Mass Spectrometry (SIFT-MS). PLoS One 2021; 16:e0258425. [PMID: 34735484 PMCID: PMC8568112 DOI: 10.1371/journal.pone.0258425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
A system to differentiate and quantify liquid and headspace vapor leaks from closed system drug-transfer devices (CSTDs) is presented. CSTDs are designed to reduce or eliminate hazardous drug (HD) exposure risk when compounding and administering HDs. CSTDs may leak liquid, headspace, or a mixture of the two. The amount of HD contained in liquid and headspace leaks may be substantially different. Use of a test solution containing two VOCs with differences in ratios of VOC concentrations in the headspace and liquid enables source apportionment of leaked material. SIFT-MS was used to detect VOCs from liquid and headspace leaks in the vapor phase. Included in this report is a novel method to determine the origin and magnitude of leaks from CSTDs. A limit of leak detection of 24 μL of headspace vapor and 0.14 μL of test liquid were found using Selected Ion Flow Tube Mass Spectrometry (SIFT-MS).
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Affiliation(s)
- Amos Doepke
- Health Effects Laboratory Division (HELD), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Chemical and Biochemical Monitoring Branch (CBMB), Alice Hamilton Laboratories, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Robert P. Streicher
- Health Effects Laboratory Division (HELD), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Chemical and Biochemical Monitoring Branch (CBMB), Alice Hamilton Laboratories, Cincinnati, Ohio, United States of America
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10
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Clark C. Helping to protect cancer nurses from exposure to hazardous drugs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S4-S8. [PMID: 34605266 DOI: 10.12968/bjon.2021.30.17.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in April 2021 on protecting nursing staff working in oncology from exposure to hazardous drugs.
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11
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Clark C. How can we protect cancer nurses from exposure to hazardous drugs? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S16-S20. [PMID: 33641389 DOI: 10.12968/bjon.2021.30.4.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Freelance medical writer Christine Clark (chris@salt.u-net.com) reports on an online meeting held in November 2020 on protecting nursing working in oncology from exposure to hazardous drugs.
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12
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Polovich M. USP General Chapter <800>: Considerations for Oncology Nursing Practice. Semin Oncol Nurs 2020; 36:151022. [PMID: 32404243 DOI: 10.1016/j.soncn.2020.151022] [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: 11/26/2022]
Abstract
OBJECTIVES To describe the nurse leader's role in implementing the hazardous drug safe-handling standards from USP General Chapter <800> that are most relevant to oncology nursing practice, and to provide strategies for reducing nurses' exposure to hazardous drugs. DATA SOURCES Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise. CONCLUSION Nurse leaders are essential to promoting a safe environment for nurses handling hazardous cancer drugs. IMPLICATIONS FOR NURSING PRACTICE Several barriers and challenges to handling hazardous drugs exist and must be overcome before oncology nurses' exposure can be reduced.
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Affiliation(s)
- Martha Polovich
- Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, GA.
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13
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Evaluation of Different Quality-Relevant Aspects of Closed System Transfer Devices (CSTDs). Pharm Res 2020; 37:81. [DOI: 10.1007/s11095-020-02784-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/16/2020] [Indexed: 11/25/2022]
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14
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Benoist H, Breuil C, Le Neindre B, Delépée R, Saint-Lorant G. Does equipment change impact blood contamination with irinotecan and its two major metabolites in a centralized cytotoxic pharmacy unit? J Oncol Pharm Pract 2020; 26:1823-1828. [DOI: 10.1177/1078155220905013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Antineoplastic drugs exposure is a major problem for caregivers’ health. The aim of this study is to assess blood contamination with irinotecan and its two metabolites in a centralized pharmacy unit for cytotoxic drug preparations workers before and after protective equipment changes. Methods The study took place in a university hospital centralized pharmacy unit for cytotoxic drug and was performed in two parts, before (Round 1: R1) and after equipment changes (Round 2: R2). Collection of pharmacy staff blood samples was performed in UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN38; APC) were determined with a validated analytical method detection test. Results A total of 15/36 (41.6%) assays were positive in R1 and 16/72 (22.2%) in R2 with a significant decrease between periods ( P = 0.035). For plasma dosages, no difference between the two periods was found ( P = 0.71); respectively 4/18 (22.2%) assays were positive in R1 and 6/36 (16.6%) in R2. For red blood cells dosages, a significant decrease between periods was found ( P = 0.01); respectively 11/18 (61%) were positive in R1 and 10/36 (27.8%) in R2. Conclusions These dosages make it possible to have the very first evaluation for plasma and red blood cell contamination with irinotecan and its metabolites in the context of equipment changes, both at individual and collective levels. This work would help to protect health workers from the potential risks represented by these molecules, especially by revealing a contamination of workers in order to objectify the results of exposure.
