Background Hypersensitivity, allergic reactions, resistance and anaphylactic shock are the most common, but scarcely published adverse health effects of occupational exposure to antibiotics. Nurses handling antibiotics frequently report smelling of the drugs and experiencing a bitter taste during preparation and administration.

A study was performed, monitoring antibiotics at nursing departments in three hospitals in Europe (Intensive Care, Department of Infectious Diseases and Children’s Department of Infectious Diseases).

Purpose To measure contamination with antibiotics on surfaces and in air during preparation using conventional techniques (needle/syringe or needle/spike/syringe combination) or using the Tevadaptor^®Closed-System drug Transfer Device (CSTD).

Material and methods Surface contamination was measured by taking wipe samples from potentially contaminated surfaces (n=30). Stationary air samples (n=16) were collected in the preparation area and personal air samples (n=20) from the nurses during preparation, administration and patient care.

Surface and air contamination was reassessed after several weeks following the implementation of the CSTD.

Surface contamination was compared before and after CSTDs’ introduction for each hospital using Friedman’s Two-Way Analysis of Variance by Ranks.

The most frequent antibiotics were monitored: vancomycine, meronem, augmentin, ceftriaxone, cefotaxime, piperacillin and benzylpenicillin.

Extracts of wipe and air samples were analysed using LC-MSMS (detection limit: 1 ng/ml extract).

Results Using conventional preparation techniques, widespread contamination with antibiotics up to 767 ng/cm² was detected. Median values for the three hospitals were 2, 1 and 0.25 ng/cm².

After implementation of the CSTD, overall contamination levels significantly decreased for the most frequently prepared antibiotics in all three hospitals to <0.03 ng/cm² (p<0.004), 0.03 ng/cm² (p=0.006) and 0.04 ng/cm^{2 (}p<0.02).

Using the conventional preparation technique, three antibiotics were detected in the environmental air of seven nurses in two hospitals (0.01 to 5 µg/m³), whereas after implementation of the CSTD only one antibiotic was detectable in environmental air in one hospital (1.4 µg/m³).

Differences in contamination between the nurses using the conventional preparation technique can be explained by the number of antibiotics used, the preparation technique and their (lack of) skills.

Conclusion Using the conventional preparation technique, surfaces and air were widely contaminated with antibiotics whereas the use of the CSTD significantly reduced contamination. Systematic use of a CSTD significantly reduces exposure of nurses to hazardous antibiotics.

No conflict of interest