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Acramel A, Fouque J, Blondeel-Gomes S, Huguet S, Rezai K, Madar O, Escalup L. Application of an Environmental Monitoring to Assess the Practices and Control the Risk of Occupational Exposure to Cyclophosphamide in Two Sites of a French Comprehensive Cancer Center. Ann Work Expo Health 2022; 66:1215-1223. [PMID: 35596678 DOI: 10.1093/annweh/wxac035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The risk of chronic exposure to antineoplastic agents in hospitals, mainly by skin contact with contaminated surfaces, is well established. The aim of this study was to assess indirectly the risk of occupational exposure to antineoplastics drugs at two hospitals by using an environmental monitoring, and to suggest ways of improving the exposure to healthcare workers. METHODS An observational study of care practices on both sites was carried out. A wipe sampling campaign was then designed to study environmental contamination throughout the chemotherapy process: receipt, storage, compounding, transport, administration, and elimination areas. Samples were analyzed by a validated LC-MS/MS method allowing trace quantification of cyclophosphamide. A guidance 'safe value' of 0.10 ng/cm2 was considered. RESULTS A total of 293 samples were analyzed, of which 58% were found to be positive. In the compounding units, the drug vials were contaminated before [range = (non-quantifiable [NQ]-0.71) ng/cm2] and after cleaning procedure [(NQ-0.62) ng/cm2], particularly when the flip-off lid was removed during cleaning. The contamination found on manual preparations was operator-dependent: [non-detectable (ND)-3.51] ng/cm2 on infusion bag surfaces; (780.61-24 698.98) ng/cm2 on medication ports. In the case of automated preparations, the average contamination was higher on infusion bag surfaces [(2.43-36.86) ng/cm2] and lower on medication ports [(0.43-7.65) ng/cm2] than manual preparations. Contamination of the analytical control area was also highlighted. In the daily care unit, the contamination was located near the infusion area (armchairs, infusion stands, floor, and patient toilets), and varied somewhat between the two sites, especially on the floor with (0.46-27.32) compared to (ND-0.18) ng/cm2. We did not detect contamination on the transport boxes, on the door handles or in the disposal areas. CONCLUSIONS The variability of contamination observed between the two sites can be explained in part by the difference in routine practices, especially training of the staff, and cleaning procedures. Findings were communicated to healthcare workers, and news interventions were implemented based on wipe sampling results. This study demonstrated a method for routine environmental monitoring and worker education as a strategy to reduce occupational exposure.
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Affiliation(s)
- Alexandre Acramel
- Institut Curie, PSL Research University, Département de Pharmacie, F-75005, Paris, France.,Université de Paris, CiTCoM, UMR 8038 CNRS, U 1268 INSERM, F-75006, Paris, France
| | - Julien Fouque
- Institut Curie, Département de Radio-Pharmacologie, F-92210, Saint-Cloud, France
| | - Sandy Blondeel-Gomes
- Institut Curie, PSL Research University, Département de Radio-Pharmacologie, F-75005, Paris, France
| | - Samuel Huguet
- Institut Curie, Département de Radio-Pharmacologie, F-92210, Saint-Cloud, France
| | - Keyvan Rezai
- Institut Curie, Département de Radio-Pharmacologie, F-92210, Saint-Cloud, France
| | - Olivier Madar
- Institut Curie, Département de Radio-Pharmacologie, F-92210, Saint-Cloud, France.,Institut Curie, PSL Research University, Département de Radio-Pharmacologie, F-75005, Paris, France
| | - Laurence Escalup
- Institut Curie, PSL Research University, Département de Pharmacie, F-75005, Paris, France
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Acramel A, Blondeel-Gomes S, Matta C, Narayani S, Madar O, Desmaris R, Escalup L, Fouque J. Reporting environmental contamination results to healthcare workers could play a crucial role in decreasing the risk of occupational exposure to antineoplastic drugs. Front Public Health 2022; 10:989977. [PMID: 36091516 PMCID: PMC9452744 DOI: 10.3389/fpubh.2022.989977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Alexandre Acramel
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France,Université Paris Cité, CiTCoM, UMR8038 CNRS, U1268 Inserm, Paris, France,*Correspondence: Alexandre Acramel
