Environmental monitoring of residual contamination of work surfaces by 14 antineoplastic drugs in 11 French chemotherapy reconstitution units between 2023 and 2025

Context
Many professionals are exposed on a daily basis, as part of their work, to antineoplastic drugs (ADs) which are hazardous to handle. Exposition route is mainly cutaneous, notably via contaminated work surfaces. Surface monitoring allows to assess the effectiveness of professional practices and cleaning procedures, and to guide efforts towards targeted preventive measures, particularly in chemotherapy reconstitution units (CRUs). This study aims to assess the current status of ADs residual contamination (RC) on surfaces within various CRUs in France and to compare these results with international data.

Methods
For surface monitoring in various CRUs in France, sampling kits accompanied by a protocol were provided to 11 CRUs in order to standardize sampling procedures. Between 2023 and 2025, 225 surface samples were thus collected from various areas within the CRUs (workbenches, isolators, fume cupboards, IT equipment, door handles, etc.). In the laboratory, 14 ADs (5-fluorouracil (5FU), cyclophosphamide, cytarabine, dacarbazine, daunorubicin, doxorubicin, epirubicin, etoposide, gemcitabine, ifosfamide, methotrexate, paclitaxel, pemetrexed, vincristine) were simultaneously detected and quantified using ultra-high-performance liquid chromatography coupled with tandem mass spectrometry. The residual amounts of ADs expressed in pg/cm² of sampled surface area were compiled into a database. Statistical analysis of the results (median value, quartile 1 and quartile 3 [Q1 - Q3]) were carried out using RStudio^® software.

Results
In total, of the 225 samples (3150 assays), 80% tested positive for at least one AD. By center, the percentage of samples testing positive for at least one AD ranged from 29% to 100%, with an average of 83%. Of the 14 ADs tested for, only daunorubicin and pemetrexed were never detected. The most frequently detected compounds were gemcitabine, cyclophosphamide and 5FU, with positivity rates of 67%, 55% and 44% respectively. The median residual quantity was 0.68 pg/cm² [0.22 – 4.96] for gemcitabine, 1.22 pg/cm² [0.20 – 4.28] for cyclophosphamide and 5.50 pg/cm² [0.71 – 34.3] for 5FU. The 90th percentiles were 27.4 pg/cm² for gemcitabine and 27.5 pg/cm² cyclophosphamide, and 238.6 pg/cm² for 5FU.

Discussion-conclusion
Residual contamination by ADs is nearly ubiquitous on work surfaces in the CRUs studied, with notable variability between centers suggesting that there is room for improvement in practices. The most frequently detected ADs and their residual quantities are consistent with those reported in international literature. Despite generally low residual levels, these results highlight the need to strengthen cleaning procedures and to continue environmental monitoring in order to reduce, as far as possible, the levels of exposure of healthcare professionals to these carcinogenic, mutagenic and reprotoxic compounds.

Keywords: occupational exposure, cytotoxic agents, environmental monitoring

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