Surface Contamination from Cytotoxic Chemotherapy Following Preparation and Administration

Abstract

ABSTRACTBackgroundSurface contamination with cytotoxic drug residue is a potential occupational health hazard to staff working in cytotoxic compounding areas and oncology wards.AimTo identify surfaces contaminated with cytotoxic drug residue and to indicate the risk of exposure to health workers handling cytotoxic drug residue.MethodWipe sampling was used to investigate surface contamination and occupational skin exposure to the marker cytotoxic drugs, fluorouracil (5‐FU) and gemcitabine (GEM), in the pharmacy cytotoxic compounding section and oncology wards. Drug packaging, primary containers and gowns were also examined. Samples were analysed using a validated HPLC method. Repeat sampling was performed on selected surfaces to monitor any impact after implementing changes in practice.ResultsThe majority of surfaces tested were contaminated. The cytotoxic work room (5‐FU 56.7–320 μg/m2; GEM 75–370 μg/m2) and oncology wards had similar levels of contamination. Cytotoxic drug residue was detected on original containers and drug vials (5‐FU < 3–6 μg; GEM 7.8–7.9 μg/wipe sample) stored in the cytotoxic work room but not on containers delivered directly from the distributor, suggesting that accidental contamination by pharmacy personnel does occur. Contamination was also detected on sections of the gowns (GEM around 0.9 mg/m2) worn by nurses in the oncology wards.ConclusionThere is a risk of dermal contamination and accidental ingestion from inappropriate use of gloves, hand washing and cleaning, during and after preparation and administration of cytotoxic drugs. Implementing effective cleaning practices to decontaminate work surfaces is recommended in all cytotoxic drug compounding and administration areas. Regular environmental monitoring is warranted in these areas to ensure that background contamination is kept to a minimum and that decontamination protocols are adhered to.