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Affiliation(s)
- H Benoist
- Service de Pharmacie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - C Breuil
- Service de Pharmacie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - B Le Neindre
- Service de Médecine du Travail, Centre Hospitalier Universitaire de Caen, Caen, France
| | - R Delépée
- Normandie University, UNICAEN, ABTE, Comprehensive Cancer Centre F. Baclesse, Caen, France
| | - G Saint-Lorant
- Service de Pharmacie, Centre Hospitalier Universitaire de Caen, Caen, France
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15
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Petoskey F, Kwok SC, Jackson W, Jiang S. Overcoming Challenges of Implementing Closed System Transfer Device Clinical In-Use Compatibility Testing for Drug Development of Antibody Drug Conjugates. J Pharm Sci 2020; 109:761-768. [DOI: 10.1016/j.xphs.2019.07.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/12/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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16
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Dubray Q, Diallo T, Loeuillet R, Andre E, Fauqueur AS, Poil S, Thromas N, Secretan PH, Cisternino S, Schlatter J. Occupational risks evaluation in a centralized antineoplastic agent preparation unit. SAGE Open Med 2019; 7:2050312119866970. [PMID: 31384466 PMCID: PMC6661790 DOI: 10.1177/2050312119866970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/10/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: The global professional risk assessment applied to the central unit of
antineoplastic agent preparations is part of a mandatory approach required
by the European legislation for workers. This study identified the hazardous
situations related to the staff activity and then enabled the preparation of
a formal plan of occupational prevention. Methods: The nature of study approved by a working group constituted by experts was
the global risk analysis. After identifying the hazardous situations, the
global risk analysis estimated the risk level of each hazardous situation
based on a criticality score, including severity and frequency. The global
risk analysis highlighted the initial and residual risks after establishing
a plan to reduce the high criticality risks. Results: Hence, 33 unacceptable hazardous situations were identified. The critical
categories of professional risks were “Product, emissions, and waste risks”
with 17 (55%) hazardous situations; “Psychosocial risk factors” with 8 (24%)
hazardous situations; and “Risks related to work equipment” with 6 (18%)
hazardous situations. Once the risk reduction plan was in place, all
hazardous situations were considered under control. The corrective actions
led to a reorganization of human resources, the update of protection
protocols, and optimization of ergonomic work tools. Staff-specific medical
monitoring and regular surface contamination tests have been scheduled
annually. In addition, initial and continuous training, specific to product
and waste risks, has been updated. Conclusion: The global professional risk assessment related to centralized antineoplastic
agent preparation unit generated failure in our system and enabled
corrective actions for staff safety.
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Affiliation(s)
- Quentin Dubray
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Taibou Diallo
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Richard Loeuillet
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Emilie Andre
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | | | - Sandrine Poil
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | - Nathalie Thromas
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
| | | | - Salvatore Cisternino
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France.,Faculté de pharmacie de Paris, Université Paris Descartes, Paris, France.,INSERM UMR-S 1144, Paris, France
| | - Joël Schlatter
- Pharmacie, Hôpital Universitaire Necker - Enfants Malades, Paris, France
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Occupational exposure to cytotoxic drugs: the importance of surface cleaning to prevent or minimise exposure. Arh Hig Rada Toksikol 2018; 69:238-249. [DOI: 10.2478/aiht-2018-69-3137] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/01/2018] [Indexed: 11/20/2022] Open
Abstract
Abstract
Healthcare workers who prepare or administer cytotoxic agents run the risk of exposure, and the risks for health are real even at doses lower than those applied in cancer patients, because, in theory, no dose is safe. The most common and problematic route of exposure is through the skin, especially as work surfaces can remain contaminated even after cleaning. This pilot study aimed to demonstrate the importance of having an effective surface decontamination protocol by determining surface contamination with cyclophosphamide, 5-fluorouracil, and paclitaxel as the most common cytotoxic drugs in an oncology day service. Samples were collected before and after drug handling and analysed with high performance liquid chromatography with diode array detection (HPLC-DAD). Of the 29 samples collected before drug handling 23 were contaminated, five of which with more than one drug. Of the 30 samples collected after drug handling 25 were contaminated, eight of which with more than one drug. The two time points did not significantly differ, which evidences a widespread contamination and ineffective cleaning. This calls for revising the cleaning protocol and handling procedure to place contamination under control as much as possible.
