Background Monitoring of contamination with cytostatics has been required by law in our country for several years. However, it was put into practice thanks to the CYTO project that was managed by our pharmacy in 2006–2010.
Purpose The use of cytostatic drugs has been rising in our country. While in 2010 our pharmacy compounded 23 000 bags and syringes, this amounted to 38 000 in 2015. Therefore, regular monitoring of contamination at all work sites involved in compounding or administration is important. The level of contamination should be monitored both in the pharmacy and in the wards. Since 2007, measurement of cyclophosphamide (CP) and platinum cytostatic (Pt) contamination has been available. Since 2015, measurement of 5-fluorouracil (FU) has been also possible. These drugs belong to the most frequently used cytostatics (together they represent 49.0% of compounded units).
Material and methods Sampling of surfaces is performed with unwoven textile moistened by acetate buffer. CP and FU were analysed by high performance liquid chromatography (Waters UPLC Aquity with Xevo TQ-S Agilent mass detector), and Pt were analysed by mass spectrometry with inductively coupled plasma (Agilent I CP-MS 7500).
Results Higher contamination was generally found in hospital wards and compounding units. Maximal detected levels of FU on floors: hospitals, 775 pg/cm2 (median 189.7 pg/cm2); pharmacies, compounding units, 564 pg/cm2 (median 3.6 pg/cm2); and pharmacies, storage rooms, 25 pg/cm2 (median <7 pg/cm2). Maximal detected levels of CP on floors: hospitals, 3244 pg/cm2 (median 101.9 pg/cm2); pharmacies, compounding units, 638 pg/cm2 (median 5.8 pg/cm2); and pharmacies, storage rooms, 235 pg/cm2 (median <1 pg/cm2). Maximal detected levels of Pt on floors: hospitals, 5390 pg/cm2 (median 47 pg/cm2); pharmacies, compounding units, 84 pg/cm2 (median 0.9 pg/cm2); and pharmacies, storage rooms, 57 pg/cm2 (median <0.2 pg/cm2).
Conclusion Measurement of contamination raised information about the level of health risk of healthcare personnel handling cytostatics (pharmacists and nurses). Hospital pharmacists can reduce contamination on their work sites and they should co-operate with wards. Preventive measures that are able to decrease contamination in wards include branched infusion lines, wall connected infusion poles instead of stands, and self-cleaning toilet seats.
References and/or acknowledgements We thank all participating hospitals.
No conflict of interest
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