Evaluation of chemical contamination when preparing chemotherapy treatments within a CCRU

Within the scope of certification for our CCRU (certified ISO-9001 since 2008) there is a constant need to propose measures to improve quality, and especially preventive measures so as to limit to the greatest possible extent exposure of personnel and the environment to cytotoxics. Indeed, despite preparation being conducted in optimal conditions by certified staff, it has been shown that the working environment as also the packaging of chemotherapies issued to the nursing staff could carry traces of cytotoxics.

The principle for the study was to proceed with handling using a non-toxic marker in order to analyse the working methods and the operator’s impact on chemical contamination. The use of quinine was retained as its molecule is fluorescent under a UV lamp while being colourless, thus limiting bias in conducting the trial, and whose fluorescence can also be neutralised with the NaCl present in the preparation. Later analysis of the preparations and the equipment needed to produce them enabled us to identify traces of contamination. The type and location of these projections were studied so as to come to an understanding of the stages at risk and find remedial solutions. The experiment was conducted by qualified personnel, i.e. pharmacy technicians trained internally and assessed every year.

This study showed that despite extreme precautions when handling these products, it is impossible to exclude all risks of contamination by cytotoxics and that there is a need to identify that risk to raise collective awareness.

Following this experiment, handling gestures were reviewed with all the technicians concerned so as to do everything possible to avoid projections and thus limit contamination of the environment by cytotoxics.