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Chaffee BW, Lander MJ, Christen C, Redic KA. Surface contamination of counting tools after mock dispensing of cyclophosphamide in a simulated outpatient pharmacy. J Oncol Pharm Pract 2018; 25:85-93. [PMID: 29592766 DOI: 10.1177/1078155218764587] [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: 11/15/2022]
Abstract
PURPOSE The primary aim was to determine if dispensing of cyclophosphamide tablets resulted in accumulated residue on pharmacy counting tools during a simulated outpatient dispensing process. Secondary objectives included determining if cyclophosphamide contamination exceeded a defined threshold level of 1 ng/cm2 and if a larger number of prescriptions dispensed resulted in increased contamination. METHODS Mock prescriptions of 40 cyclophosphamide 50 mg tablets were counted on clean trays in three scenarios using a simulated outpatient pharmacy after assaying five cleaned trays as controls. The three scenarios consisted of five simulated dispensings of one, three, or six prescriptions dispensed per scenario. Wipe samples of trays and spatulas were collected and assayed for all trays, including the five clean trays used as controls. Contamination was defined as an assayed cyclophosphamide level at or above 0.001 ng/cm2 and levels above 1 ng/cm2 were considered sufficient to cause risk of human uptake. Mean contamination for each scenario was calculated and compared using one-way analysis of variance. P-values of < 0.05 implied significance. RESULTS Mean cyclophosphamide contamination on trays used to count one, three, and six cyclophosphamide prescriptions was 0.51 ± 0.10 (p=0.0003), 1.02 ± 0.10 (p < 0.0001), and 1.82 ± 0.10 ng/cm2 (p < 0.0001), respectively. Control trays did not show detectable cyclophosphamide contamination. Increasing the number of prescriptions dispensed from 1 to 3, 1 to 6, and 3 to 6 counts increased contamination by 0.51 ± 0.15 (p = 0.0140), 1.31 + 0.15 (p < 0.0001), and 0.80 ± 0.15 ng/cm2 (p = 0.0004), respectively. CONCLUSION Dispensing one or more prescriptions of 40 cyclophosphamide 50 mg tablets contaminates pharmacy counting tools, and an increased number of prescriptions dispensed correlates with increased level of contamination. Counting out three or more prescriptions leads to trays having contamination that surpasses the threshold at which worker exposure may be increased. Pharmacies should consider devoting a separate tray to cyclophosphamide tablets, as cross-contamination could occur with other drugs and the efficacy of decontamination methods is unclear. Employee exposure could be minimized with the use of personal protective equipment, environmental controls, and cleaning trays between uses. Future investigation should assess the extent of drug powder dispersion, the effects of various cleaning methods, and the potential extent of contamination with different oral cytotoxic drugs.
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Affiliation(s)
- Bruce W Chaffee
- 1 Department of Pharmacy Services, Michigan Medicine, Ann Arbor, USA.,2 15514 College of Pharmacy, University of Michigan , Ann Arbor, USA
| | | | - Catherine Christen
- 1 Department of Pharmacy Services, Michigan Medicine, Ann Arbor, USA.,2 15514 College of Pharmacy, University of Michigan , Ann Arbor, USA
| | - Kimberly A Redic
- 1 Department of Pharmacy Services, Michigan Medicine, Ann Arbor, USA.,2 15514 College of Pharmacy, University of Michigan , Ann Arbor, USA
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Gurusamy KS, Best LMJ, Tanguay C, Lennan E, Korva M, Bussières J. Closed-system drug-transfer devices plus safe handling of hazardous drugs versus safe handling alone for reducing exposure to infusional hazardous drugs in healthcare staff. Cochrane Database Syst Rev 2018; 3:CD012860. [PMID: 29582940 PMCID: PMC6360647 DOI: 10.1002/14651858.cd012860.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Occupational exposure to hazardous drugs can decrease fertility and result in miscarriages, stillbirths, and cancers in healthcare staff. Several recommended practices aim to reduce this exposure, including protective clothing, gloves, and biological safety cabinets ('safe handling'). There is significant uncertainty as to whether using closed-system drug-transfer devices (CSTD) in addition to safe handling decreases the contamination and risk of staff exposure to infusional hazardous drugs compared to safe handling alone. OBJECTIVES To assess the effects of closed-system drug-transfer of infusional hazardous drugs plus safe handling versus safe handling alone for reducing staff exposure to infusional hazardous drugs and risk of staff contamination. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH-UPDATE, CINAHL, Science Citation Index Expanded, economic evaluation databases, the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov to October 2017. SELECTION CRITERIA We included comparative studies of any study design (irrespective of language, blinding, or publication status) that compared CSTD plus safe handling versus safe handling alone for infusional hazardous drugs. