Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home
Share
Compartir

OCCUPATIONAL EXPOSURE TO ANTINEOPLASTIC AGENTS

Muti-channel infusion pump for delivery of chemotherapy and needle and syringe

Environmental Sampling, Decontamination Protective Equipment, Closed System Transfer Devices, and Work Practice.

Environmental Sampling

Environmental sampling is a relatively new approach used to determine the level of workplace contamination by antineoplastic agents. The procedure has been used extensively in other situations, especially for monitoring contamination by radioactive materials. Typically, work surfaces are sampled with a moistened wipe and the material is extracted and analyzed for specific antineoplastic agents. Currently, it is possible to identify and quantitate six to eight agents with this technique.

 

Acampora A, Castiglia L, Miraglia N, Pieri M, Soave C, Liotti F and Sannolo N. A case study: Surface contamination of cyclophosphamide due to working practices and cleaning procedures in two Italian hospitals. Ann Occup Hyg. 2005; 49:611-618.

Bigelow S, Schulz H, Dobish R and Chambers CR. Antineoplastic agent workplace contamination study: the Alberta Cancer Board Pharmacy perspective Phase III. J Oncol Pharm Practice. 2009; 15:157-160.

Burton LC and James CA. Rapid method for the determination of ifosfamide and cyclophosphamide in plasma by high-performance liquid chromatography with solid-phase extraction. J Chromatog. 1988; 431:450-454.

Bussières JF, Theoret Y, Port-Labarthe and Larocque D. Program to monitor surface contamination by methotrexate in a hematology-oncology satellite pharmacy. Am J Health-Syst Pharm. 2007; 64:531-535.

Castiglia L, Miraglia N, Pieri M, Simonelli A, Basilicata P, Genovese G, Guadagni R, Acampora A, Sannolo N and Scafarto MV. Evaluation of occupational exposure to antiblastic drugs in an Italian hospital oncological department. J Occup Health. 2008; 50: 48-56.

Cavallo D, Ursini CL, Perniconi B, Francesco AD, Giglio M, Rubino FM, Marinaccio A and Iavicoli S. Evaluation of gentotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees. Mutat Res. 2005; 587:45-51.

Chu WC, Hon C-Y, Danyluk Q, Chua PPS and Astrakianakis G. Pilot assessment of the antineoplastic drug contamination levels in British Columbia hospitals pre- and post-cleaning. J Oncol Pharm Practice. 2012; 18:46-51.

Connor TH Anderson RW, Sessink PJM, Broadfield L and Power LA. Surface contamination with antineoplastic agents in six cancer treatment centers in the United States and Canada. Am J Health-Syst Pharm. 1999; 56: 1427-1432.

Connor TH, Shults M and Fraser MP. Determination of the vaporization of solutions of mutagenic antineoplastic agents at 23 and 37º C using a desiccator technique. Mutat Res. 2000; 470:85-92.

Connor TH, Van Balen P and Sessink PJ. Monitoring for hazardous drugs in the operating room. Ann Surg Oncol. 2002; 10:821-822 (comment).

Connor TH, Anderson RW, Sessink PJ and Spivey SM. Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area. Am J Health-Syst Pharm. 2002; 59: 68-72.

Connor TH, Sessink PJM, Harrison BR, Pretty JR, Peters BG, Alfaro RM, Bilos A, Beckmann G, Bing MR, Anderson LM and DeChristoforo R. Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: Results of three studies. Am J Health-Syst Pharm. 2005; 62:475-484.

Connor, TH. External contamination of antineoplastic drug vials. Hosp Pharm Eur. 2005; Nov/Dec: 52-54.

Connor TH, DeBord G, Pretty JR, Oliver MS, Roth TS, Lees PSJ, Krieg EF, Rogers B, Escalante CP, Toennis CA, Clark JC, Johnson B and McDiarmid MA. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med. 2010; 52:1019-1027.

Couch J, Gibbins J and Connor TH. Evaluation of chemotherapy drug exposure at a veterinary teaching hospital in Michigan. J Occup Environ Hyg. 2013;10:D45-D51.

Crauste-Manciet S, Sessink PJM, Ferrari S, Jomier J-Y and Brossard D. Environmental contamination with cytotoxic drugs in healthcare using positive air pressure isolators. Ann Occup Hyg. 2005; 49:619-628.

Delporte JP, Chenoix P and Hubert P. Chemical contamination of the primary packaging of 5-fluorouracil RTU solutions commercially available on the Belgian market. Eur Hosp Pharm. 1999; 5:119-121.

deWerk Neal A, Wadden RA and Chiou WL. Exposure of hospital workers to airborne antineoplastic agents. Am J Hosp Pharm. 1983; 40:597-601.

Dorr RT and Alberts DS. Topical absorption and inactivation of cytotoxic anticancer agents in vitro. Cancer. 1992; 70 (supp 4): 983-987.

Fabrizi G, Fioretti M, Rocca LM and Curini R. DESI-MS2: a rapid and innovative method for trace analysis of six cytostatic drugs in health care setting. Anal Bioanal Chem. 2012; 403:973-983.

Favier B, Rull FM, Bertucat H, Pivot C, LeBoucher G, Charlety D, Dubois V, Veyre MC, Ardiet C and Latour JF. Surface and human contamination with 5-fluorouracil in six hospital pharmacies. J Pharmacie Clinique. 2001; 20; 157-162.

Favier B, Gilles L, Ardiet C and Latour JF. External contamination of vials containing cytotoxic agents supplied by pharmaceutical manufacturers. J Oncol Pharm Practice. 2003; 9:15-20.

Favier B, Gilles L, Latour JF, Desage M and Giammarile F. Contamination of syringe plungers during the sampling of cyclophosphamide solutions. J Oncol Pharm Practice. 2005; 11:1-5.

Ferk F, Misík M, Grummt T, Majer B, Fuerhacker M, Buchmann C, Vital M, Uhl M, Lenz K, Grillitsch B, Parzefall W, Nersesyan A and Knasmüller S. Genotoxic effects of wastewater from an oncological ward. Mutat Res. 2008; 672:69-75.

Fleury-Souverain S, Nussbaumer S, Mattiuzzo M and Bonnabry P. Determination of the external contamination and cross-contamination by cytotoxic drugs on the surfaces of vials available on the Swiss market. J Onc Pharm Practice. Published online 14 May 2013. DOI: 10.1177/1078155213482683.

