Research about Environmental Contamination by Cytotoxics
Evaluation of environmental contamination with cytotoxic drugs in the hospital is one of the fundamental requirements to ensure the safety of all healthcare professionals. Safe handling procedures should be closely monitored in all areas where antineoplastic drugs are delivered, stored, prepared, administered and disposed of. Over the last few years environmental contamination with cytotoxic drugs in hospitals units has been reported in several publications. However, detailed information on surface contamination with antineoplastic drugs in European hospitals in areas where these drugs are handled, is still limited. Therefore, the European Society of Oncology Pharmacy (ESOP) undertook the first independent, multi-centre, pan European study, involving over a dozen hospitals, to measure the current state of cytotoxic contamination in the workplace. This project is called MASHA – Research about Environmental Contamination by Cytotoxics and Management of Safe Handling Procedures. The study is designed to investigate any possible weak points during drug preparation, transportation and application, and during the disposal of medical devices after treatment.
The MASHA project is consists of three parts, with each part having different goals.
Materials and Methods:
A pilot study was conducted before the final form of the ESOP project was implemented. The study was carried out at nineteen hospitals in Europe but, for statistical evaluation, the results were collected from only fifteen of them.
In the pharmacy
In the ward
Each sample was analysed for the presence of 12 cytotoxic drugs: 5-fluorouracil, cyclophosphamide, ifosfamide, gemcitabin, etoposide, methotrexate, paclitaxel, docetaxel, topotecan, irinotecan, doxorubicin and epirubicin, using LC MS/MS.
Results and Discussion:
The pilot study demonstrated the presence of surface contamination in the preparation and administration areas of all investigated hospitals, with the level of contamination different in each hospital.
Figure 1 Overview of the results after PART I, PART II and PART III
Contamination was detected mostly on work surfaces of BSCs/Isolators, floors (in pharmacies and wards) and the armrests of patient's chairs (Figure 2 and Figure 3). The highest number of positive results was recorded with gemcitabine, 5-fluorouracil, cyclophosphamide and paclitaxel. The highest value was noticed for gemcitabin (170.5 ng/cm2) and 5-fluorouracil (36.9 ng/cm2) in PART I and PART II, respectively. 69% of wards (9/13) improved or stayed at the same level with regards to the number of positive samples.
Figure 2 The percentage of positive results for all substances and all hospitals in pharmacies (PART I, PART II and PART III)
Figure 3 The percentage of positive results for all substances and all hospitals in the wards (PART I, PART II and PART III)
Results and Discussion::
The ESOP pilot study provided a brief overview of the local procedures for safe handling of cytotoxic drugs in European hospitals. The results in PART I suggest that current cleaning procedures in some hospitals may not be effective in removing all drug residue from surfaces. In PART II and PART III of the study, improvements could be seen, with reduced positive samples, the amount of surface concentration detected and the reduction of the 90th percentile from 0.032 ng/cm2 to 0.021 ng/cm2.