Background Due to their carcinogenic, mutagenic and teratogenic properties, handling cytotoxic drugs presents a risk of occupational exposure for healthcare workers.
Purpose To evaluate and limit occupational risk, environmental monitoring was conducted in 7 French hospital pharmacies that prepare formulations of carboplatin, cisplatin and oxaliplatin. Platinum was used as the tracer (~20% of the production).
Materials and Methods From 2010 to 2012, 7 cytotoxic drug preparation units were investigated. Different types of surface were evaluated: the external surface of vials containing cytotoxic materials, workplace surfaces and the surfaces of antineoplastic drug preparations. Surfaces were sampled with a moistened swab. After pre-concentration by cloud point extraction, the quantity of elemental platinum was evaluated by graphite furnace atomic absorption spectrometry. The lower limit of detection corresponded to 2 ng of platinum per sample.
Results A total of 518 samples analysed had various levels of contamination and we found a frequency of cytotoxic contamination of more than 37% of samples (>2 ng). Contamination was found on 38% of vials of cisplatin, carboplatin and oxaliplatin from different manufacturers (n = 111, max 66 ng), 56% of cytotoxic preparations (n = 18, max 78 ng) with 29% of packagings (n = 24, max 15 ng) and 56% of workplace surfaces (n = 365) contaminated. Surfaces inside isolators were the most contaminated area (59%, n=169) compared with storage areas (28%, n = 89), controlled areas (15%, n = 55), control laboratories (24%, n = 25) and other areas (4%, n = 27). However the highest level of contamination was found inside storage boxes of vials containing cytotoxics with more than 20,000 ng of Pt.
Conclusions Regarding environmental monitoring, two major sources of contamination were identified: the outer surface of vials of cytotoxic material and handling cytotoxic drugs inside the isolator. Other contamination spreads from those initial points of contamination. Thus, it seems necessary to use effective individual protective equipment but also to use efficient cleaning protocols to limit chemical contamination and thus, to prevent occupational exposure.
No conflict of interest.
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