Floridia L, Pietropaolo AM, Tavazzani M, Rubino FM, Colombi A. High-performance liquid chromatography of methotrexate for environmental monitoring of surface contamination in hospital departments and assessment of occupational exposure. J Chromatog B. 1999; 726:95-103.

Fransman W, Vermeulen R and Kromhout H. Occupational dermal exposure to cyclophosphamide in Dutch hospitals: A pilot study. Ann Occup Hyg. 2004; 48:237-244.

Fransman W, Vermeulen R and Kromhout H. Dermal exposure to cyclophosphamide in hospitals during preparation, nursing and cleaning activities. Int Arch Occup Health. 2005; 78:403-412.

Fransman W, Huizer D and Tuerk J. Inhalation and dermal exposure to eight antineoplastic drugs in an industrial laundry facility. Int Arch Occup Environ Health. 2007; 80:396-403.

Gilbar PJ. External contamination of cytotoxic drug vials. J Pharm Pract Res. 2005; 35:264-265.

Gonzalez R, Massoomi F. Manufacturers' recommendations for handling spilled hazardous drugs. Am J Health-Syst Pharm. 2010; 67:1985-1986.

Guerbet M, Goullé JP and Lubrano J. Evaluation of the risk of contamination of surgical personnel by vaporization of oxaliplatin during the intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Surg Oncol. 2007; 33:623-629.

Hama T, Aoyama T, Shirai T, Higuchi S, Yokokawa T and Sugimoto Y. Environmental contamination due to preparation of cyclophosphamide and exposure to pharmacists to it. Jpn J Pharm Health Care Sci. 2009; 35: 693-700.

Hama K, Fukushima K, Hirabatake M, Hashida T and Kataoka K. Verification of surface contamination of Japanese cyclophosphamide vials and an example of exposure by handling. J Oncol Pharm Practice. 2011; 18:201-206.

Hedmer M, Jonsson BAG, Nygren O. Development and validation of methods for environmental monitoring of cyclophosphamide in workplaces. J Environ Monit. 2004; 6:979-984.

Hedmer M, Georgiadi A, Rämme Bremberg E, Jönsson BAG and Eksborg S. Surface contamination of cyclophosphamide packaging and surface contamination with antineoplastic drugs in a hospital pharmacy in Sweden. Ann Occup Hyg. 2005; 49:629-637.

Hedmer M, Tinnerberg H, Axmon A and Jönsson BAG. Environmental and biological monitoring of antineoplastic drugs in four workplaces in a Swedish hospital. Int Arch Occup Environ Health. 2008; 81:899-911.

Hepp R and Gentschew G. Untersuchung zur außenkontamination der primärverpackungen von zytostatika. Krankenhauspharmazie. 1988; 1:22-27.

Hon C-Y, Teschke K, Chua P, Venners S and Nakashima L. Occupational exposure to antineoplastic drugs: Identification of job categories potentially exposed throughout the hospital medication system. Saf Health Work. 2011; 2:273-281.

Hon CY, Chua PPS, Danyluk Q and Astrakianakis G. Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study. J Oncol Pharm Pract. DOI: 10.1177/1078155213497070. published online 8 August 2013.

Hon C-Y, Teschke K, Chu W, Demers P and Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013; 10:374-383.

Ikeda K, Yagi Y, Tkegami M, Lu Y, Morimoto K and Kurokawa N. Efforts to ensure safety of hospital pharmacy personnel occupationally exposed to antineoplastic drugs during a preparation task. Hosp Pharm. 2007; 42:209-218.

Ishiwata S, Taga A, Sano H, Kobayashi M, Nomiyama J, Harada S, Kita A, Takada M and Sugiura R. Evaluation of brilliance and visibility of fluorescence and chemiluminescence solution for training of preparing injections. Yakugaku Zasshi. 2011; 131:1361-1367 (Japanese).

Kleinberg ML and Quinn MJ. Airborne drug levels in a laminar flow hood. Am J Hosp Pharm. 1981; 38:1301-1303.

Kiffmeyer TK, Götze H-J, Jursch M and Lüders U. Trace enrichment, chromatographic separtation and biodegradation of cytostatic compounds in surface water. Fresenius J Anal Chem. 1998; 361:185-191.

Kiffmeyer T, Tuerk J, Hahn M, Stuetzer H, Hadtstein C, Heinemann A and Eickmann U. Application and assessment of a regular environmental monitoring of the antineoplastic drug contamination level in pharmacies – the MEWIP project. Ann Occup Hyg. 2013; 57:444-455.

Kiffmeyer TK, Ing KG and Schoppe G. External contamination of cytotoxic drug packing: Safe handling and cleaning procedures. J Onc Pharm Practice. 2000; 6:13.

Kiffmeyer TK, Kube C, Opiolka S, Schmidt KG, Schoppe G and Sessink PJM. Vapour pressures, evaporation behavior and airborne concentrations of hazardous drugs: implications for occupational safety. Pharaceutical J. 2002; 268:331-337.

Kopp B, Crauste-Manciet S, Guibert A, Mourier W, Guerrauly-Moro M-N, Ferrari S, Jomier J-Y, Brossard D and Schierl R. Environmental and biological monitoring of platinum-containing drugs in two hospital pharmacies using positive air pressure isolators. Ann Occup. Hyg. 2013; 57:374-383.

Kopp B, Schierl R and Nowak D. Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health. 2013; 86:47-55.

Kromhout H, Hoek F, Uitterhoeve R, Huijbers R, Overmars RF, Anzion R and Vermeulen R. Postulating a dermal pathway for exposure to antineoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. Ann occup Hyg. 2000; 44:551-560.

Labuhn K, Valanis B, Schoeny R, Loveday K and Vollmer WM. Nurses' and pharmacists exposure to antineoplastic drugs:Findings from industrial hygiene scans and urine mutagenicity tests. Cancer Nursing. 1998; 21:79-89.

Larson RR, Khazaeli MB and Dillon HK. Monitoring method for surface contamination caused by selected antineoplastic agents. Am J Health Syst Pharm. 2002; 59 (3): 270-277.

Larson RR, Khazaeli MB and Dillon HK. Development of an HPLC Method for simultaneous analysis of five antineoplastic agents Appl Occ Env Hyg. 2003; 18:109-119.

Larson RR, Khazaeli MB and Dillon HK. A new monitoring method using solid sorbent media for evaluation of airborne cyclophosphamide and other antineoplastic agents. Appl Occ Env Hyg. 2003; 18:120-131.

Leboucher G, Serratrice F, Bertholle V Thore L and Bost M. Evaluation of platinum contamination of a hazardous drug preparation area in a hospital pharmacy. Bull Cancer. 2002; 89:949-955.