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials and extracted data. We calculated the risk ratio (RR) and mean difference (MD) with 95% confidence intervals (CI) using both fixed-effect and random-effects models. We assessed risk of bias according to the risk of bias in non-randomised studies of interventions (ROBINS-I) tool, used an intracluster correlation coefficient of 0.10, and we assessed the quality of the evidence using GRADE. MAIN RESULTS We included 23 observational cluster studies (358 hospitals) in this review. We did not find any randomised controlled trials or formal economic evaluations. In 21 studies, the people who used the intervention (CSTD plus safe handling) and control (safe handling alone) were pharmacists or pharmacy technicians; in the other two studies, the people who used the intervention and control were nurses, pharmacists, or pharmacy technicians. The CSTD used in the studies were PhaSeal (13 studies), Tevadaptor (1 study), SpikeSwan (1 study), PhaSeal and Tevadaptor (1 study), varied (5 studies), and not stated (2 studies). The studies' descriptions of the control groups were varied. Twenty-one studies provide data on one or more outcomes for this systematic review. All the studies are at serious risk of bias. The quality of evidence is very low for all the outcomes.There is no evidence of differences in the proportion of people with positive urine tests for exposure between the CSTD and control groups for cyclophosphamide alone (RR 0.83, 95% CI 0.46 to 1.52; I² = 12%; 2 studies; 2 hospitals; 20 participants; CSTD: 76.1% versus control: 91.7%); cyclophosphamide or ifosfamide (RR 0.09, 95% CI 0.00 to 2.79; 1 study; 1 hospital; 14 participants; CSTD: 6.4% versus control: 71.4%); and cyclophosphamide, ifosfamide, or gemcitabine (RR not estimable; 1 study; 1 hospital; 36 participants; 0% in both groups).There is no evidence of a difference in the proportion of surface samples contaminated in the pharmacy areas or patient-care areas for any of the drugs except 5-fluorouracil, which was lower in the CSTD group than in the control (RR 0.65, 95% CI 0.43 to 0.97; 3 studies, 106 hospitals, 1008 samples; CSTD: 9% versus control: 13.9%).The amount of cyclophosphamide was lower in pharmacy areas in the CSTD group than in the control group (MD -49.34 pg/cm², 95% CI -84.11 to -14.56, I² = 0%, 7 studies; 282 hospitals, 1793 surface samples). Additionally, one interrupted time-series study (3 hospitals; 342 samples) demonstrated a change in the slope between pre-CSTD and CSTD (3.9439 pg/cm², 95% CI 1.2303 to 6.6576; P = 0.010), but not between CSTD and post-CSTD withdrawal (-1.9331 pg/cm², 95% CI -5.1260 to 1.2598; P = 0.20). There is no evidence of difference in the amount of the other drugs between CSTD and control groups in the pharmacy areas or patient-care areas.None of the studies report on atmospheric contamination, blood tests, or other measures of exposure to infusional hazardous drugs such as urine mutagenicity, chromosomal aberrations, sister chromatid exchanges, or micronuclei induction.None of the studies report short-term health benefits such as reduction in skin rashes, medium-term reproductive health benefits such as fertility and parity, or long-term health benefits related to the development of any type of cancer or adverse events.Five studies (six hospitals) report the potential cost savings through the use of CSTD. The studies used different methods of calculating the costs, and the results were not reported in a format that could be pooled via meta-analysis. There is significant variability between the studies in terms of whether CSTD resulted in cost savings (the point estimates of the average potential cost savings ranged from (2017) USD -642,656 to (2017) USD 221,818). AUTHORS' CONCLUSIONS There is currently no evidence to support or refute the routine use of closed-system drug transfer devices in addition to safe handling of infusional hazardous drugs, as there is no evidence of differences in exposure or financial benefits between CSTD plus safe handling versus safe handling alone (very low-quality evidence). None of the studies report health benefits.Well-designed multicentre randomised controlled trials may be feasible depending upon the proportion of people with exposure. The next best study design is interrupted time-series. This design is likely to provide a better estimate than uncontrolled before-after studies or cross-sectional studies. Future studies may involve other alternate ways of reducing exposure in addition to safe handling as one intervention group in a multi-arm parallel design or factorial design trial. Future studies should have designs that decrease the risk of bias and enable measurement of direct health benefits in addition to exposure. Studies using exposure should be tested for a relevant selection of hazardous drugs used in the hospital to provide an estimate of the exposure and health benefits of using CSTD. Steps should be undertaken to ensure that there are no other differences between CSTD and control groups, so that one can obtain a reasonable estimate of the health benefits of using CSTD.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- University College LondonDivision of Surgery and Interventional Science9th Floor, Royal Free HospitalRowland Hill StreetLondonUKNW3 2PF
