Background Workplace contamination with antineoplastic drugs put health workers at risk of exposure. The environment may be contaminated even in the absence of any handling as external contamination of vials originating from the pharmaceutical manufacturer is widely reported. It constitutes a source of dermal exposure but also of inhalation exposure as vaporisation of antineoplastic agents at room temperature has also been reported with various drugs, such as cyclophosphamide (CP).
Purpose The main goals of this report were to study surface contamination by CP on several surfaces in areas where cytostatics are prepared and administered and also on the vials and their outer packaging to identify areas for improvement in our working protocols.
Material and methods Drug vials containing CP and their outer packaging were wipe sampled. Different surfaces in the preparation and administration areas were also investigated: the work area inside the safety cabinet (before and after cleaning), the phone and computer keyboard in the preparation room, the bags with diluted cytostatics, the table in the administration area, the toilet door handle and the infusion pump control panel. Analysis was performed by liquid chromatography.
Results The amount of CP detected ranged from 0.00019 μg/cm2 to 0.00031 μg/cm2. The highest contamination was found on the work surface of the biological safety cabinet before it was cleaned at the end of the work. There was no contamination on the work area inside the safety cabinet after cleaning or on the phone, or on the computer keyboard or the door handle. Because of these results, working protocols were reviewed and new security measures were included: decontamination of vials after their reception with NaOH 0.03 M solution and elimination of their outer packaging; decontamination of surfaces in the administration area; and nurses to wear gloves to administer medications.
Conclusion Low amounts of CP have been detected in preparation and administration areas, as well as on external surfaces of vials and their outer packaging. As a consequence, we changed our daily practice to reduce exposure of health workers.
No conflict of interest.