A scoping review of surface wipe sampling for antineoplastic drug contamination in patient care areas

Antineoplastic drug (AD) exposure can cause adverse health effects for healthcare workers. AD contamination on surfaces persists despite interventions to reduce it. The United States Pharmacopeial Convention recommends surface sampling as a measure of exposure control but does not offer guidance regarding specific ADs, surfaces in patient care areas, or size of surface area to sample. This scoping review of literature published since January 1, 2004 aimed to identify specific surfaces in patient care areas which were tested and found to be contaminated with ADs. The authors describe (a) which ADs were assessed, (b) the percent of surfaces contaminated; and sizes of sampling areas for surface testing, and (c) whether personal protective equipment (PPE) or closed system transfer devices (CSTDs) were utilized to reduce healthcare worker exposure and AD surface contamination. The majority of studies were conducted in North America or Europe. The most common location for testing was hospitals. Most studies sampled for one to three marker drugs of interest, with cyclophosphamide being the most common. Most studies utilized a standardized surface area with 100 to 900 cm² being the most common. Time of day varied, but most sampling was conducted at the end of the workday before cleaning. Gas chromatography-tandem mass spectrometry (GC-MSMS) and liquid chromatography-tandem mass spectrometry (LC-MSMS) were the most frequent analytical methods used. Contamination was found most often on floors, nursing counters, armchairs, intravenous (IV) poles/pumps, patient tables, hazardous drug (HD) waste containers, doorknobs/handles, storage shelves, bathroom surfaces, HD vials/bags, and telephones. PPE and CSTD use were not consistently reported. Based on this review, the authors make several recommendations for the standardization of data collection and reporting of findings. Key among these is the need to measure and report data on the use of PPE and CSTDs to modify environmental contamination and, critically, healthcare worker exposure to ADs.