| | - Sandy Blondeel-Gomes
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France
| | - Carla Matta
- Département d'Oncologie Médicale, Institut Curie, Saint-Cloud, France
| | | | - Olivier Madar
- Département de Radiopharmacologie, Institut Curie, PSL Research University, Paris, France,Département de Radiopharmacologie, Institut Curie, Saint-Cloud, France
| | - Romain Desmaris
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Laurence Escalup
- Département de Pharmacie, Institut Curie, PSL Research University, Paris, France
| | - Julien Fouque
- Département de Radiopharmacologie, Institut Curie, Saint-Cloud, France
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Demircan Yildirim F, Ekmekci I. Design of Analytical Method Validation Protocol Evaluating Environmental Monitoring of AND Contamination on Surfaces Based on Cleaning Validation Procedures: A Multi Component RP-UHPLC Method. J Chromatogr Sci 2022; 60:926-936. [PMID: 35980296 DOI: 10.1093/chromsci/bmac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022]
Abstract
Environmental monitoring of anti-neoplastic drug (AND) residues in workplaces is crucial to limit exposure to workers who handle with them. Although wipe sampling is the most appropriate methodology to evaluate the risk, conflicting results are also reported due to the lack of standardized and validated procedures. In this study, procedures for surface contamination of ANDs in workplaces are presented, with a focus on sampling, sample preparation and instrumentation. The analytical method validation parameters are designed to comply with requirements of The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q7 Good Manufacturing Practice (GMP) for active pharmaceutical ingredients. Additionally, the study provides a simple, specific, rapid and multi-component analytical method to evaluate seven ANDs that are Gefitinib, Imatinib, Dasatinib, Axitinib, Erlotinib, Nilotinib and Sorafenib at very low concentration levels, simultaneously. Quantitative, precise and reproducible results obtained from the study show that environmental monitoring procedure and analytical method validation protocol presented in the study can be used to reduce and monitor occupational exposure risk to ANDs in wokplaces.
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Affiliation(s)
- Fatma Demircan Yildirim
- Istanbul Commerce University, Department of Occupational Health and Safety, Istanbul, 34840, Turkey
| | - Ismail Ekmekci
- Istanbul Commerce University, Faculty of Industrial Engineering, Istanbul, 34840, Turkey
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Bishay S, Michalowska-Suterska M, Edling A, Battle J. Evaluation of the hazardous drug surface contamination in pharmacy compounding and administration clinical setting after adoption of standardized cleaning workflow and a closed system transfer device. PHARMACEUTICAL TECHNOLOGY IN HOSPITAL PHARMACY 2022. [DOI: 10.1515/pthp-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
The compounding and administration of hazardous drugs present a potential risk to healthcare worker and patient safety. This study sought to evaluate the HD surface contamination in multiple pharmacy and nursing areas that include standardized cleaning techniques and utilization of closed system transfer devices.
Methods
This study was conducted at six different areas in the pharmacy and nursing areas. Each area was assessed three times for five different HD’s surface contamination at an initial, 3 month, and 6 month follow up. Hazardous drug surface testing was performed for five most compounded HDs. A total of 90 individual samples were taken and analyzed during the study.
Results
A total of 30 samples were collected at three different timepoints for a total of 90 individual samples and analysis results. All 90 samples were negative (below the lower limit of detection; 0.01 ng/cm2), for their respective drug residue.
Conclusions
The method and design described in this evaluation may offer a way to determine if a facility’s current HD work practices and controls retain reduced HD surface contamination based upon published threshold values. Adoption and utilization of standardized work, including use of a closed system transfer device, and cleaning practices, described in this study, may present an option for facilities to retain reduced HD surface contamination, based upon previously determined threshold values.
