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E Silva LS, Machado CDSB, Linden R, Antunes MV, da Silva LC, Wayhs CAY, Capp E, Ness SLR. Residual contamination in antineoplastic drug packaging. J Oncol Pharm Pract 2023; 29:1862-1867. [PMID: 36659825 DOI: 10.1177/10781552231151693] [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: 01/21/2023]
Abstract
INTRODUCTION The handling of antineoplastic drugs should follow strict supervision and safety rules to minimize the occupational exposure risks to professionals involved. The external surface contamination of drug vials is recognized as a health risk. So, our goal was to determine if there is residual contamination on the vials and containers surface of the antineoplastic drugs doxorubicin (DOX) and cyclophosphamide (CP). METHODS A cross-sectional study was conducted. Samples were collected using a uniform sampling procedure on the inner surfaces of the packages/boxes and the outer surfaces of the vials. The analyzes were executed by high-performance liquid chromatography/mass spectrometry (UHPLC-MS/MS). RESULTS A total of 209 samples were analyzed, 66 of CP and 143 of DOX. CP levels were detected in nine samples (13.63%), three were below the lower limit of quantification (LLQ) and the other six had contamination levels ranging from 1.24 to 28.04 ng/filter. DOX levels were detected in 36 samples (25.17%), two were below the LLQ and the others had levels between 1.32 and 664.84 ng/filter. The majority of samples with residual contamination were in vials (80.0%), however, boxes also showed contamination. CONCLUSIONS The results revealed the presence of residual contamination in the vials and packages of CP and DOX drugs. Although the residues found in each sample are small, special care should be taken in the handling and disposal of the antineoplastic drugs. The use of personal protective equipment is fundamental while handling the vials and packaging of cytotoxic drugs.
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Affiliation(s)
- Luciana Stein E Silva
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cibele da Silva Barbosa Machado
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Linden
- Analytical Toxicology Laboratory, Feevale University, Novo Hamburgo, RS, Brazil
| | | | - Laura Cé da Silva
- Analytical Toxicology Laboratory, Feevale University, Novo Hamburgo, RS, Brazil
- Graduate Program in Toxicology and Toxicological Analysis, Feevale University, Novo Hamburgo, RS, Brazil
| | - Carlos Alberto Yasin Wayhs
- Center for Intravenous Drug Preparation, Department of Pharmacy, Hospital de Clínicas Porto Alegre, Porto Alegre, RS, Brazil
| | - Edison Capp
- Post Graduate Program in Health Sciences: Gynecology and Obstetrics, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Gynecology and Obstetrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sandro Luís Ribeiro Ness
- Center for Intravenous Drug Preparation, Department of Pharmacy, Hospital de Clínicas Porto Alegre, Porto Alegre, RS, Brazil
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Cotteret C, Secretan PH, Gilles-Afchain L, Rousseau J, Vidal F, Salguero-Hernandez G, Batista J, Valverde V, Guitton J, Cisternino S, Schlatter J. External contamination of antineoplastic drug vials: an occupational risk to consider. Eur J Hosp Pharm 2022; 29:284-286. [PMID: 32978219 PMCID: PMC9660623 DOI: 10.1136/ejhpharm-2020-002440] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022] Open
Abstract
Risk management for workers involved in the handling and preparation of cytotoxic drugs is challenging. This study aims to investigate drug contamination of the exterior surfaces of cytotoxic drug vials. Two batches of commercially available cytotoxic drugs in unprotected vials (ifosfamide, etoposide phosphate and cyclophosphamide) and plastic shrink wrap vials (doxorubicin, cytarabine and busulfan) were tested without removing the flip-off cap or the plastic wrap, and without prewashing. The results showed significant trace amounts of cytotoxic drugs on the exterior surfaces in both unprotected (eg, cyclophosphamide, ifosfamide) and protected plastic shrink wrap vials (eg, cytarabine), indicating that the secondary packaging of protected vials does not systematically prevent exposure to the handlers. These results focus on the need for guidelines to prevent cytotoxic vial contamination and safety recommendations for staff in the handling and storage of these vials.