Lee S-G, Tkaczuk M, Jankewicz G and Ambados F. Surface contamination from cytotoxic chemotherapy following preparation and administration. J Pharm Pract Res. 2007; 37:271-276.

Mader RM, Rizovski B and Steger GG. On-line solid-phase extraction and determination of paclitaxel in human plasma. J Chromatog B. 2002; 769:357-361.

Maeda S, Miyawaki K, Matsumoto S, Oishi M, Miwa Y and Kurokawa N. Evaluation of environmental contaminations and occupational exposures involved in preparation of chemotherapeutic drugs. Yakugaku Zasshi. 2010; 130:903-910.

Mason HJ, Morton J, Garfitt SJ, Iqbal S and Jones K. Cytotoxic drug contamination on the outside of vials delivered to a hospital pharmacy. Ann occup Hyg. 2003; 47:681-685.

Mason HJ, Blair S, Sams C, Jones K, Garfitt SJ, Cuschieri MJ and Baxter PJ. Exposure to antineoplastic drugs in two UK hospital pharmacy units. Ann Occup Hyg. 2005; 49:603-610.

McDevitt JJ, Lees PSJ and McDiarmid MA. Exposure of hospital pharmacists and nurses to antineoplastic agents. J Occup Med. 1993; 35:57-60.

McDiarmid MA, Egan T, Furio M, Bonacci M and Watts SR. Sampling for airborne fluorouracil in a hospital drug preparation area. Am J Hosp Pharm. 1986; 43:1942-1945.

Meijster T, Veldhof R and Kromhout H. Inventariserend onderzoek naar gebruik van en blootstelling aan cytostatica buiten het ziekenhuis. 2003 (English abstract).

Meijster T, Fransman W, Veldhof R and Kromhout H. Exposure to antineoplastic drugs outside the hospital environment. Ann Occup Hyg. 2006; 50:657-664.

Micoli G, Turci R, Arpellini M and Minoia C. Determination of 5-fluorouracil in environmental samples by solid-phase extraction and high-performance liquid chromatography with ultraviolet detection. J Chromatog B. 2001; 750:25-32.

Minoia C, Turci R, Sottani C, Schiavi A, Perbellini L, Angeleri S, Draicchio F and Apostoli P. Application of high performance liquid chromatography/tandem mass spectrometry in the environmental and biological monitoring of health care personnel occupationally exposed to cyclophosphamide and ifosfamide. Rapid Commun Mass Spectrom. 1998; 12: 1485-1493.

Minoia C, Turci R, Sottani C, Schiavi A, Perbellini L, Angeleri S, Frigerio F, Draicchio F and Apostoli P. Risk assessment concerning hospital personnel participating in the preparation and administration of antineoplastic drugs. [Italian] Giornale Italiano di Medicina del Lavoro ed Ergonomia. 1999; 21:93-107.

Naito T, Osawa T, Suzuki N, Goto T, Takada A, Nakamichi H, Onuki Y, Imai K, Nakanishi K and Kawakami J. Comparison of contamination levels on the exterior surfaces of vials containing platinum anticancer drugs in Japan. Biol Pharm Bull. 2012; 35:2043-2049.

Nussbaumer S, Bonnabry P, Veuthey JL and Fleury-Souverain S. Analysis of anticancer drugs: a review. Talanta. 2011; 85:2265-2289.

Nussbaumer S, Geiser L, Sadeghipour F, Hochstrasser D, Bonnabry P, Veuthey JL and Fleury-Souverain S. Wipe sampling procedure coupled to LC-MS/MS analysis for the simultaneous determination of 10 cytotoxic drugs on different surfaces. Anal Bioanal Chem. 2012; 402:2499-2509.

Nygren O and Lundgren C. Determination of platinum in workroom air and in blood and urine from nursing staff attending patients receiving cisplatin chemotherapy. Int Arch Occ Environ Health. 1997; 70:209-214.

Nygren O, Gustavsson B, Strom L and Friberg A. Cisplatin contamination on the outside of drug vials. Ann occup Hyg. 2002; 46: 555-557.

Nygren O, Gustavsson B and Eriksson R. A test method for assessment of spill and leakage from drug preparation systems. Ann Occup Hyg. 2005; 49:711-718.

Nygren O. Wipe samples as a tool for monitoring aerosol deposition in workplaces. J Environ Monit. 2006; 8;49-52.

Odraska P, Dolezalova L, Piler P, Oravec M and Blaha L. Utilization of the solid sorbent media in monitoring of airborne cyclophosphamide concentrations and the implications for occupational hygiene. J Environ Monit. 2011; 13:1480-1487.

Odraska P, Dolezalova L, Kuta J, Oravec M, Piler P and Blaha L. Evaluation of the efficacy of additional measures introduced for the protection of healthcare personnel handling antineoplastic drugs. Ann Occup Hyg. 2013; 57:240-250.

Pethran A, Hauff K and Hessel H . Biological, cytogenetic and ambient monitoring of exposure to antineoplastic drugs. J Oncol Pharm Practice. 1998; 4:57.

Pethran A, Schierl R and Schmaus G. Wipe samples of workplaces with cytotoxic drug exposition. Krankenhauspharmazie. 2001; 1:11-15. (English abstract).

Pretty JR, Connor TH, Spasojevic I, Kurtz KS, McLaurin JL, B' Hymer C, Debord DG. Sampling and mass spectrometric analytical methods for five antineoplastic drugs in the healthcare environment. J Oncol Pharm Pract. 2010; 18:23-36.

Pyy L, Sorsa M and Hakala E. Ambient monitoring of cyclophosphamide in manufacturing and hospitals. Am Ind Hyg Assoc J. 1988; 49: 314-317.

Ros JJW, Simons KA, Verzijl JM, de Bijl GA and Pelders MG. Practical applications of a validated method of analysis for the detection of traces of cyclophosphamide on injection bottles and at oncological outpatient center. Ziekenhuisfarmacie. 1997; 13:168-171.

Rubino FM, Floridia L, Pietropaolo AM, Tavazzani M and Colombi A. Measurement of surface contamination by certain antineoplastic drugs using high-performance liquid chromatography: Applications in occupational hygiene investigations in hospital environments. Med Lav. 1999; 90: 572-583.

Sabatini L, Barbieri A, Tosi M and Violante FS. A new high-performance liquid chromatographic/electrospray ionization tandem mass spectrometric method for the simultaneous determination of cyclophosphamide, methotrexate and 5-fluorouracil as markers of surface contamination for occupational exposure monitoring. J Mass Spectrom. 2005; 40:669-674.

