Surface contamination monitoring program with 9 Antineoplastic Drugs in 109 Canadian Hospitals; Results Obtained During the COVID-19 Pandemic

Introduction
The manipulation of antineoplastic drugs leads to contamination on the surfaces. Several guidelines on the safe manipulation of antineoplastic drugs help limit the risks for workers’ health. Occupational exposure to antineoplastic drugs can cause long-term adverse effects on the health of workers. No acceptable exposure limit has been determined and it is therefore necessary to limit exposure as much as possible.

Objectives
Evaluate the contamination of Canadian hospitals’ surfaces. Describe the impact of the pandemic context on this monitoring program.

Method
Twelve standardized sampling sites were sampled in each hospital, six in oncology pharmacy and six in outpatient clinic. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng / cm2) were: 0.001 for cyclophosphamide; 0.3 for docetaxel; 0.04 for 5- fluorouracil; 0.001 for gemcitabine; 0.3 for ifosfamide; 0.003 for irinotecan; 0.002 for methotrexate; 0.04 for paclitaxel and 0.01 for vinorelbine.

Results
Hospitals sampled their surfaces from January 1st to June 18th, during the COVID-19 pandemic.
109 Canadian hospitals participated. 1216 compliant samples were analyzed. The antineoplastics most frequently measured on surfaces were cyclophosphamide (33.9% of positive samples) and gemcitabine (15.8% of positive samples). The 75th percentile of the concentration measured on the surfaces was 0.00165 ng / cm² for cyclophosphamide and 0.0005 ng / cm² for gemcitabine. Less than 7% of surfaces
were contaminated with 5-fluorouracil, docetaxel, ifosfamide, irinotecan, paclitaxel, or vinorelbine. The most contaminated surfaces by cyclophosphamide were the armrest of patient treatment chair (72.5% of contaminated surfaces), the front grille inside the hood (59.3%) and the floor in front of the hood (53.1%). No institution has canceled its participation in the study, despite the pandemic context. The testing labs shut down for several weeks, but the results were delivered to hospitals when operations resumed.

Conclusion
The context of the COVID-19 pandemic did not decrease participation in the Canadian monitoring program. Some surfaces are at a higher risk of contamination and are frequently contaminated with antineoplastics. Our monitoring program allows for a periodical assessment of a centers’ situation and it can be compared with global results from 109 centers; this comparison helps centers to determine if
additional measures need to be put in place.