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Affiliation(s)
- Camille Cotteret
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | | | | | - Julia Rousseau
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Fabrice Vidal
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | | | - Jonathan Batista
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Vicky Valverde
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Jerome Guitton
- Pharmacy, Centre Régional de Lutte Contre le Cancer Centre Léon Bérard, Lyon, France
| | - Salvatore Cisternino
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
- Faculté de Pharmacie, Université Paris Descartes, Inserm UMR-S1144, Paris, France
| | - Joël Schlatter
- Pharmacie clinique, Hôpital universitaire Necker-Enfants Malades, Paris, France
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van den Berg RB, de Poot S, Swart EL, Crul M. Assessment of occupational exposure to nebulized isopropyl alcohol as disinfectant during aseptic compounding of parenteral cytotoxic drugs in cleanrooms. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:361-368. [PMID: 34185621 DOI: 10.1080/15459624.2021.1933505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pharmacy technicians are exposed to volatile organic compounds, like the disinfectant isopropyl alcohol (IPA), during the process of aseptic compounding of parenteral cytotoxic drugs. The occupational exposure to nebulized IPA during aseptic compounding has not been investigated. The aim of this study was to investigate the exposure to IPA during aseptic compounding of parenteral cytotoxic drugs and to assess compliance with legal and regulatory limits. As a secondary endpoint, the difference between two disinfection methods was compared regarding the exposure to IPA. The exposure to IPA was measured during five working shifts of 8 hr and one shift of 4 hr. The concentration IPA was measured by using a six-gas monitor. Total daily exposure was calculated as 8-hr Time Weighted Average (TWA) air concentration in mg/m3 and compared with an Occupational Exposure Limit (OEL) value of 500 mg/m3 and incidental peak exposure of 5,000 mg/m3. To assess whether the 8-hr TWA air concentration meets the legal and regulatory limits the Similar Exposure Groups (SEG) compliance test was used. A paired sample t-test was conducted to assess difference in exposure between two disinfection methods. The average 8-hr TWA exposure to IPA during the six measurements varied from 2.6 mg/m3 to 43.9 mg/m3 and the highest momentary concentration measured was 860 mg/m3. The result of the SEG compliance test was 3.392 (Ur value) and was greater than the Ut value of 2.187 which means the exposure to IPA is in compliance with the OEL value. No significant difference in exposure was shown between two disinfection methods (p = 0.49). In conclusion, exposure to IPA during aseptic compounding of parenteral cytotoxic drugs showed compliance to the OEL values with no significant difference in exposure between two disinfection methods.
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Affiliation(s)
- Roland B van den Berg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stan de Poot
- Department of Occupational Health & Safety, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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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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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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A new approach to assessing occupational exposure to antineoplastic drugs in hospital environments. Arh Hig Rada Toksikol 2018; 69:226-237. [DOI: 10.2478/aiht-2018-69-3125] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/01/2018] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cytotoxic antineoplastic drugs (ADs) pose occupational risk and therefore require safe handling practices. We created, optimised, and validated an innovative monitoring protocol for simultaneously assessing 21 ADs in the healthcare environment, and also proposed surface exposure levels (SELs) to facilitate the interpretation of monitoring results, as there are currently no occupational exposure limits for ADs. The environmental AD monitoring data were collected in nine Italian hospitals between 2008 and 2017 and include 74,565 measurements in 4,814 wipe samples. Excellent overall recovery and sensitivity of the analytical methods along with innovative desorption automation make this protocol useful for routine monitoring. AD contamination was found in 3,081 measurements, confirming potential exposure in healthcare workers. Samples taken at the beginning and the end of work shifts, allowed to calculate 75th and 90th percentile values for each ADs both in preparation and administration units and we created a traffic-light colour-coding system to facilitate interpretation of the findings. The introduction of SELs will provide a solid basis for improving occupational safety and focusing on contamination control.
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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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Marie P, Christophe C, Manon R, Marc M, Charleric B, Patrice V. Environmental monitoring by surface sampling for cytotoxics: a review. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:52. [PMID: 28063118 DOI: 10.1007/s10661-016-5762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Abstract
Environmental monitoring is usually conducted by surface sampling to detect and quantify the presence of cytotoxic drugs after their reconstitution and administration. This technique reveals the origins of residual contamination and is an important component in order to protect healthcare workers from the potential risk of occupational exposure. The aim of this work is to compare various techniques and results of surface sampling for cytotoxics. For each technique, sample processing methods and their analysis were compared from literature data. Sampling is often performed by the wiping technique. After treatment, various single or multicompound technical analyses are used, in particular liquid or gas chromatography involving different detection methods: ultraviolet, mass spectrometry, plasma torch, and voltammetry. Some methods are validated to ensure reliability. Despite published guidelines and the use of isolator technology for the preparation of cytotoxic drugs, workplace contamination persists, leading to chemotherapeutic agents' exposure of healthcare workers. Efforts need to be maintained with particular emphasis on harmonization and on determining alert level for cytotoxic contamination.
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Affiliation(s)
- Petit Marie
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Curti Christophe
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
| | - Roche Manon
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France.
