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van den Berg RB, de Poot S, Swart EL, Crul M. Assessment of occupational exposure to nebulized isopropyl alcohol as disinfectant during aseptic compounding of parenteral cytotoxic drugs in cleanrooms. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:361-368. [PMID: 34185621 DOI: 10.1080/15459624.2021.1933505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pharmacy technicians are exposed to volatile organic compounds, like the disinfectant isopropyl alcohol (IPA), during the process of aseptic compounding of parenteral cytotoxic drugs. The occupational exposure to nebulized IPA during aseptic compounding has not been investigated. The aim of this study was to investigate the exposure to IPA during aseptic compounding of parenteral cytotoxic drugs and to assess compliance with legal and regulatory limits. As a secondary endpoint, the difference between two disinfection methods was compared regarding the exposure to IPA. The exposure to IPA was measured during five working shifts of 8 hr and one shift of 4 hr. The concentration IPA was measured by using a six-gas monitor. Total daily exposure was calculated as 8-hr Time Weighted Average (TWA) air concentration in mg/m3 and compared with an Occupational Exposure Limit (OEL) value of 500 mg/m3 and incidental peak exposure of 5,000 mg/m3. To assess whether the 8-hr TWA air concentration meets the legal and regulatory limits the Similar Exposure Groups (SEG) compliance test was used. A paired sample t-test was conducted to assess difference in exposure between two disinfection methods. The average 8-hr TWA exposure to IPA during the six measurements varied from 2.6 mg/m3 to 43.9 mg/m3 and the highest momentary concentration measured was 860 mg/m3. The result of the SEG compliance test was 3.392 (Ur value) and was greater than the Ut value of 2.187 which means the exposure to IPA is in compliance with the OEL value. No significant difference in exposure was shown between two disinfection methods (p = 0.49). In conclusion, exposure to IPA during aseptic compounding of parenteral cytotoxic drugs showed compliance to the OEL values with no significant difference in exposure between two disinfection methods.
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Affiliation(s)
- Roland B van den Berg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Stan de Poot
- Department of Occupational Health & Safety, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Eleonora L Swart
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mirjam Crul
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Marie P, Christophe C, Manon R, Marc M, Charleric B, Patrice V. Environmental monitoring by surface sampling for cytotoxics: a review. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:52. [PMID: 28063118 DOI: 10.1007/s10661-016-5762-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/27/2016] [Indexed: 06/06/2023]
Abstract
Environmental monitoring is usually conducted by surface sampling to detect and quantify the presence of cytotoxic drugs after their reconstitution and administration. This technique reveals the origins of residual contamination and is an important component in order to protect healthcare workers from the potential risk of occupational exposure. The aim of this work is to compare various techniques and results of surface sampling for cytotoxics. For each technique, sample processing methods and their analysis were compared from literature data. Sampling is often performed by the wiping technique. After treatment, various single or multicompound technical analyses are used, in particular liquid or gas chromatography involving different detection methods: ultraviolet, mass spectrometry, plasma torch, and voltammetry. Some methods are validated to ensure reliability. Despite published guidelines and the use of isolator technology for the preparation of cytotoxic drugs, workplace contamination persists, leading to chemotherapeutic agents' exposure of healthcare workers. Efforts need to be maintained with particular emphasis on harmonization and on determining alert level for cytotoxic contamination.
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Affiliation(s)
- Petit Marie
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Curti Christophe
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
| | - Roche Manon
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France.
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central des Opérations Pharmaceutiques (SCOP), Administration Centrale, rue Brochier, 13005, Marseille, France.
