Surface contamination of cytotoxic medicine in preparation and patient care areas in Australian hospitals: a retrospective cross-sectional study

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-06-07 DOI:10.1002/jppr.1925

Vincent Woodward BSc, MPharm, Meghrie Panjarjian BSc, MPharm, Devika Devi MPharm, Jane Hanrahan BSc (Hons), PhD, Michael Soriano BPharm, Matt Roper BMedSc (Hons), BPharm (Hons), Hala Musa BSc (Hons), MS, MPharm, Stephanie Davies BPharm, Peter Samios BPharm, GradDipClinPharm, Michael Teh BPharm, GradDipHospPharm, Peter Barclay BPharm, Clare Naughtin BPharm, Régis Vaillancourt BPharm, PharmD, Carl Nikolaidis BSc, Bryan Pelland BSc, Jonathan Penm BPharm (Hons), GradCertEdStud (Higher Ed), PhD

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Abstract

Background

Cytotoxic medicine contamination of preparation and administration areas of oncology healthcare facilities poses a risk to staff facing repeated low-level exposure over time. The use of closed-system transfer devices (CSTDs) during preparation and administration of cytotoxic products may reduce the levels of contamination. The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.

Aim

The primary aim was to determine the levels of cytotoxic medicine contamination in preparation and administration areas of hospitals that use CSTDs compared to those that do not.

Method

A retrospective, cross-sectional study across four Australian hospitals was conducted. Cytotoxic medicine contamination was determined via surface wipe sampling on six specified surfaces. The samples were tested for cyclophosphamide, docetaxel, etoposide, ifosfamide, irinotecan, methotrexate, paclitaxel, pemetrexed, topotecan, and vinblastine. This project was exempt due to the local policy requirements that constitute research by the South Eastern Sydney Local Health District Human Research Ethics Committee (Reference no: ETH01899). The justification for this ethics exemption was as follows: this was a study involving sample testing only and did not include human participants or participation.

Results

Environmental contamination with cytotoxic medications was observed at all hospitals, regardless of the CSTD used. Of the 24 samples tested, the agent most frequently seen was ifosfamide with 29% (n = 7), followed by cyclophosphamide 13% (n = 3), and methotrexate 8% (n = 2). There was no statistically significant difference between hospitals that used CSTDs compared to hospitals that did not (25% vs 42%, p = 0.67). Contamination was more extensive in preparation areas than administration areas, and was observed on the biological safety cabinets (BSC) worktop, packaging bench, and floor in front of the BSCs.

Conclusion

All sites had contamination present for cytotoxic medicines. There was no statistically significant difference in the proportion of contaminated surfaces between sites that used CSTDs versus sites where CSTDs were not used. Only ifosfamide contamination was identified in pharmacy areas that used CSTDs. Safe work practices and staff training are encouraged to further minimise exposure risk.

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澳大利亚医院准备区和病人护理区的细胞毒性药物表面污染：一项回顾性横断面研究

在肿瘤医疗机构的制备和用药区域，细胞毒性药物污染会给长期反复接触低浓度药物的工作人员带来风险。在准备和使用细胞毒性产品时使用封闭系统转移装置（CSTD）可降低污染水平。这项研究的主要目的是确定使用封闭系统转移装置的医院与未使用封闭系统转移装置的医院在准备和给药区域的细胞毒性药物污染水平。该研究对澳大利亚四家医院进行了一项回顾性横断面研究，通过对六种特定表面进行表面擦拭取样来确定细胞毒性药物污染情况。样本中检测了环磷酰胺、多西他赛、依托泊苷、伊福法胺、伊立替康、甲氨蝶呤、紫杉醇、培美曲塞、托泊替康和长春新碱。根据悉尼东南部地方卫生区人类研究伦理委员会（South Eastern Sydney Local Health District Human Research Ethics Committee，编号：ETH01899）的当地研究政策要求，该项目获得了伦理豁免。获得伦理豁免的理由如下：这是一项仅涉及样本检测的研究，不包括人类参与者或参与。所有医院都发现了细胞毒性药物的环境污染，无论使用的是哪种 CSTD。在检测的 24 份样本中，最常见的药物是伊福酰胺，占 29%（7 人），其次是环磷酰胺，占 13%（3 人），甲氨蝶呤占 8%（2 人）。使用 CSTD 的医院与未使用 CSTD 的医院在统计学上没有明显差异（25% vs 42%，P = 0.67）。配制区的污染比用药区更严重，生物安全柜 (BSC) 工作台、包装台和生物安全柜前的地板上都有污染。在统计学上，使用化学安全柜和未使用化学安全柜的医疗点在受污染表面的比例上没有明显差异。只有在使用 CSTD 的药房区域发现了伊福酰胺污染。我们鼓励采用安全的工作方法并对员工进行培训，以进一步将接触风险降至最低。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.