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Detection of contamination with antineoplastic agents in a hospital pharmacy department
P J Sessink1, R B Anzion, P H Van den Broek
1Department of Toxicology, Faculty of Medical Sciences, University of Nijmegen, The Netherlands.
Abstract:
The contamination with fluorouracil, cyclophosphamide and methotrexate was studied in a hospital pharmacy department where these drugs were prepared. In the preparation room, air samples were taken before and during preparation of the drugs. Methotrexate was detected in one sample which was collected during preparation (0.3 micrograms/m3). Spot samples were taken in the vertical laminar airflow safety hood before and after preparation of the drugs and after cleaning of the hood. Contamination of the laminar airflow hood was: cyclophosphamide: 1-160 ng/cm2; fluorouracil: 10-62 ng/cm2 and methotrexate: 2-633 ng/cm2. Spot samples from the floor in front of and beneath the laminar airflow hood showed contamination with especially fluorouracil (48-236 micrograms/m2). The gloves used during preparation of the drugs were contaminated mainly with fluorouracil (5-980 ng/cm2). Urine samples from two workers involved in the preparation of the drugs were analysed for unmetabolized cyclophosphamide; it was not detected. Although no uptake of cyclophosphamide was established, it is shown that the methods for measurement of cyclophosphamide, fluorouracil and methotrexate in the preparation room are applicable for the control of occupational exposure to these drugs.
Insights
This study investigated contamination from chemotherapy drugs like fluorouracil, cyclophosphamide, and methotrexate in a hospital pharmacy. While no cyclophosphamide uptake was found in workers, contamination was detected on surfaces and gloves, highlighting the need for exposure control.
Area of Science:
- Occupational Health
- Pharmaceutical Sciences
- Environmental Monitoring
Background:
- Chemotherapy drugs such as fluorouracil, cyclophosphamide, and methotrexate pose potential occupational exposure risks during preparation in hospital pharmacies.
- Effective monitoring methods are crucial for assessing and mitigating exposure risks for healthcare personnel handling cytotoxic agents.
Purpose of the Study:
- To assess the extent of contamination with fluorouracil, cyclophosphamide, and methotrexate in a hospital pharmacy preparation area.
- To evaluate the effectiveness of safety measures and monitoring techniques for occupational exposure to these hazardous drugs.
Main Methods:
- Air, surface (laminar airflow hood, floor), and glove samples were collected during chemotherapy drug preparation.
- Urine samples from two pharmacy workers were analyzed for unmetabolized cyclophosphamide.
- Analytical methods were employed to quantify drug residues in various environmental and biological samples.
Main Results:
- Methotrexate was detected in air samples during preparation (0.3 micrograms/m3).
- Significant contamination of the laminar airflow hood and surrounding floor areas was observed for fluorouracil, cyclophosphamide, and methotrexate.
- Gloves showed considerable contamination, primarily with fluorouracil.
- No unmetabolized cyclophosphamide was detected in the urine samples of the involved workers.
Conclusions:
- Despite the absence of detected cyclophosphamide uptake, environmental contamination with cytotoxic drugs is evident in the preparation area.
- The analytical methods used are suitable for monitoring occupational exposure to cyclophosphamide, fluorouracil, and methotrexate.
- Continuous monitoring and stringent safety protocols are essential to minimize healthcare worker exposure to hazardous chemotherapy agents.