A national overview of the knowledge and needs related to environmental cytotoxic contamination

A. Faucheron1, J. Fouque1, A. Acramel2, M. Lafay2, L. Escalup2, O. Madar1 1. Institut Curie, Département de Radio-Pharmacologie, Paris et Saint-Cloud, France
2. Institut Curie, Département de Pharmacie, Paris et Saint-Cloud, France

Goal
In 2015, an analytical method was implemented for the evaluation of environmental contamination with cyclophosphamide (CP) within our hospital. In order to propose this activity to other health facilities (HF), involving the quantification of additional cytotoxic anticancer drugs (CAD), a national overview was submitted to HF equipped with a centralized cytotoxic drugs reconstitution unit (CDRU).

Methods
An online questionnaire (Google Forms) was forwarded to several French hospital pharmacies CDRU. The survey period lasted from September 11 to October 28, 2019 among a register of 61 HF. The data was extracted on EXCEL®, software and then analyzed.

Results
The survey was completed by approximately 87 % of HF (n = 53). The average number of CAD produced each year by the HF is 19,400 (median = 18,000). The majority of HF (n = 40 ; 75 %) consider that they have good knowledge (≥ 7/10) of environmental contamination, and mainly 7 risk areas are identified. Among the 2/3 of the HF carrying out surface wipe sampling, 92 % of them subcontract the analysis. The median of the number of molecules requested for contamination monitoring is 5, and the 5-fluorouracil is almost systematically reported (86.8 %). CP, platinum salts, paclitaxel and gemcitabine are respectively mentioned in 73.6 %, 69.8 %, 66.0 % and 34.0 % of cases. A median of 12 wipe samples per campaign is mentioned. A frequency of 1 to 2 campaigns per year would be enough to analyze the samples for the majority of the HF (81 %). Almost 80 % of the HF could be interested in this environmental contamination monitoring. The average budget assigned by the CDRU managers for this monitoring would be 2,500 € per year.

Discussion-Conclusion
The high response rate reflects the interest of CDRUs managers in this topic. This questionnaire revealed the knowledge and current management of the different HF to evaluate environmental contamination. A majority of CDRUs managers have already been sensitized and consider that this risk is under control. There appears to be a relation between the volume of production and the feeling of good control towards contamination. The answers of the HF on their needs in terms of contamination monitoring allowed us to clarify the expectations for implementation of a subcontracting process. The dosage of 10 substances, kits of 5 wipe samples as well as annual or biannual campaigns would satisfy over 90 % of the HF. Following this overview, an economic study was carried out to verify the viability of this subcontracting project.

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