Validation of cleaning procedures used in an Italian Hospital Pharmacy for antineoplastic drug decontamination: a new tool for industrial hygiene

Tackling antineoplastic drugs' contamination in healthcare settings: New insights on surface cleaning approaches

Effective decontamination of hospital surfaces is crucial to protect workers from antineoplastic drugs (ADs) since dermal absorption is the main exposure route to these hazardous medicinal products. Sampling after daily cleaning in oncologic settings from a tertiary hospital was initially performed and exhibited low contamination levels; however, cyclophosphamide was still found (up to 957 pg/cm2) above the guidance value (100 pg/cm2) in four locations, evidencing the need to properly assess and update the cleaning protocols. Then, cleaning efficiencies of six solutions and different protocols were evaluated (including, for the first time, four commercial cleaning solutions/disinfectants not designed specifically for AD removal) after deliberate contamination of three model surfaces with 13 pharmaceuticals: bicalutamide, capecitabine, cyclophosphamide, cyproterone, doxorubicin, etoposide, flutamide, ifosfamide, imatinib, megestrol, mycophenolate mofetil, paclitaxel, and prednisone. Wipe sampling and liquid chromatography-tandem mass spectrometry were employed to determine surface contamination after cleaning. Results revealed that: (i) none of the solutions or procedures totally removed all target pharmaceuticals from surfaces; (ii) the removal efficiency increased with cleaning steps (average removals above 90% were attained for Vyclean and Clinell Universal Spray using two cleaning steps); and (iii) the cleaning efficiency was likely favored by the application of the solution/disinfectant directly on the surfaces. Therefore, considering the dissimilar chemical structures and properties of the numerous ADs in use, the cleaning agent and protocol should be adjusted to the reality of each healthcare unit. Still, the scientific community is encouraged to develop a cleaning solution/protocol to simultaneously eliminate/remove as many ADs as possible.

Occupational Exposure Assessment to Antineoplastic Drugs in Nine Italian Hospital Centers over a 5-Year Survey Program

In the present study, surface contamination where antineoplastic drugs (ADs) are present was investigated, as occupational exposure risk is still an open debate. Despite recommendations and safety standard procedures being in place in health care settings, quantifiable levels of ADs are being reported in the recent literature. Thus, a survey monitoring program was conducted over five years (2016–2021) in nine Italian hospitals. The repeated surveys produced 8288 data points that have been grouped according to the main hospital settings, such as pharmacy areas and patient care units. Based on the most often prepared ADs, the investigated drugs were cyclophosphamide (CP), gemcitabine (GEM), 5-fluorouracil (5–FU), and platinum compounds (Pt). Patient care units had a frequency of positive wipe samples (59%) higher than pharmacies (44%). Conversely, pharmacies had a frequency of positive pad samples higher (24%) than patient care units (10%). Moreover, by statistical analysis, pad samples had a significantly higher risk of contamination in pharmacy areas than in patient care units. In this study, the 75th and the 90th percentiles of the contamination levels were obtained. The 90th percentile was chosen to describe a suitable benchmark that compares results obtained by the present research with those previously reported in the literature. Based upon surface contamination loads, our data showed that 5–FU had the highest concentration values, but the lowest frequency of positive samples. In pharmacy areas, the 90th percentile of 5–FU data distribution was less than 0.346 ng/cm² and less than 0.443 ng/cm² in patient care units. AD levels are higher than those reported for health care settings in other European countries yet trends of contamination in Italy have shown to decrease over time.