Cytotoxic surface contamination in hospitals: Current practices, challenges and perspectives

Area of Science:

• Occupational Health
• Environmental Monitoring
• Pharmaceutical Sciences

Background:

• Cytotoxic chemotherapies are widely used despite advances in cancer treatment.
• Potential contamination from handling cytotoxic drugs poses risks to healthcare professionals.
• Standardized environmental monitoring is needed to ensure safe handling and cleaning procedures.

Purpose of the Study:

• To review and standardize methods for monitoring cytotoxic drug contamination in healthcare environments.
• To identify optimal sample sizes and drug tracers for reliable contamination assessment.
• To inform the development of guidelines for environmental monitoring in pharmacies and patient care areas.

Main Methods:

• Systematic literature search of PubMed/Medline and Embase databases (2017-2022).
• Inclusion of studies reporting environmental contamination results for pharmacy technicians and nurses.
• Analysis of 29 studies encompassing 16,196 wipe samples and 189,571 assays.

Main Results:

• Overall surface contamination detected in 39.8% of samples and 8.2% of assays.
• Multicentric studies with 500-800 samples can reduce heterogeneity.
• Monitoring key tracers like cyclophosphamide and paclitaxel is recommended, with recent thresholds near 0.1 ng/cm².

Conclusions:

• Healthcare professionals face significant exposure risks from cytotoxic contamination.
• Standardized monitoring requires adequate sample sizes and quantification of high-frequency contamination tracers.
• Developing guidelines for contamination monitoring is essential for pharmacies and patient care areas.