Schierl R, Bohlandt A and Nowak D. Guidance values for surface monitoring of antineoplastic drugs in German pharmacies. Ann Occup Hyg. 2009; 53:1-9.

Schierl R, Herwig A, Pfaller A, Groebmair and Fischer E. Surface contamination of antineoplastic drug vials: Comparison of unprotected and protected vials. Am J Health-Syst Pharm. 2010; 67:428-429.

Schierl R, Novotna J, Piso P, Bohlandt A and Nowak D. Low surface contamination by cis/oxaliplatin during hyperthermic intraperitoneal chemotherapy (HIPEC). Eur J Surg Oncol. 2012; 38:88-94.

Schmaus G, Schierl R and Funck S. Monitoring surface contamination by antineoplastic drugs using gas chromatography-mass spectrometry and voltammetry. Am J Health-Syst Pharm. 2002; 59:956-961.

Schmid K, Boettcher MI, Pelz JOW, Meyer T, Korinth G, Angerer J and Drexler. Investigation on safety of hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) with Mitomycin C. Eur J Surg Oncol. 2006; 32:1222-1225.

Sessink PJM, Anzion RB, Van den Broek PHH and Bos RP. Detection of contamination with antineoplastic agents in a hospital pharmacy department. Pharm Weekbl (Sci). 1992; 14:16-22.

Sessink PJM, Joost HC, Pierik FH, Anzion RBM and Bos RP. Occupational exposure of animal caretakers to cyclophosphamide. J Occup Med. 1993; 35:47-52.

Sessink PJM, Friemèl NSS, Anzion RBM and Bos RP. Biological and environmental monitoring of occupational exposure of pharmaceutical plant workers to methotrexate. Int Arch Occup Environ Health. 1994; 65:401-403.

Sessink PJM, Wittenhorst BCJ, Anzion RBM and Rob RP. Exposure of pharmacy technicians to antineoplastic agents: Reevaluation after additional protective measures. Arch Environ Health. 1997; 52:240-244.

Sessink PJM, Rolf M-AE and Rydèn NS. Evaluation of the PhaSeal hazardous drug containment system. Hosp Pharm. 1999; 34:1311-1317.

Sessink PJM, Connor TH, Jorgenson JA and Tyler TG. Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device. J Oncol Pharm Practice. 2011; 17:39-48.

Shahsavarani S, Godefroid RJ and Harrison BR. Evaluation of occupational exposure to tablet trituration dust. ASHP Midyear Clinical Meeting. 1993; P-59(E) abs.

Siderov J, Kirsa S and McLauchlan R. Surface contamination of cytotoxic chemotherapy preparation areas in Australian hospital pharmacy departments. J Pharm Pract Res. 2009; 39: 117-121.

Siderov J, Kirsa S and McLauchlan R. Surface contamination of cytotoxic chemotherapy preparation areas in Australian hospital pharmacy departments. J Pharm Pract Res. 2009; 39: 117-121.

Siderov J, Kirsa S and McLauchlan R. External surface contamination of cytotoxic admixtures” Caveat Emptor. J Pharm Pract Res. 2011; 41:181-182.

Sorsa M, Pyy L, Salomaa S, Nyland L and Yager JW. Biological and environmental monitoring of occupational exposure to cyclophosphamide in industry and hospitals. Mutat Res. 1988; 204:465-479.

Sottani C, Turci R, Micoli G, Fiorention ML and Minoia C. Rapid and sensitive determination of paclitaxel (Taxol) in environmental samples by high-performance liquid chromatography tandem mass spectrometry. Rapid Comm Mass Spectrom. 2000; 14:930-935.

Sottani C, Truci R, Schierl R, Gaggeri R, Barbieri A, Violante FS and Minoia C. Simultaneous determination of gemcitabine, taxol, cyclophosphamide and ifosphamide in wipe sampels by high-performance liquid chromatography/tandem mass spectrometry: protocol of validation and uncertainty of measurment. Rapid Commun Mass Spectrom. 2007; 21:1289:1296.

Sottani C, Porro B, Cornelli M, Imbriani M and Minoia C. An analysis to study trends in occupational exposure to antineoplastic drugs among health care workers. J Chromatog B. 2010; 878:2593-2605.

Sottani C, Porro B, Imbriani M and Minoia C. Occupational exposure to antineoplastic drugs in four Italian health care settings. Toxicol Lett. 2012; 213:107-115.

Stover D and Achutan C. Occupational exposures to antineoplastic drugs in an oncology-hematology department. J Occup Environ Hyg. 2011; 8: D1-D6.

Stuart A, Stephens AD, Welch L and Sugarbaker PH. Safety monitoring of the coliseum technique for heated intraoperative intraperitoneal chemotherapy with mitomycin C. Ann Surg Oncol. 2002; 9:186-191.

Sugiura S, Asano M, Kinoshita K, Tanimura M and Nabeshima T. Risks to health professionals from hazardous drugs in Japan: a pilot study of environmental and biological monitoring of occupational exposure to cyclophosphamide. J Oncol Pharm Practice. 2010; 17:14-19.

Suguira S, Nakanishi H, Asano M, Hashida T, Tanimura M, Hama T and Nabeshima T. Multicenter study for environmental and biological monitoring of occupational exposure to cyclophosphamide in Japan. J Oncol Pharm Practice. 2010; 17:20-28.

Tanimura M, Yamada K, Sugiura S, Mori K, Nagata H, Tadokoro K, Miyake T, Hamaguchi Y, Sessink P, Nabeshima T. An environmental and biological study of occupational exposure to cyclophosphamide in the pharmacy of a Japanese community hospital designated for the treatment of cancer. J Health Sci. 2009; 55: 750-756.

Touzin K, Bussières JF, Langlois É, Lefebvre M and Gallant C. Cyclophosphamide contamination observed on the surface of drug vials and the efficacy of cleaning on vial contamination. Ann Occup Hyg. 2008; 1-7.

Touzin K, Bussières JF and Langlois É. Evaluation of surface contamination in a hospital hematology-oncology pharmacy. J Oncol Pharm Practice. 2009; 15: 53-61.

Tuerk J, Reinders M, Dryer M, Kiffmeyer TK, Schmidt KG and Kuss HM. Analysis of antibiotics in urine and wipe samples from environmental and biological monitoring- comparison of HPLC with UV-, single MS- and tandem MS-detection. J Chromatog. 2006; 831:72-80.