| | - Lawrence MJ Best
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRowland Hill StreetLondonUKNW32PF
| | - Cynthia Tanguay
- CHU Sainte‐JustineUnité de Recherche en Pratique Pharmaceutique3175 Côte Sainte‐CatherineMontrealQuebecCanadaH3T 1C5
| | - Elaine Lennan
- University Hospital SouthamptonDepartment of ChemotherapySouthamptonUK
| | - Mika Korva
- Finnish Institute of Occupational HealthTurkuFinland
| | - Jean‐François Bussières
- CHU Sainte‐JustineUnité de Recherche en Pratique Pharmaceutique3175 Côte Sainte‐CatherineMontrealQuebecCanadaH3T 1C5
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Alexander K, Northrup N, Clarke D, Lindell H, Laver T. Engineering controls in veterinary oncology: A survey of 148 ACVIM board-certified oncologists and environmental surveillance in 20 specialty hospitals. Vet Comp Oncol 2018; 16:385-391. [PMID: 29446222 DOI: 10.1111/vco.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Abstract
Engineering controls (EC, facility and equipment barriers between hazards and people) are used to avoid exposure to chemotherapy drugs. In this study, American College of Veterinary Internal Medicine board-certified veterinary oncologists were surveyed about their use of containment primary EC (C-PEC) and supplemental EC (closed system transfer devices, CSTD). The survey was completed by 148 (38%) of practicing diplomates. All used EC. Both C-PEC and CSTD were used at 92% of hospitals; however, US Pharmacopoeial Convention Chapter <800> (USP <800>) standards were met at only 19% of hospitals and oncologists did not know the type of C-PEC at 18% of hospitals. Next, surface contamination and EC use were assessed with environmental surveillance for carboplatin, cyclophosphamide, doxorubicin, and vincristine in 20 veterinary specialty hospitals using a commercially available kit. No contamination with carboplatin, doxorubicin, or vincristine was detected, however, there was contamination with cyclophosphamide at 4 hospitals. Based on this study, most veterinary oncologists use C-PEC and CSTD, but few meet USP <800> standards. Current measures appear effective for preventing contamination with IV drugs, but additional measures are needed for oral drugs.
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Affiliation(s)
- K Alexander
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - N Northrup
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - D Clarke
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - H Lindell
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - T Laver
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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Karakoç MD. A Cost Saving and Waste Minimization Study About Handling of the Antineoplastic Agents. Turk J Pharm Sci 2017; 14:304-310. [PMID: 32454629 DOI: 10.4274/tjps.25238] [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: 08/11/2016] [Accepted: 02/09/2017] [Indexed: 12/01/2022]
Abstract
Objectives As a cancer treatment option, chemotherapy costs make up a large part of the budgets of social insurance foundations and related expenditures are increasing continuously annually. Cost saving and waste minimizing strategies are required to reduce the expenditures in the field of oncology. The study aimed to reduce the amount of wasted antineoplastic drugs and medical supply consumption. Materials and Methods The study explains why vials with a larger size and drugs in liquid form should be preferred over various smaller sizes and powder forms of antineoplastic preparations. Results Amounts of drug wastage, vial adaptor, and transfer set consumption data were recorded regularly for a period of seven months. The average vial adaptor consumption per patient in the last three months decreased from 5 to 3.3. The preference of liquid forms as much as possible instead of powder forms, which has a shorter stability time after dilution, and the choice of larger package sizes of frequently used drugs decreased vial adaptor consumption. Potential savings were calculated as around 31.660 USD annually. Costs of total wasted doses were 8.699.87 USD, and the whole antineoplastic drug consumption was 515.500 USD during the study. A decrease of 0.58 USD was observed per capita when the first and last three-month periods were compared in terms of waste costs. Conclusion These values indicate that the reduction of wasted drugs have potential annual savings of 3.375 USD. It is shown that total potential savings of 35.000 USD could be made per year. By implementing the same principles in all hospitals in Turkey, approximately 2.8 million USD could be made annually. The pharmaceutical industry and hospital pharmacists have important responsibilities in this issue.
