Evaluation of working practice and chemical contamination - Oncology day care units

Many antineoplastic drugs are classified as carcinogenic, mutagenic and teratogenic for humans. Therefore, minimization of exposure is required for employees from preparation to administration. The aim of this study was to evaluate working practices and safety measures during drug administration and to assess workplace conta­mination in outpatient oncology health care settings.

Questionnaires about working procedures were sent to 137 day hospitals and private practices in Southern Germany. Workplace contamination by 5-fluorouracil, platinum, gemcitabine, cyclophosphamide, ifosfamide, methotrexate, docetaxel, and paclitaxel was assessed by means of wipe samples.

Forty institutions participated in the study, and in 28 units wipe samples were taken. Depending on the kind of activity, 5 % to 80 % of working procedures were not in accordance with actual recommendations for safe handling of antineoplastic drugs. Totally, 60% of the wipe sampling results were above the limit of detection (LOD). Most frequent contaminations were detected for 5-FU (93%) and platinum (88%). Antineoplastic drugs have been found on all surfaces and results ranged between < LOD and 750,000 pg/cm². There was no correlation between the amount of drugs handled and the extent of surface contamination. However, specific working practices like use of closed infusion systems resulted in a lower number of positive wipe samples.

In summary, workplace contamination with antineoplastic drugs in day care units is still present. As patients have to be considered as a potential source of contamination, surface contamination is difficult to avoid. However, our data revealed that it is possible to administer a large number of preparations without causing high workplace contamination.