Tuerk J, Kiffmeyer TK, Hadtstein C, Heinemann A, Hahn M, Stuetzer H, Kuss HM and Eickmann U. Development and validation of an LC-MS/MS procedure for environmental monitoring of eight cytostatic drugs in pharmacies. Intern J Environ Anal Chem. 2011; 91:1178-1190.

Turci R, Micoli G and Minoia C. Determination of methotrexate in environmental samples by solid phase extraction and high performance liquid chromatorgraphy: ultraviolet or tandem mass spectrometry detection. Rapid Comm Mass Spectrom. 2000; 14:685-691.

Turci R, Sottani C, Spagnoli G and Minoia C. Biological and environmental monitoring of hospital personnel exposed to antineoplastic agents: a review of analytical methods. J Chromatog B. 2003; 789:169-209.

Turci R and Minoia C. Residual hazard assessment related to handling of antineoplastic drugs: safety system evolution and quality assurance of analytical measurement. Ann NY Acad Sci. 2006; 1076:649-656.

Turci R, Minola C, Sottani C, Coghi R, Severi P, Castriotta C, Del Bianco M and Imbriani M. Occupational exposure to antineoplastic drugs in seven Italian hospitals: the effect of quality assurance ad adherence to guidelines. J Oncol Pharm Practice. 2011; 17:320-332.

Ursini CL, Cavallo D, Colombi A, Giglio M, Marinaccio A and Iavicoli S. Evaluation of early DNA damage in healthcare workers handeling antineoplastic drugs. Int Arch Occup Environ Health. 2006; 80:134-140.

Valanis B. Environmental and direct measures of exposure. Occup Med. 1986; 1:431-444.

Villarini M, Dominici L, Piccinini R, Fatigoni C, Ambrogi M, Curti G, Morucci P, Muzi G, Monarca S and Moretti M. Assessment of primary, oxidative and excision repaired DNA damage in hospital personnel handling antineoplastic drugs. Mutagenesis. November 2010; 1-11.

Wick C, Slawson MH, Jorgenson JA and Tyler LS. Using a closed-system protective device to reduce personnel exposure to antineoplastic agents. Am J Health-Syst Pharm. 2003; 60:2314-2320.

Wilken A. Beobachtungen zur Außenkotamination der primärverpackungen von zytostatika. Krakenhauspharmazie. 1997; 1:37-39.

Yabunaka H, Sakaguchi F, Kobayashi Y and Nakanishi H. Investigation on vaporization of solution of Endoxan®. Jpn J Pharm Health Care Sci. 2010; 36:343- 346.

Yoshida J, Kosaka H, Tomika K and Kumagai S. Genotoxic Risks to nurses from contamination of the work enviroment with antineoplastic drugs in Japan. J Occup Health; 2006; 48:517-522.

Yoshida J, Koda S, Nishida S, Yoshida T, Miyajima K and Kumagai S. Association between occupational exposure levels of antineoplastic drugs and work environment in five hospitals in Japan. J Oncol Pharm Practice. 2010; 17:29-38.

Yoshida J, Kosaka H, Tomioka K and Kumagai S. Genotoxic risks to nurses from contamination of the work environment with antineoplastic drugs in Japan. J Occup Health. 2006; 48:517-522.

Yoshida J, Koda S, Nishida S, Nakano H, Tei G and Kumagai S. Association between occupational exposure and control measures for antineoplastic drugs in a pharmacy of a hospital. Ann Occup Hyg. 2013; 57:251-260.

Zeedijk M, Greijdanus B, Steenstra FB and Uges DRA. Monitoring exposure of cytotoxics on the hospital ward: measuring surface contamination of four different cytotoxic drugs from one wipe sample. Eur J Hosp Pharm. 2005; 1:18-22.

Ziegler E, Mason HJ and Baxter PJ. Occupational exposure to cytotoxic drugs in two UK oncology wards. Occup Environ Med. 2002; 59:608-612.


Decontamination and Deactivation of Antineoplastic Agents

Several reports have dealt with methods for the decontamination and/or deactivation of antineoplastic agents. Although bleach (hypochlorite) is often recommended for the decontamination purposes, it is not effective with all classes of agents. Therefore, it cannot be assumed that cleaning with bleach solutions will destroy all types of antineoplastic agents. Some antineoplastic drugs are listed by the US Environmental Protection Agency as Hazardous waste and must be disposed of accordingly (see 40 CFR 261.33).

Barek J, Cvaccka J, Zima J, De Meo M, Laget M, Michelon J and Castegnaro M. Chemical degradation of wastes of antineoplastic agents amsacrine, azathioprine, asparaginase and thiotepa. Ann Occup Hyg. 1998; 42:259-266.

Benvenuto JA, Connor TH, Monteith DK, Laidlaw JA, Adams SC, Matney TS and Theiss JC. Degradation and inactivation of antitumor drugs. J Pharm Sci. 1993; 82:988-991.

Castegnaro M, De Meo M, Laget M, Michelon J, Garren L, Sportouch MH and Hansel S. Chemical degradation of wastes of antineoplastic agents 2: Six anthracyclines: idarubicin,doxorubicin, epirubicin, pirarubicin, aclarubicin, and daunorubicin. Int Arch Occup Environ Health. 1997; 70:378-384.

Chu WC, Hon C-Y, Danyluk Q, Chua PPS and Astrakianakis G. Pilot assessment of the antineoplastic drug contamination levels in British Columbia hospitals pre- and post-cleaning. J Oncol Pharm Practice. (Published on line 2011; DOI: 10.1177/1078155211402106).

Hansel S, Castegnaro M, Sportouch MH, De Meo M, Milhavet JC, Laget M and Dumenil G. Chemical degradation of wastes of antineoplastic agents: cyclophosphamide, ifosfamide and melphalan. Int Arch Occup Environ Health. 1997; 69:109-114.

Hon CY, Chua PPS, Danyluk Q and Astrakianakis G. Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces: a pilot study. J Oncol Pharm Pract. DOI: 10.1177/1078155213497070. published online 8 August 2013.

Lamerie TQ, Nussbaumer, S, Décaudin B, Fleury-Souverain S, Goosens J-F, Bonnabry P and Odou P. Evaluation of decontamination efficiency of cleaning solutions on stainless steel and glass surfaces contaminated by 10 antineoplastic agents. Ann Occup Hyg. 2013; 57:456-469.

