Tackling antineoplastic drugs' contamination in healthcare settings: New insights on surface cleaning approaches

Effective decontamination of hospital surfaces is crucial to protect workers from antineoplastic drugs (ADs) since dermal absorption is the main exposure route to these hazardous medicinal products. Sampling after daily cleaning in oncologic settings from a tertiary hospital was initially performed and exhibited low contamination levels; however, cyclophosphamide was still found (up to 957 pg/cm²) above the guidance value (100 pg/cm²) in four locations, evidencing the need to properly assess and update the cleaning protocols. Then, cleaning efficiencies of six solutions and different protocols were evaluated (including, for the first time, four commercial cleaning solutions/disinfectants not designed specifically for AD removal) after deliberate contamination of three model surfaces with 13 pharmaceuticals: bicalutamide, capecitabine, cyclophosphamide, cyproterone, doxorubicin, etoposide, flutamide, ifosfamide, imatinib, megestrol, mycophenolate mofetil, paclitaxel, and prednisone. Wipe sampling and liquid chromatography-tandem mass spectrometry were employed to determine surface contamination after cleaning. Results revealed that: (i) none of the solutions or procedures totally removed all target pharmaceuticals from surfaces; (ii) the removal efficiency increased with cleaning steps (average removals above 90% were attained for Vyclean and Clinell Universal Spray using two cleaning steps); and (iii) the cleaning efficiency was likely favored by the application of the solution/disinfectant directly on the surfaces. Therefore, considering the dissimilar chemical structures and properties of the numerous ADs in use, the cleaning agent and protocol should be adjusted to the reality of each healthcare unit. Still, the scientific community is encouraged to develop a cleaning solution/protocol to simultaneously eliminate/remove as many ADs as possible.