Impact and appreciation of two methods aiming at reducing hazardous drug environmental contamination: The centralization of the priming of IV tubing in the pharmacy and use of a closed-system transfer device

Abstract

Objectives

The main objective was to evaluate the impact of two methods aiming at reducing hazardous drug environmental contamination: the centralization of the priming of IV tubing in the pharmacy and the use of a closed-system transfer device. The secondary objective was to evaluate the satisfaction of pharmacy technicians using a survey.

Methods

Sites in the hematology-oncology satellite pharmacy and care unit were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate before and after the centralization of the priming of IV tubing in the pharmacy and before and after using a closed-system transfer device. The limits of detection for cyclophosphamide, ifosfamide and methotrexate were, respectively, of 0.0015 ng/cm², 0.0012 ng/cm² and 0.0060 ng/cm². The pharmacy technician satisfaction was evaluated using a questionnaire.

Results

A total of 225 samples was quantified. After the centralization of priming in the pharmacy, no significant difference was found in the proportion of positive samples for cyclophosphamide, ifosfamide and methotrexate. Traces of cyclophosphamide found on the floor in patient care areas was significantly reduced (median[min-max] 0.08[0.06−0.09]ng/cm² vs. 0.03[0.02−0.05], p < 0.0001). After using a closed-system transfer device, a significant difference was found for the proportion of cyclophosphamide positive samples (15/45(33%) vs. 0/45(0%), p < 0.0001), but no significant difference was found for ifosfamide (12/45(27%) vs. 5/45(11%), p = 0.059) and methotrexate (1/45(2%) vs. 2/45(4%), p = 0.557). Pharmacy technicians raised issues following the centralization of priming (e.g. workload) and the use of closed-system transfer devices (e.g. spills, particles, workload and handling difficulties).

Conclusion

The centralization of the priming of IV tubing in the pharmacy reduced floor contamination in patient care areas without increasing surface contamination in the pharmacy. Closed-system transfer devices reduced contamination in pharmacy, but handling issues were raised by pharmacy technicians.

Keywords

Hazardous drugs priming of IV tubing centralization closed-system transfer device

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References

National Institutute for Occupational Safety and Health. Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings, www.cdc.gov/niosh (2004, accessed 4 October 2012).

Association pour la santé et la sécurité au travail – secteur des affaires sociales. Prevention guide – safe handling of hazardous drugs, http://www.asstsas.qc.ca/Documents/Publications/Repertoire%20de%20nos%20publications/Autres/GP65A-hazardous_drugs.pdf (2008, accessed 4 October 2012).

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