Panic in the cytotoxic drug production unit - Simulation of an Incident Exposing to Cytotoxic Contamination Risk

Introduction
Exposure to cytotoxic in the context of an incident (bottle breakage, bag leakage) is a rare but stressful situation for the staff of the cytotoxic drug production unit. Within the hospital, only theoretical training is provided for staff likely to be exposed to cytotoxic during preparation and transport.

Objective
The objectives of this work were to analyze and evaluate the knowledge of different professionals, to organize practical training through a simulation exercise on how to respond in the event of an incident, and to assess the satisfaction of the simulation’s training.

Material and Method
Training was developed in several stages: briefing, knowledge assessment quiz (before), individual or paired simulation, knowledge assessment quiz (after), debriefing, and satisfaction questionnaire. Scenarios and quizzes were designed for two different situations, tailored to the staff undergoing training. During the simulation, an external evaluator assessed the scenario implementation according to five items: initial incident handling (use of the kit and reading the procedure), securing the area, wearing personal protective equipment (PPE), decontamination, and waste management. A facilitator was present to ensure the smooth running of the simulation.

Results
17 professionals attended the training: 7 pharmacy technician, 4 pharmacists, 1 nurse’s aide, 5 logistics agents. Regarding the simulation, the success rate for each aforementioned item was respectively 77%, 63%, 72%, 65%, and 100%. For the quizzes, the correct response rate was 74% before the simulation, compared to 85% afterward. All participants were satisfied with the training and believed that it would help them handle such incidents more calmly in the future. Participants expressed a desire to repeat this practical training regularly.

Discussion and Conclusion
After simple theoretical training, the entire procedure does not seem to be fully mastered. Simulation training helped solidify theoretical knowledge and better handle a real incident. Additionally, it helped identify point for improvement, leading to the creation of quick-reference sheets for emergency incident management. Based on these results, this simulation will be integrated into the initial and ongoing training plan for URCC staff. This work could be extended by deploying this training to staff in care units.