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Affiliation(s)
- Sally Bishay
- Inpatient Pharmacy, Stamford Hospital , Stamford , CT , USA
| | | | - Andrea Edling
- Inpatient Pharmacy, Stamford Hospital , Stamford , CT , USA
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Portilha-Cunha MF, Gouveia TIA, Garcia-Costa AL, Alves A, Santos MSF. Multi-Matrix Approach for the Analysis of Bicalutamide Residues in Oncology Centers by HPLC-FLD. Molecules 2021; 26:5561. [PMID: 34577031 PMCID: PMC8471255 DOI: 10.3390/molecules26185561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
Cytostatics are toxic pharmaceuticals, whose presence in surfaces puts healthcare workers at risk. These drugs might also end up in hospital effluents (HWW), potentially damaging aquatic ecosystems. Bicalutamide is a cytostatic extensively consumed worldwide, but few analytical methods exist for its quantification and most of them require advanced techniques, such as liquid chromatography mass spectrometry (LC-MS), which are very complex and expensive for large monitoring studies. Therefore, a simple but reliable multi-matrix high performance liquid chromatographic method, with fluorescence detection, was developed and validated to rapidly screen abnormal concentrations of bicalutamide in HWW and relevant contamination levels of bicalutamide in indoor surfaces (>100 pg/cm2), prior to confirmation by LC-MS. The method presents good linearity and relatively low method detection limits (HWW: 0.14 ng/mL; surfaces: 0.28 pg/cm2). Global uncertainty was below 20% for concentrations higher than 25 ng/mL (HWW) and 50 pg/cm2 (surfaces); global uncertainty was little affected by the matrix. Therefore, a multi-matrix assessment could be achieved with this method, thus contributing to a holistic quantification of bicalutamide along the cytostatic circuit. Bicalutamide was not detected in any of the grab samples from a Portuguese hospital, but an enlarged sampling is required to conclude about its occurrence and exposure risks.
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Affiliation(s)
| | | | | | | | - Mónica S. F. Santos
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal; (M.F.P.-C.); (T.I.A.G.); (A.L.G.-C.); (A.A.)
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Portilha-Cunha MF, Ramos S, Silva AMT, Norton P, Alves A, Santos MSF. An Improved LC-MS/MS Method for the Analysis of Thirteen Cytostatics on Workplace Surfaces. Pharmaceuticals (Basel) 2021; 14:ph14080754. [PMID: 34451851 PMCID: PMC8398795 DOI: 10.3390/ph14080754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Cytostatics are drugs used in cancer treatment, which pose serious risks to healthcare workers. Dermal absorption via surface contamination is the key exposure route; thus, rapid, reliable, and validated analytical methods for multicomponent detection are crucial to identify the exposure risk. A surface-wipe-sampling technique compatible with hospitals' safety requirements (gauze, 1 mL isopropanol) and a fast and simple extraction method (1 mL acetonitrile, 20 min ultrasonic bath, evaporation, reconstitution in 200 µL acetonitrile), coupled with liquid chromatography-tandem mass spectrometry analysis, were developed. It allowed identification and quantification of 13 cytostatics on surfaces: cyclophosphamide, doxorubicin, etoposide, ifosfamide, paclitaxel, bicalutamide, capecitabine, cyproterone, flutamide, imatinib, megestrol, mycophenolate mofetil, prednisone. Good linearity, sensitivity, and precision were achieved (R2 > 0.997, IDLs < 4.0 pg/cm2, average CV 16%, respectively). Accuracy for four model surfaces (melamine-coated wood, phenolic compact, steel 304, steel 316) was acceptable (80 ± 12%), except for capecitabine and doxorubicin. Global uncertainty is below 35% for concentrations above 100 pg/cm2 (except for capecitabine and doxorubicin)-a guidance value for relevant contamination. Method application in a Portuguese university hospital (28 samples) identified the presence of seven cytostatics, at concentrations below 100 pg/cm2, except for three samples. The widespread presence of cyclophosphamide evinces the necessity to review implemented procedures.
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Affiliation(s)
- Maria Francisca Portilha-Cunha
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (M.F.P.-C.); (A.A.)
| | - Sara Ramos
- Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal;
| | - Adrián M. T. Silva
- Laboratory of Separation and Reaction Engineering—Laboratory of Catalysis and Materials (LSRE–LCM), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
| | - Pedro Norton
- Departamento de Saúde Ocupacional, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal;
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
| | - Arminda Alves
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (M.F.P.-C.); (A.A.)
| | - Mónica S. F. Santos
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (M.F.P.-C.); (A.A.)
- Correspondence: ; Tel.: +351-225084854
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