Antineoplastic drugs contamination of workplace surfaces in two Portuguese hospitals

Despite the classification as known or suspected human carcinogens, by the International Agency for Research on Cancer, the antineoplastic drugs are extensively used in cancer treatment due to their specificity and efficacy. As human carcinogens, these drugs represent a serious threat to the healthcare workers involved in their preparation and administration. This work aims to contribute to better characterize the occupational exposure of healthcare professionals to antineoplastic drugs, by assessing workplace surfaces contamination of pharmacy and administration units of two Portuguese hospitals. Surface contamination was assessed by the determination of cyclophosphamide, 5-fluorouracil, and paclitaxel. These three drugs were used as surrogate markers for surfaces contamination by cytotoxic drugs. Wipe samples were taken and analyzed by HPLCDAD. From the total of 327 analyzed samples, in 121 (37%) was possible to detect and quantify at least one drug. Additionally, 28 samples (8.6 %) indicate contamination by more than one antineoplastic drug, mainly in the administration unit, in both hospitals. Considering the findings in both hospitals, specific measures should be taken, particularly those related with the promotion of good practices and safety procedures and also routine monitoring of surfaces contamination in order to guarantee the appliance of safety measures.

Hospital surfaces contamination with antineoplastic drugs: influence of cleaning procedures

Introduction: The raising frequency of cancer diseases is leading to a widespread application of antineoplastic drugs, thus increasing the probability of workplace surfaces contamination. Most of these drugs are classified by the International Agency for Research on Cancer as known or suspected human carcinogens. Skin absorption is the main route for antineoplastic drugs exposure in occupational settings, therefore cleaning protocols have paramount influence in surfaces contamination and, consequently, in exposure. The aim of this study was to assess surfaces contamination in a Portuguese chemotherapy unit before and during drug administration, in both preparation and administration facilities. Methods: Samples were collected by wipe-sampling from potentially contaminated surfaces selected by previous protocol observation. Samples were analyzed by HPLCDAD. Cyclophosphamide (CP), 5-fluorouracil (5FU), and paclitaxel (PTX) were used as surrogate markers for surfaces contamination for all cytotoxic drugs. Results: From the 34 samples collected before any preparation and administration activities, 41.2% were contaminated with 5-FU (4.0-84.7 ng/cm2) and 23.5% of the samples were contaminated with CP (19.8-139.6 μg/cm2). Only 2 samples presented contamination by PTX (5.9%) with a maximum value of 3.7 ng/cm2. Of the 37 samples collected during preparation and administration of antineoplastic drugs, 48.7% were contaminated with 5-FU (1.9-88.7 ng/cm2) and 24.3% with CP (12.0-93.9 μg/cm2). None of the samples showed contamination with PTX. Discussion: Data showed differences in contamination levels before and after the handling of antineoplastic drugs in preparation and in administration settings. These results point out the importance of cleaning procedures. This is well in accordance to previous studies that showed how the type of cleaning procedures and products used can be determinant for surfaces decontamination.