Methods for decreasing external vial contamination
Over the last decade, several studies have been published showing environmental contamination with cytostatic drugs in preparation and administration areas in hospitals in Europe and North America. Pharmacy technicians, pharmacists and nurses involved in the preparation and administration of cytostatic drugs are concerned about the risks of exposure to these toxic drugs that may results in adverse health effects.
Despite the widespread promulgation of safety guidelines, the use of standard protective measures and the use of engineering controls, hospital workers continue to be exposed to these drugs. However, some studies have shown reduction in workplace contamination or the presence of drugs in the urine after the adoption of protective measures and the introduction of containment systems.
Sources of contamination
_Contamination of the workplace and subsequent exposure of hospital workers may result from several sources. The process of preparing the drug solution for delivery to the patient can result in the release of small amounts of the drug. Larger spills of drugs happen less frequently but may contribute to long-term contamination of the workplace. Treatment of the patient and disposal of residual drug solution in i.v. bags, i.v. tubing, and patient waste contribute to workplace contamination and the potential exposure of nursing personnel and housekeeping staff to these drugs.
A number of European and a few American studies have demonstrated that the outer surface of the vials containing cytostatic drugs are often contaminated with the drug. The sources of this contamination are not well understood but could be linked to the lack of cleaning or incomplete cleaning of the vials after filling, improper vial washing, contamination from broken vials after washing in storage or transport, or handling vials with contaminated hands or gloves. As a results, the contamination on the outer surface of the vials may be transferred to hands and gloves finally resulting in contamination of the environment and exposure of the workers. Results of some studies showing contamination of vials will be presented in addition to solutions how to reduce the contamination. Necessity and effectiveness of preventive measures will be discussed.
The results of several studies have shown contamination of the outer surface of drug vials for cytostatic drugs. Although contamination can be reduced by using decontamination equipment and containment of the vials, it cannot be guaranteed that there is no contamination left at all. The importance of always wearing gloves when handling vials and packaging of vials is emphasized.