Workplace Contamination with Antineoplastic Agents in a New Cancer Hospital Using a Closed-System Drug Transfer Device

Abstract

Objective

To determine levels of environmental chemotherapy contamination in a new cancer hospital that has exclusively used a closed-system drug transfer device (PhaSeal) for preparing and administering all compatible antineoplastics.

Methods

After 6 months of operation, surface samples were collected from pharmacy and nursing areas to determine levels of contamination with cyclophosphamide and ifosfamide. In addition, urine samples were collected from pharmacists, pharmacy technicians, and nurses to determine employee exposure to these agents. All samples were analyzed using liquid chromatography/tandem mass spectrometry.

Results

Twenty-one percent (7/34) of surface samples collected tested positive for cyclophosphamide contamination. Twelve percent (4/34) of surface samples tested positive for ifosfamide. To place this into perspective, historical data collected at our outpatient oncology infusion clinic 6 months after converting to PhaSeal from conventional methods of antineoplastic preparation showed 33% (7/21) and 71% (15/21) of samples tested positive for cyclophosphamide and ifosfamide, respectively. The level of ifosfamide contamination found in samples that tested positive at our new hospital also appeared to be lower than in positive samples at the outpatient infusion clinic. In the current study, the urine of one participant (1/11), a pharmacy technician, tested positive for low levels of cyclophosphamide and ifosfamide. To compare, 71% and 0% of participants tested at the outpatient infusion clinic had positive urine samples prior to and 6 months after implementation of PhaSeal, respectively. Conclusions: Compared with historical levels of contamination in our outpatient oncology infusion clinic, levels of chemotherapy contamination appeared lower. However, some contamination was still present in our new cancer hospital where PhaSeal had been used exclusively.