Evaluation of surface contamination by cytotoxic drugs (CD) in the centralized cytotoxic reconstitution unit (URCC)
1 : Pharmacie, Centre Hospitalier de Bourg-en-Bresse, 900, route de Paris - CS 90401, 01012 BOURG EN BRESSE cedex FRANCE
Cytotoxic drugs preparation is an hazardous activity, can involved an exposure of workplace and hospital personnel. Consequences on professionals health could be acute (skin toxicity) or delayed (reprotoxicity, genotoxicity, carcinogen). As part of a continuous improvement and staff protection approach, surface contamination rate with CD was evaluated by wipe sampling.
20 wipe samples were obtained from critical steps of the process: preparation, dispensation, administration. All samples were analyzed for 20 CD, selected according to unit activity. The CD contamination was determined by liquid chromatography tandem mass spectrometry. CD found were classified into 4 groups: not found (below the limit of detection), low quantity (< 10 times the limit of quantification (LOQ)), intermediate quantity (between 10 and 100 times the LOQ), high quantity (> 100 times the LOQ).
Several CD were found in the isolator (iso) in low or intermediate quantities: 5 Fluorouracil, Cytarabine, Gemcitabine, Etoposide, Methotrexate, Cyclophosphamide, Ifosfamide and Platinum. Ifosfamide in high quantity was found on the neoprene glove of iso. Etoposide was found in intermediate quantities on a infusion bag. None of the CD selected were found in the preparation room (PR), in the dispensing area (DA) and in the day hospital (DH).
PR, DA, and DH were not contaminated, suggesting effective cleaning process and safe administration (thanks to the use of secure administration device). To decrease contamination (already limited) cleaning methods have been reviewed. Despite the use of a closed system for Ifosfamide, the high contamination level in the iso requires corrective measures focused on good preparation practices and on continuous training of pharmacy technicians with the implementation of a fluorescein test to raise their awareness. Realizing samples for detecting surface contamination is currently not recommended. A comparison with other centers appears to be essential in order to optimize the management of these contaminations.