Lé LMM, Jolivot PA, Yaye HS, Rieutord A, Bellanger A, Pradeau D, Barbault-Foucher S and Caudron E. Effectiveness of cleaning of workplace cytotoxic surface. Int Arch Occup Environ Health. 2013; 86:333-341.

Lee S-G, Ambados F Tkaczuk M andJankewicz G. Paclitaxel exposure and its effective decontamination. J Pharm Pract Res. 2009; 39:181-185.

Lunn G and Sansone EB. Reductive destruction of dacarbazine, procarbazine hydrochloride, isoniazid, and iproniazid. Am J Hosp Pharm. 1987; 44:2519-2524.

Lunn G, Sansone EB, Andrews AW and Hellwig LC. Degradation and disposal of some antineoplastic drugs. J Pharm Sci. 1989; 78:652-659.

Roberts S, Khammo N, McDonnell and Sewell GJ. Studies on the decontamination of surfaces exposed to cytotoxic drugs in chemotherapy workstations. J Oncol Pharm Practice. 2006; 12:95-104.

Smith CA. Managing pharmaceutical Waste-What pharmacists should know. J Phram Soc Wisconsin. 2002; Nov/Dec: 17-22.

Touzin K, Bussières JF, Langlois É, Lefebvre M and Gallant C. Cyclophosphamide contamination observed on the surface of drug vials and the efficacy of cleaning on vial contamination. Ann Occup Hyg. 2008; 1-7.

Touzin K, Bussières JF, Langlois É, Lefebvre M and Métra A. Pilot study comparing the efficacy of two cleaning techniques in reducing environmental contamination with cyclophosphamide. Ann Occup Hyg. 2010; 54:351-359.

Wren AE, Melia CD, Garner ST and Denyer SP. Decontamination methods for cytotoxic drugs. 1. Use of a bioluminescent technique to monitor the inactivation of methotrexate with chlorine-based agents. J Clin Pharm and Therap. 1993; 18:133-137.


Evaluation of Protective Equipment for Handling Antineoplastic Agents

The most often used type of protective equipment for handling antineoplastic agents is gloves. Typically latex and other materials have been employed for this use. However, with the growing concern over latex allergies, newer materials are being marketed and evaluated for use with these agents. Protective gowns are another piece of equipment that is commonly used in the handling of antineoplastic agents. This section also deals with biological safety cabinets and closed system devices used in the preparation of antineoplastic drugs.

Benoit L, Cheynel N, Ortega-Deballon P, Di Giacomo G, Chauffert B, Rat P. Closed hyperthermic intraperitoneal chemotherapy with open abdomen: a novel technique to reduce exposure of the surgical team to chemotherapy drugs. Ann Surg Oncol. 2007; 15:542-546.

Boccellino M, Pedata P, Castiglia L, La Porta R, Pieri M, Quagliuolo L, Acampora A, Sannolo N and Miraglia N. Doxorubicin can penetrate nitrile gloves and induces apoptosis in keratinocytes cell lines. Toxicol Lett. 2010; 197:61-68.

Capron A, Destree J, Jacobs P and Wallemacq P. Permeability of gloves to selected chemotherapeutic agents after treatment with alcohol or isopropyl alcohol. Am J Health- Syst Pharm. 2012; 69:1665-1670.

Cazin J-L and Gosselin P. Implementing a multiple-isolator unit for centralized preparation of cytotoxic drugs in a cancer center pharmacy. Pharm World Sci. 1999; 21:177-183.

Colligan SA and Horstman SW. Permeation of cancer chemotherapeutic drugs through glove materials under static and flexed conditions. Appl Occ Environ Hyg. 1990; 5:848-852.

Connor TH, Laidlaw JL, Theiss JC Anderson RW and Matney TS. Permeability of latex and polyvinyl chloride gloves to carmustine. Am J Hosp Pharm. 1984; 41:676-679.

Connor TH. An evaluation of the permeability of disposable poylpropylene-based protective gowns to a battery of cancer chemotherapy drugs. Appl Occup Environ Hyg. 1993;8:785-789.

Connor TH. Permeability testing of glove materials for use with cancer chemotherapy drugs. Oncology. 1995; 52:256-259.

Connor TH. Permeability of nitrile rubber, latex, polyurethane, and neoprene gloves to 18 antineoplastic drugs. Am J Health-Syst Pharm. 1999; 56: 2450-53.

Connor TH and Xiang Q. The effect of isopropyl alcohol on the permeation of gloves exposed to antineoplastic agents. J Oncol Pharm Practice. 2000; 6: 109-114.

Connor TH. Using PPE to prevent occupational exposure to antineoplastic and other hazardous drugs. Pharm Purchasing & Products. 2006; 2:4-6.

Connor TH. Personal protective equipment for use in handling hazardous drugs. Pharm Purchasing & Products. 2006; 3:2-6.

Dinter-Heidorn H and Carstens G. Comparative study on protective gloves for handling cytotoxic medications: A model study with carmustine. Pharmaceutisch Weekblad Sci. 1992; 14:180-184.

Dolezalova L, Odraska P, Gorna L, Prudilova M, Vejpustkova R and Blaha L. Evaporation of selected cytotoxic drugs and permeation of protective gloves - research into the occupational risks of health care personnel handling hazardous cytotoxic drugs (CYTO project). Klin Onkol. 2009; 22(5):218-222.

Donner AL. Possible risk of working with antineoplastic drugs in horizontal laminar flow hoods (letter). Am J Hosp Pharm. 1978; 35:900.

Furlow B. How to improve the safety of chemotherapy administration. Oncology Nurse Advisor. 2010; 21-25.

Georgiad A, Ramme E, Wretman C and Eksborg S. How to create acceptable working conditions for hospital pharmacy staff when preparing cytotoxic drugs. Euro J Hosp Pharm. 2004; 3: 40-42.

Gross ER and Groce DF. An evaluation of nitrile gloves as an alternative to natural rubber latex for handling chemotherapeutic agents. J Oncol Pharm Practice. 1998; 4:165-168.

Klein M, Rau S, Samev N and Carstens G. Protection offered by selected medical gloves made of either latex or a synthetic elastomer against exposure to nine cytotoxic agents. European Hosp Pharm. 1999; 5:152-158.

Klein M, Lambov N, Samev N and Carstens G. Permeation of cytotoxic formulations through swatches from selected medical gloves. Am J Health-Syst Pharm. 2003; 1006-1011.

Korinth G, Schmidt K., Midasch O, Boettcher M I, Angerer J and Drexler H. Investigations on permeation of mitomycin C through double layers of natural rubber gloves. Ann Occup Hyg. 2007; 51:593-600.