| | - Montana Marc
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Oncopharma, Hôpital Nord, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Bornet Charleric
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Pharmacie Usage Intérieur Hôpital de la Conception, Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
| | - Vanelle Patrice
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service Central de la Qualité et de l'Information Pharmaceutiques (SCQIP), Hôpital de la Conception, 147 Boulevard Baille, 13005, Marseille, France
- CNRS, ICR, UMR 7273, Laboratoire de Pharmaco-Chimie Radicalaire, Faculté de Pharmacie, Aix-Marseille Université, 27 Boulevard Jean Moulin-CS30064, 13385, Marseille Cedex 05, France
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Lee SG, Tkaczuk M, Jankewicz G, Ambados F. Surface Contamination from Cytotoxic Chemotherapy Following Preparation and Administration. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2007.tb00763.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Ganyk Jankewicz
- Occupational Hygienist, School of Population Health and Clinical Practice; The University of Adelaide
| | - Fotios Ambados
- The Queen Elizabeth Hospital; Woodville South South Australia
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Siderov J, Kirsa S, McLauchlan R. Surface Contamination of Cytotoxic Chemotherapy Preparation Areas in Australian Hospital Pharmacy Departments. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2009.tb00434.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Sue Kirsa
- Peter MacCallum Cancer Centre; East Melbourne
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Siderov J, Kirsa S, McLauchlan R. External Surface Contamination of Cytotoxic Admixtures: Caveat Emptor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2011.tb00856.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Power LA, Sessink PJM, Gesy K, Charbonneau F. Hazardous drug residue on exterior vial surfaces: evaluation of a commercial manufacturing process. Hosp Pharm 2014; 49:355-62. [PMID: 24958942 DOI: 10.1310/hpj4904-355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Hazardous drug residue on the exterior surface of drug vials poses a potential risk for exposure of health care workers involved in handling these products. The purpose of this article is to heighten the awareness of this serious issue and to evaluate a commercial manufacturing process for removing and containing hazardous drug (HD) residue on exterior vial surfaces. Additionally, findings from this study are interpreted, incorporated into the current body of evidence, and discussed by experts in this field. METHODS This study includes separate evaluations for the presence or absence of surface drug contamination on the vials of 3 HD products: 5-fluorouracil, cisplatin, and methotrexate. The drug products were packaged in vials using a patented prewashing/decontamination method, application of a polyvinylchloride (PVC) base, and use of clear glass vials. An additional step of encasing the vial in a shrink-wrapped sheath was used for 5-fluorouracil and cisplatin. RESULTS Of all 5-fluorouracil (110 vials), methotrexate (60 vials), and cisplatin (60 vials) tested, only 2 had detectable amounts of surface residue. One 5-fluorouracil vial was found to have approximately 4 mg of 5-fluorouracil on the surface of the vial. The second contaminated vial was cisplatin, which was discovered to have 131 ng of platinum, equal to 200 ng of cisplatin or 0.2 μL of cisplatin solution, on the vial sheath. CONCLUSION Using validated extraction and analytic methods, all but 2 of the 230 tested vials were found to be free of surface drug contamination. Pharmacy leaders need to take an active role in promoting the need for clean HD vials. Manufacturers should be required to provide their clients with data derived from externally validated analytic studies, reporting the level of HD contamination on the exterior of their vial products.
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Affiliation(s)
- Luci A Power
- Senior Pharmacy Consultant, Power Enterprises , San Francisco, California
| | | | - Kathy Gesy
- Provincial Leader, Oncology Pharmacy Services, Saskatchewan Cancer Agency , Saskatoon, Saskatchewan, Canada
| | - Flay Charbonneau
- Manager, Pharmacy, Sunnybrook Odette Cancer Centre , Toronto, Ontario, Canada
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Siderov J, Kirsa S, McLauchlan R. Reducing workplace cytotoxic surface contamination using a closed-system drug transfer device. J Oncol Pharm Pract 2009; 16:19-25. [PMID: 19965949 DOI: 10.1177/1078155209352543] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The potential for staff exposure to antineoplastic agents exists in the workplace despite current recommended safe handling procedures. Reliance on cytotoxic drug safety cabinets (CDSC) to provide total protection from exposure to hazardous drugs is insufficient. Preventing workplace contamination is the best strategy to minimise exposure. PhaSeal is a commercially available system for ensuring the leak-free transfer of hazardous drugs, fitting both the NIOSH and ISOPP definitions of a closed system. To date, there have been no published studies examining the use of a closed system drug transfer device (PhaSeal) under Australian conditions.The purpose of this study is to determine the impact of a closed system drug transfer device on cytotoxic surface contamination in the cytotoxic preparation areas of two Australian metropolitan public hospitals. METHOD This was a pre- and post-intervention study in which chemical contamination was tested at baseline then at five and 12 months after the introduction of the a closed system drug transfer device. Cyclophosphamide was used as a surrogate marker for all cytotoxic drugs. Surface wipe sampling was performed at specified sites within the cytotoxic suite using a standardized technique. Commercial products of cyclophosphamide were also sampled. RESULTS After five months, contamination was reduced in 13 of the 22 sites sampled (59%), with four of these samples showing undetectable levels of contamination. Two other site samples (9%) remained unchanged. The total contamination of surfaces tested was reduced by 24%. After five months hospital 1 withdrew from the study. After 12 months, surface contamination was reduced in 75% of sample sites. The total contamination of surfaces tested was reduced by 68%. The wipes of the external surface of commercial products detected cyclophosphamide contamination. CONCLUSION When used inside a CDSC, the closed system drug transfer device PhaSeal further reduces surface contamination, in some instances to undetectable levels.
