Antineoplastic drug contamination and safe handling practices in Canadian healthcare centres: Results from the 2025 monitoring program

Abstract

Introduction

Occupational exposure to antineoplastic drugs remains a significant concern for healthcare workers. Surface contamination is a key indicator of exposure risks and reflects the effectiveness of practices. This study aimed to describe contamination with 11 antineoplastic drugs on 12 surfaces in Canadian healthcare centres participating in the 2025 monitoring program and to examine practices implemented by these centres, including the potential influence of hazardous drug committees.

Methods

Each centre sampled six standardized sites in oncology pharmacies and six in outpatient clinics. Ultra-performance liquid chromatography-tandem mass spectrometry quantified cyclophosphamide, docetaxel, doxorubicin, etoposide, 5-fluorouracil, gemcitabine, irinotecan, methotrexate, paclitaxel and vinorelbine. Inductively coupled plasma mass spectrometry quantified platinum-based drugs. The Kolmogorov–Smirnov test assessed differences in contamination, and chi-square tests compared practice implementation.

Results

A total of 127 centres participated. Overall, 35% (504/1 453) of surfaces were contaminated, most frequently cyclophosphamide (22%, 90^th percentile 0.0052 ng/cm²) and gemcitabine (14%, 0.0017 ng/cm²). The most contaminated sites were the front grille inside the biological safety cabinet (70%) and the armrest of the treatment chair (67%). More than half of centres (67/122, 55%) reported having a hazardous drugs committee. Cyclophosphamide surface contamination differed by committee presence and meeting frequency (p = 0.034). Centres with a committee were more likely to implement certain handling practices, including cleaning vials before storage (p = 0.004).

Conclusions

Surface contamination remains frequent but at low concentrations, with evidence of improvement over time. Multidisciplinary committees, continuous monitoring and broader staff engagement are essential to strengthen safety culture and reduce occupational exposure.