Labella CJ. Does your pharmacy have a compounding isolator? Am J Health-Syst Pharm. 2007; 64:855-858.

Lalande L, Galy G, Dussossoy E, Noyel JE and Pivot C. Evaluation of safe infusion devices for antineoplastic administration. J Infus Nurs. 2012; 35:321-327.

Laidlaw JL, Connor TH, Theiss JC Anderson RW and Matney TS . Permeability of latex and polyvinyl gloves to 20 antineoplastic drugs. Am J Hosp Pharm. 1984; 41:2618-2623.

Laidlaw JL, Connor TH, Theiss JC, Anderson RW and Matney TS. Permeability of four disposable protective-clothing materials to seven antineoplastic drugs. Am J Hosp Pharm. 1985; 42:2449-2454.

Mader RM, Rizovski B, Steger GG Moser K, Rainer H and Dittrich C. Permeability of latex membranes to anti-cancer drugs. Int J Pharmaceut. 1991; 68:151-156.

Mellström GA, Wrangsjö K, Wahlberg JE and Fryklund B. The value and limitations of protective gloves in medical health service:Part I. Dermatol Nurs. 1996; 8:160-164.

Mellström GA, Wrangsjö K, Wahlberg JE and Fryklund B. The value and limitations of protective gloves in medical health service:Part II. Dermatol Nurs. 1996; 8:287-295.

Mellström GA, Wrangsjö K, Wahlberg JE and Fryklund B. The value and limitations of protective gloves in medical health service:Part III. Dermatol Nurs. 1996; 8:345-355.

Nygren O. Wipe samples as a tool for monitoring aerosol deposition in workplaces. J Environ Monit. 2006; 8;49-52.

Odraska P, Dolezalova L, Kuta J, Oravec M, Piler P and Blaha L. Evaluation of the efficacy of additional measures introduced for the protection of healthcare personnel handling antineoplastic drugs. Ann Occup Hyg. 2012; August 27 (Epub ahead of printing) DOI:10.1093/annhyg/mes057.

Peters GF, McKeon MK and Weiss WT. Potential for airborne contamination in turbulent- and unidirectional-airflow compounding aseptic isolators. Am J Health-Syst Pharm. 2007; 64:622-631.

Seger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, Bates DW and Rothschild JM. Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract. 2012; Nov 1:344-350.

Singleton L and Connor, TH. An evaluation of the permeability of chemotherapy gloves to three cancer chemotherapy drugs. Onc Nurs Forum. 1999; 26:1491-1496.

Slevin ML, Ang LM, Johnston A and Turner P. The efficiency of protective gloves used in the handling of cytotoxic drugs. Cancer Chemother Pharmacol. 1984; 12:151-53.

Stajich GV, Barnett CW, Turner SV and Henderson CA. Protective measures used by oncologic office nurses handling parenteral antineoplastic agents. Oncol Nurs Forum. 1986; 13:47-49.

Stoikes ME, Carlson JD, Farris FF and Walker PR. Permeability of latex and polyvinyl chloride gloves to fluorouracil and methotrexate. Am J Hosp Pharm. 1987; 44:1341-1346.

Thomas PH and Fenton-May V. Protection offered by various gloves to carmustine exposure. The Pharm J. 1987; 238:775-777.

Thomsen K and Mikklesen HI. Protective capacity of gloves used for handling nitrogen mustard. Contact Derm. 1975; 1:268-269.

Tompa A, Jakab M, Biro A, Magyar B, Fodor Z, Klupp T and Major J. Chemical safety and health conditions among Hungarian hospital nurses. Ann NY Acad Sci. 2006; 1076:635-648.

Wagner JT. Considerations for choosing a primary engineering control for compounding sterile products. Int J Pharm Comp. 2005; 9:284-290.

Wallemacq PE, Capron A, Vanbinst R, Boeckmans E, Gillard J and Favier B. Permeability of 13 different gloves to 13 cytotoxic agents under controlled dynamic conditions. Am J Health-Syst Pharm. 2006; 63:547-556.

Yaniv AW and Knoer SJ. Implementation of an i.v.-compounding robot in a hospital-based cancer center pharmacy. Am J Health-Syst Pharm. 2013; 70:2030-2037.


Closed System Transfer Devices (CSTDs) and Similar Devices

NIOSH defines a closed system drug transfer device as: “A drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drug or vapor concentrations outside the system.” There are several CDTDs currently available from different manufacturers. CSTDs have been shown to reduce the levels of surface contamination present where antineoplastic drugs are handled and to reduce the percentage of wipe samples that have detectable amounts of antineoplastic drugs.

Connor TH, Anderson RW, Sessink PJ and Spivey SM. Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area. Am J Health-Syst Pharm. 2002; 59:68-72.

Clark BA and Sessink PJM. Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents. J Oncol Pharm Prac. 2013; 19:99-104.

De Ausen L, DeFreitas EF, Littleton L and Lustik M. Leakage from closed-system transfer devices as detected by a radioactive tracer. Am J Health-Syst Pharm. 2013; 70:619-623.

De Prijck K, D'Haese E, Vandenbroucke J, Coucke W, Robays H and Nelis HJ. Microbiological challenge of four protective devices for the reconstitution of cytotoxic agents. Lett Appl Micro. 2008; 47:543-548.

Edwards MS, Solimando DA, Grollman FR, Pang JL, Chasick AH, Hightman CM, Johnson AD, Mickens MG and Preston LM. Cost savings realized by use of the PhaSeal® closed-system transfer device for preparation of antineoplastic agents. J Oncol Pharm Pract. 2013; 19:338-347.

Favier B, Labrosse H, Gilles-Afchain L, Cropet C, Perol D, Chaumard N, Latour JF and Hild P. The PhaSeal® system: impact of its use on workplace contamination and duration of chemotherapy preparation. J Oncol Pharm Practice. 2011; 18:37-45.

Forges F, Simoens X and Chauvin F. Comparative parallel assessment of a transfer device in reducing 5-fluorouracil environmental contamination inside positive air pressure isolators. J Oncol Pharm Practice. 2011; 17:61-67.

Hama K, Kitada N, Fukushima K, Hashida T and Kataoka K. Investigation on residual-related error and the effect of solution properties using protective devices for the reconstitution of cytotoxic agents in actual situations. J Oncol Pharm Practice. 2011; 17:55-60.

