From the centralized cytotoxic reconstitution unit (CCRU) to the day care unit (DCU), all involved with chemical contamination: spread simulation

Background/objectives:
Managing external cytotoxic contamination of vials and preparations is a major challenge. An analysis of failure mode, effects and criticality was previously performed in 2022 and highlighted risks associated with our cytotoxic preparations process, and particularly a lack of information among exposed staff. The aim of our study is to assess healthcare professionals’ knowledge, from the CCRU to the DCU, and to develop a simulation game on the diffusion of external chemical contamination of vials and preparations.

Materials and methods:
1) Survey focusing on perception/protection regarding the chemical contamination risk 2) Simulation of external contamination spreading in the CCRU and DCU by quinine (125 mg/ml) on 6 vials, 3 bags, 3 syringes, 6 packages. A negative control (absence of prior fluorescence) and a positive control (diffusion of contamination) were carried out in the 2 units. A simulation of production was carried out: receipt/storage of vials, preparation of materials, output from isolator, releasing, transport, administration, elimination. At the end of the simulation, fluorescence was detected with the healthcare teams using a 325nm UV lamp.

Results:
1) Survey : 19 replies were received : 4 pharmacy techicians (PT), 2 pharmacists, 3 pharmacy suppliers (PS), 5 nursing assistants (NA), 3 nurses (N), 2 coordination nurses (CN). Healthcare workers feel: little (5/19), moderately (10/19), very (4/19) exposed, with different results by profession: CN, PS little, NA, PT moderately, N very exposed. 2) Simulation: at the CCRU, contamination spread to: gloves/clothes worn by the assitant manipulator (PT) and the PS, gloves worn by the pharmacist in charge of preparations releasing, isolator (seat, dynamic exit airlock, screen), storage rack, manufacturing sheet, delivery briefcase and delivery note.
At the DCU, contamination spread to: nurse’s gloves, computer mouse, nursing station desk and bench, trays containing injection kits, seat, floor, IV pole, pump, side table in patients’ rooms. Results were then presented to participants via an interactive quiz.

Discussion/conclusion:
The majority of professionals involved with the risk of chemical contamination feel moderately or not at all exposed. Exaggerating quinine contamination made it possible to raise awareness among exposed staff in a playful way, and to quickly and easily make visible the spread of chemical contamination of the cytotoxic preparation from the CCRU to the DCU. The visualization of these processes has enabled us to implement preventive measures adapted to each stage: phone on loudspeaker in the clean room, systematic glove wearing for every pump flow adjustment and when preparing injection material in the nursing station, more frequent glove changes, introduction of oversleeve gloves.

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