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Affiliation(s)
- Jim Siderov
- Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia.
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Lee SG, Jankewicz GJ, Lee NW. Assessing Flucloxacillin Contamination and Decontamination-A Laboratory Study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2009. [DOI: 10.1002/j.2055-2335.2009.tb00429.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Su-Gil Lee
- Discipline of Public Health, School of Population Health and Clinical Practice; The University of Adelaide
| | - Ganyk J Jankewicz
- Discipline of Public Health, School of Population Health and Clinical Practice; The University of Adelaide
| | - Nae-Woo Lee
- Division of Safety Engineering; Pukyong National University; Busan Korea
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Bereznicki LR, Jackson SL, Peterson GM, Khan SA, Rao PGM, Rao BHA, Singh D, Bedi TRS, Koju R, Adhikari O, Alam K, Khan GM, Palaian S, Clifford RM, Gilbar P. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2006. [DOI: 10.1002/j.2055-2335.2006.tb00595.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Gregory M Peterson
- Unit for Medication Outcomes Research and Education; Tasmania School of Pharmacy; Hobart Tas. 7001 Australia
| | | | | | - BH Anand Rao
- Department of Surgery; Kasturba Medical College and Hospital Manipal; India
| | - Dharam Singh
- Pharmacy Department; Peter MacCallum Cancer Centre; East Melbourne Vic. 3002 Australia
| | - TRS Bedi
- Kathmandu University Medical College
| | | | | | - Kadir Alam
- Department of Pharmacy; Kathmandu University; Dhulikhel Nepal
| | - GM Khan
- Department of Pharmacy; Kathmandu University; Dhulikhel Nepal
| | - Subish Palaian
- Department of Pharmacy and Pharmacology; Manipal College of Medical Sciences; Pokhara Nepal
| | - Rhonda M Clifford
- School of Biomedical; Biomolecular and Chemical Sciences University of Western Australia; Crawley WA 6009 Australia
| | - Peter Gilbar
- The Society of Hospital Pharmacists of Australia; Toowoomba Health Services; Toowoomba Qld 4350 Australia
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Burke R, Lu CY, Das R, Palaian S, DA L, GMR P, PR S, NM N, NP N, Siderov J, Stafford L, Elliott RA, McLachlan GB, Lucas A, Sirianni L, Mishra P, Alurkar VM, Subish P. Letters to the Editor. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2006. [DOI: 10.1002/j.2055-2335.2006.tb00892.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rosemary Burke
- Concord Repatriation General Hospital; Concord NSW 2139 Australia
| | - Christine Y Lu
- School of Medical Sciences; University of New South Wales, and Department of Clinical Pharmacology St Vincent's Hospital Sydney; Darlinghurst NSW 2010 Australia
| | - Rabindranath Das
- Department of Medicine; Manipal Teaching Hospital; Pokhara Nepal
| | - Subish Palaian
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal India
- Department of Pharmacology; Manipal College of Medical Sciences; Pokhara Nepal
| | - Leelavathy DA
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal India
| | - Padma GMR
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal India
| | - Shankar PR
- Department of Pharmacology; Manipal College of Medical Sciences; Pokhara Nepal
| | - Nair NM
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal India
| | - Nair NP
- Department of Pharmacy Practice; Manipal College of Pharmaceutical Sciences; Manipal India
| | - Jim Siderov
- Peter MacCallum Cancer Centre; East Melbourne Vic. 8006 Australia
| | - Leanne Stafford
- School of Pharmacy; Curtin University of Technology Clinical Pharmacist (Cardiovascular) Fremantle Hospital and Health Service; Perth WA 6845 Australia
| | - Rohan A Elliott
- Department of Pharmacy Practice; Monash University, Clinical Pharmacist, Austin Health; Heidelberg Vic. 3084 Australia
| | | | - Anna Lucas
- Austin Health; Heidelberg Vic. 3084 Australia
| | | | | | | | - P Subish
- Department of Pharmacology; Manipal Teaching Hospital, Manipal College of Medical Sciences; Pokhara Nepal
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