Background and Importance Exposure to Hazardous Drugs (HD) is a potential health risk. Multiple regulatory agencies have provided guidance involving enhanced cleaning procedures and the use of Closed System Transfer Devices (CSTDs) to minimise the risk of exposure. However, despite the potential for side effects involving the use of antibiotics (ABs), guidance has not been provided for facilities to reduce or minimise these risks.
Aim and Objectives The aim of this study was to identify the level of AB and HD surface contamination in a hospital pharmacy and eight wards to increase awareness for the need for enhanced controls involved in AB use.
Material and Methods Six HDs were analysed in four surface wipe samples from a pharmacy and two wards. Sampling was repeated four times (trials) over a period of eight months (288 endpoints). A CSTD was used for HD preparation during the entire study. Eight ABs were analysed in two surface wipe samples from six wards collected during the four trials (384 endpoints). Sampling was at the same timepoints as for HD sampling. A CSTD was not used in AB handling. Enhanced cleaning was implemented following the first trial. Samples were analysed with liquid chromatography tandem mass spectrometry.
Results HD surface contamination was detected in 6% of the samples collected during the four trials. Samples with high levels of contamination were not found. AB surface contamination was detected in 68% of the samples. 15% of the samples show high levels of contamination. Despite enhanced cleaning procedures, AB contamination was increased in the last trials compared to the initial trials.
Conclusion and Relevance The study illustrates that institutional guidance, involving the use of a CSTD and effective cleaning, has proven to be effective to minimise unintentional exposure of healthcare workers to HD surface contamination. On the contrary, guidance, controls and cleaning were not sufficient to reduce surface contamination with potential harmful ABs.
References and/or Acknowledgements 1. Alert and action levels for surface contamination with HDs in The Netherlands (https://www.dokterhoe.nl/fileadmin/user_upload/documents/cytostatica/meetstrategie-werkinstructie.pdf)
Conflict of Interest Corporate sponsored research or other substantive relationships:
The study was financially supported by ICU Medical USA. Paul Sessink is receiving an honorarium from ICU Medical for this presentation.
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