Application of annual monitoring of environmental contamination to limit the risk of occupational exposure to hazardous drugs on two hospital sites

A. Acramel1, A. Faucheron2, J. Fouque2, B. Marie3, A. Hurgon1, M. Lafay1, S. Huguet2, K. Rezai2, O. Madar2, L. Escalup1
1. Institut Curie, Pharmacy department, Paris and Saint-Cloud, France
2. Institut Curie, Radio-Pharmacology department, Paris and Saint-Cloud, France
3. Institut Curie, Occupational health department, Paris and Saint-Cloud, France

Goal
We previously carried out an exhaustive mapping of the environmental contamination related to the handling of cytotoxic drugs on 2 hospital sites, associating it with a level of risk of occupational exposure. The aim of this work is to assess the impact of the corrective measures that were defined as a result of this study.

Methods
A wipe sampling campaign was carried out within 1 year of an initial assessment, considering the areas previously investigated and other potentially critical points. Samples were taken using the same procedures: quantification of cyclophosphamide by LC-MS/MS (limit of quantification: 0.05 ng/cm2; limit of detection: 0.01 ng/cm2; wiping efficiency: 87.5 %). The main points (re)assessed were: decontamination of manufacturer vials; external contamination of chemotherapy bags (manual vs. automated); the risk of cross-contamination between preparations; decontamination procedures inside the isolator and in the analytical control area; contamination of administration areas, toilets (caregivers vs. patients) and cleaning of surfaces in healthcare departments.

Results
The results show a significant decrease in the contamination of 2 potential sources of contact with healthcare professionals: manufacturer vials after decontamination ([NQ-92] vs [ND] ng), manual chemotherapy preparations ([ND-404] vs [NQ-20] ng) and automated preparations ([279-4239] vs [41-309] ng). The analytical control area decontamination procedures allow a low level of contamination to be maintained. In isolators, residual contamination persists. Concerning the risk of cross-contamination between chemotherapy preparations, traces were found in PLACEBO bags for 1 of the 3 operators evaluated.
In the care units, the results show a very low residual contamination in the administration area (with the exception of the floor: [ND-27] vs [ND-0.99] ng/cm2). The same is true for the environment close to caregivers: patient reception signs, DECTs and caregiver toilets [ND-NQ].

Discussion-Conclusion
This monitoring made it possible to assess the effectiveness of the corrective measures put in place. Overall, practices are significantly improving in the patient environment and the risk of occupational exposure for caregivers is under control. Progress is still to be made concerning bio-cleaning: the floor remains contaminated, certainly because of a significant level of contamination before the implementation of this monitoring. To maintain exposure control, regular awareness-raising of good practices is therefore necessary. Improvement or maintenance of these residual levels will be assessed during the next campaign including a new tracer (paclitaxel).

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