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central des Opérations Pharmaceutiques (SCOP), Administration Centrale, rue Brochier, 13005, Marseille, France.
| | - Montana Marc
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Oncopharma, Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Bornet Charleric
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Pharmacie Usage Intérieur Hôpital de la Conception, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Vanelle Patrice
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
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Kawakami J. [Clinical pharmacology and pharmacoepidemiology for medication safety in clinical settings]. YAKUGAKU ZASSHI 2015; 135:619-24. [PMID: 25832841 DOI: 10.1248/yakushi.14-00252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In this review, optimization of individualized analgesic therapy in cancer-pain patients (1), pharmacoepidemiological studies using a hospital database (DB) (2), and other clinical and practical research studies (3) were summarized. (1) The aim of the analgesic study was to evaluate individual factors in the effects of pain-relief, and ADR of analgesics from the viewpoints of clinical pharmacokinetics and pharmacodynamics. Oxycodone, fentanyl, and gabapentin were used. For the dose escalation and ADR of oxycodone, the plasma disposition of noroxycodone regulated by CYP3A5 polymorphisms and cancer cachexia were found to be individual factors. The ADR and clinical response of fentanyl were affected by polymorphisms of CYP3A5 and ABCB1. In the pharmacokinetics of gabapentin, concomitant magnesium oxide reduced the intestinal absorption of gabapentin. (2) The aim of the DB study was to demonstrate a pharmacoepidemiological advantage using a hospital DB of a million-scale for post-marketing safety management. We tried to detect fluoroquinolone (FQ)-induced tendon disorders, because its risk ratio in Japan has not been clarified. The risk of a tendon disorder in FQ-prescribed patients was 0.082% (95%CI: 0.049-0.137%), and significantly higher than that in cephalosporin-prescribed patients. The risk ratio in FQ-prescribed patients in relation to cephalosporin-prescribed patients was 6.29 (95%CI: 2.27-17.46). (3) Individual variation of plasma exposure of free linezolid and its ratio to minimum inhibitory concentration in critically ill patients, as well as three other studies, were described. In conclusion, our achievement in accurately assessing these would contribute to medication safety and the appropriate use of medicines in clinical settings.
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Affiliation(s)
- Junichi Kawakami
- Department of Hospital Pharmacy, Hamamatsu University School of Medicine
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Power LA, Sessink PJM, Gesy K, Charbonneau F. Hazardous drug residue on exterior vial surfaces: evaluation of a commercial manufacturing process. Hosp Pharm 2014; 49:355-62. [PMID: 24958942 DOI: 10.1310/hpj4904-355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Hazardous drug residue on the exterior surface of drug vials poses a potential risk for exposure of health care workers involved in handling these products. The purpose of this article is to heighten the awareness of this serious issue and to evaluate a commercial manufacturing process for removing and containing hazardous drug (HD) residue on exterior vial surfaces. Additionally, findings from this study are interpreted, incorporated into the current body of evidence, and discussed by experts in this field. METHODS This study includes separate evaluations for the presence or absence of surface drug contamination on the vials of 3 HD products: 5-fluorouracil, cisplatin, and methotrexate. The drug products were packaged in vials using a patented prewashing/decontamination method, application of a polyvinylchloride (PVC) base, and use of clear glass vials. An additional step of encasing the vial in a shrink-wrapped sheath was used for 5-fluorouracil and cisplatin. RESULTS Of all 5-fluorouracil (110 vials), methotrexate (60 vials), and cisplatin (60 vials) tested, only 2 had detectable amounts of surface residue. One 5-fluorouracil vial was found to have approximately 4 mg of 5-fluorouracil on the surface of the vial. The second contaminated vial was cisplatin, which was discovered to have 131 ng of platinum, equal to 200 ng of cisplatin or 0.2 μL of cisplatin solution, on the vial sheath. CONCLUSION Using validated extraction and analytic methods, all but 2 of the 230 tested vials were found to be free of surface drug contamination. Pharmacy leaders need to take an active role in promoting the need for clean HD vials. Manufacturers should be required to provide their clients with data derived from externally validated analytic studies, reporting the level of HD contamination on the exterior of their vial products.
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Affiliation(s)
- Luci A Power
- Senior Pharmacy Consultant, Power Enterprises , San Francisco, California
| | | | - Kathy Gesy
- Provincial Leader, Oncology Pharmacy Services, Saskatchewan Cancer Agency , Saskatoon, Saskatchewan, Canada
| | - Flay Charbonneau
- Manager, Pharmacy, Sunnybrook Odette Cancer Centre , Toronto, Ontario, Canada
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