Comparative contamination study with cyclophosphamide,fluorouracil and ifosfamide: standard technique versus a proprietary closed-handling system

Abstract

Introduction. In 2003 more than 55 000 preparations of injectable hazardous drugs were made in the central admixture service of the University Hospital in Leuven, Belgium. According to the literature, surface contamination occurs, despite the use of special equipment and procedures. The objective of this study was to compare the surface and glove contamination with cyclophosphamide, ifosfamide and fluorouracil, following preparation using either a standard admixture technique or the fully enclosed PhaSeal® system.

Method. During a period of 4 months cyclophosphamide and fluorouracil were prepared with the PhaSeal® system. Following a period of 2 months using the classical technique, cyclophosphamide and ifosfamide were prepared for an 18-month period with the PhaSeal® system. Samples were taken before the start of the 4-month period, in the middle and at the end of the PhaSeal® period, 2 months after stopping PhaSeal® and again after 18 months of working with PhaSeal®. The total number of samples was 104.

Results. For fluorouracil only one of the 14 surface samples was detectable, probably because the detection limit is too high. No differences between the results of the surface samples for cyclophosphamide and ifosfamide were detected. However, a rather big spill due to incorrect use of the system could have influenced these results. Differences in contamination on the gloves were more important.

Conclusion. Good compliance with standard preparation and cleaning techniques results in equal levels of contamination on surfaces compared with the PhaSeal® system. However, the PhaSeal® system is an important improvement in reducing contamination on gloves.