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Simons A, Toland S. Perceived adverse effects from handling systemic anti-cancer therapy agents. ACTA ACUST UNITED AC 2017; 26:S38-S44. [PMID: 28880622 DOI: 10.12968/bjon.2017.26.16.s38] [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] [Indexed: 11/11/2022]
Abstract
This article explores the immediate adverse effects experienced by nurses during the administration of systemic anti-cancer therapy (SACT), specifically cytotoxic chemotherapy, and whether closed systems are being used to minimise exposure risk. Many SACT agents are known to be carcinogenic, teratogenic and mutagenic and this has led to concerns relating to the increased number of healthcare workers potentially exposed to these agents. An anonymous online survey was designed, made up of four questions, to elicit whether adverse effects were experienced by nurses during preparation, administration or following administration of chemotherapy. A total of 46% of respondents stated that they experienced some form of adverse effect either during preparation, administration or following administration of SACT. More formal research is required in this area to explore the relationship between exposure to SACT and perceived adverse effects in healthcare workers administering SACT.
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Affiliation(s)
- Alison Simons
- Senior Lecturer, Birmingham City University, Edgbaston
| | - Samantha Toland
- Senior Lecturer, Birmingham City University, Lead Chemotherapy Nurse, Worcestershire Acute Hospitals Trust
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Cruickshank S, Henry R. Foreword. ACTA ACUST UNITED AC 2017; 26:S3-S4. [PMID: 28981321 DOI: 10.12968/bjon.2017.26.sup16b.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is a significant body of evidence describing the benefits of using systemic anti-cancer therapy (SACT) agents, such as chemotherapy, biological, hormone and antibiotics, to treat people diagnosed with cancer (Cancer Research UK, 2017). However, the potential improvements in survival outcomes must be regularly weighed against the risk of adverse health effects associated with exposure to them. For patients, the risks are balanced against the need to treat the cancer. For health professionals, the risks simply result from the occupational exposure that can occur when caring for patients receiving these drugs. Collectively referred to as cytotoxic agents, SACTs are known to be toxic; they are considered carcinogenic to humans, and are classified as hazardous (National Institute for Occupational Safety and Health (NIOSH), 2010).
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Affiliation(s)
- Susanne Cruickshank
- Associate Professor of Cancer Nursing, Faculty of Health Sciences and Sport, University of Stirling, and Chair, Royal College of Nursing (RCN) Cancer and Breast Care Forum
| | - Richard Henry
- President, UK Oncology Nursing Society (UKONS) and Lecturer in Cancer Nursing, Queen's University, Belfast
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Field A, Hughes G, Rowland S. A strategy for formulating regulation on CSTDs. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:S15-S22. [PMID: 28981323 DOI: 10.12968/bjon.2017.26.sup16b.s15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article identifies what steps need to be taken to ensure the mandatory use of closed system transfer devices by all health professionals involved in the hazardous drug journey.
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Affiliation(s)
- Allison Field
- Lead Chemotherapy Nurse, Dudley Group NHS Foundation Trust
| | - Gemma Hughes
- Clinical Nurse Educator, Heart of England NHS Foundation Trust
| | - Sarah Rowland
- Chemotherapy and IV Access Clinical Nurse Specialist, Cardiff and Vale University Health Board
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Meade E, Simons A, Toland S. The need for national mandatory guidance on CSTDs. ACTA ACUST UNITED AC 2017; 26:S5-S14. [DOI: 10.12968/bjon.2017.26.sup16b.s5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Meade
- Advanced Nurse Practitioner in Oncology, HSE Dublin Mid Leinster, Midland Regional Hospital Tullamore, Ireland
| | - Alison Simons
- Senior Lecturer, Pathway Leader Haematology and Cancer Care, Birmingham City University, UK
| | - Samantha Toland
- Lead Chemotherapy Nurse, Worcestershire Acute Hospitals NHS Trust, UK
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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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