Harrison BR, Peters BG and Bing MR. Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques. Am J Health-Syst Pharm. 2006; 63:1736-1744.

Jorgenson JA, Spivey SM, Au C, Canann D, Ritter H and Smith B. Contamination comparison of transfer devices intended for handling hazardous drugs. Hosp Pharm. 2008; 43:723-727.

Kopp B, Schierl R and Nowak D. Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health. 2013; 86:47-55.

Lamerie TQ, Carrez L, Decaudin B, Bouchoud L, Goossens JF, Barthelemy C, Bonnabry P and Odou P. Multiple-test assessment of devices to protect healthcare workers when administering cytotoxic drugs to patients. J Oncol Pharm Practice. 2011; 18:191-200.

Le Garlantezec P, Rizzo-Padoin N, Aupee O, Lamand V, Broto H and Almeras D. Evaluation of the performance of transfer devices in a closed system using a radioactive solution of [(99m) Tc]. Ann Pharm Fr. 2011; 69:192-191 (French, English abstract).

Nygren O, Gustavsson B, Strom L, Eriksson R, Jarneborn L and Friberg A. Exposure to anti-cancer drugs during preparation and administration. Investigations of an open and a closed system. J Environ Monit. 2002; 4:739-732.

Nygren O, Gustavsson B and Eriksson R. A test method for assessment of spill and leakage from drug preparation systems. Ann Occup Hyg. 2005; 49:711-718.

Nygren O, Olofsson E and Johansson L. Spill and leakage using a drug preparing system based on double-filter technology. Ann Occup Hyg. 2008; 52:95-98.

Nygren O, Olofsson E and Johannson L. NIOSH definition of closed-system transfer devices (Letter to the Editor). Ann Occup Hyg. 2009; 53:549.

Nyman H, Jorgenson J and Slawson MH. Workplace contamination with antineoplastic agents in a new cancer hospital using a closed-system drug transfer device. Hosp Pharm. 2007; 42:219-225.

Power LA. Closed-system transfer devices for safe handling of injectable hazardous drugs. Pharm Pract News. 2013;1-16.

Sessink PJM, Rolf M-AE and Ryden NS. Evaluation of the PhaSeal hazardous drug containment system. Hosp Pharm. 1999; 34:1311-17.

Sessink PJM, Connor TH, Jorgenson JA and Tyler TG. Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device. J Oncol Pharm Practice. 2011; 17:39-48.

Sessink PJM, Trahan J and Coyne JW. Reduction in surface contamination with cyclophosphamide in 30 hospital pharmacies following implementation of a closed-system drug transfer device. Hosp Pharm. 2013; 48:204-212.

Siderov J, Kirsa S and McLauchlan R. Reducing workplace cytotoxic surface contamination using a closed-system drug transfer device. J Oncol Pharm Pract. 2010; 16:19-25.

Spivey S and Connor TH. Determining sources of workplace contamination with antineoplastic drugs and comparing conventional IV drug preparation with a closed system. Hosp Pharm. 2003; 38:135-139.

Tans B and Willems L. Comparative contamination study with cyclophosphamide, fluorouracil and ifosfamide: standard versus a proprietary closed-handling system. J Oncol Pharm Practice. 2004; 10:217-223.

Vandenbroucke J and Robays H. How to protect environment and employees against cytotoxic agents, the UZ Ghent experience. J Oncol Pharm Practice. 2001; 6:146-152.

Vyas N, Yainnakis D, Turner A and Sewell GJ. Occupational exposure to anti-cancer drugs: A review of effects of new technology. J Onc Pharm Practice. Published online 22 August 2013. DOI: 10.1177/1078155213498630.

Wakui N, Ookubo T, Iwasaki Y, Ito R, Saito K and Nakazawa H. Development of a closed drug preparation method for oral anticancer drugs. J Oncol Pharm Practice. 2013; 19:315-320.

Wick C, Slawson MH, Jorgenson JA and Tyler LS. Using a closed-system protective device to reduce personnel exposure to antineoplastic agents. Am J Health-Syst Pharm. 2003; 60:2314-2320.

Yoshida J, Tei G, Mochizuki C, Masu Y, Koda S and Kumagai S. Use of a closed system device to reduce occupational contamination and exposure to antineoplastic drugs in the hospital work environment. Ann Occup Hyg. 2009; 53:153-160.

Zock MD, Soefje S and Rickabaugh K. Evaluation of surface contamination with cyclophosphamide following simulated hazardous drug preparation activities using two closed-system products. J Oncol Pharm Practice. 2011; 17:49-54.


Work Practice Evaluation

Several approaches have been developed for evaluating work practice techniques for drug preparation and drug administration. These approaches typically rely on a non-toxic substitute for the drug that can be easily visualized by ultra violet light or other means. Some test kits are available for various manufacturers.

Friese CR, Himes-Ferris L, Frasier MN, McCullagh MC, Griggs JJ. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf. 2012; 21:753-759.

Georgiadi A, Rämme E, Wretman C and Eksborg S. How to create acceptable working conditions for hospital pharmacy staff when preparing cytotoxic drugs. Eur J Hosp Pharm. 2004; 3:40-42.

Harrison BR, Godefroid RJ and Kavanaugh EA. Quality-assurance testing of staff pharmacists handling cytotoxic agents. Am J Health-Syst Pharm. 1996; 53:402-407.

Keat CH, Sooaid NS, Yun CY and Sriraman M. Improving safety-related knowledge, attitude and practices of nurses handling cytotoxic anticancer drugs: Pharmacists’ experience in a general hospital, Malaysia. Asian Pac J Cancer Prev. 2013; 14:69-73.

Kopp B, Schierl R and Nowak D. Evaluation of working practices and surface contamination with antineoplastic drugs in outpatient oncology health care settings. Int Arch Occup Environ Health. 2013; 86:47-55.

Kromhout H, Hoek F, Uitterhoeve R, Huijbers R, Overmars RF, Anzion R and Vermeulen R. Postulating a dermal pathway for exposure to antineoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. Ann Occup Hyg. 2000; 44:551-560.

Spivey S and Connor TH. Determining sources of workplace contamination with antineoplastic drugs and comparing conventional IV drug preparation with a closed system. Hosp Pharm. 2003; 38:135-139.

Van Raalte J, Rice C and Moss E. Visible-light system for detecting doxorubicin contamination on skin and surfaces. Am J Hosp Pharm. 1990; 47:1067-1074.

 
Contact Us:
  • Page last reviewed: December 31, 2013
  • Page last updated: February 12, 2014
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC-INFO