title: Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques.
abstract: OBJECTIVE
  A comparison was conducted of the levels of surface contamination with two commonly used antineoplastic drugs, cyclophosphamide and fluorouracil, on countertops, floors, and hood surfaces in three oncology pharmacies following preparation with standard hazardous drug (HD) preparation techniques, or a closed-system drug transfer device (CSTD) in conjunction with standard HD preparation techniques, or a CSTD in conjunction with standard HD preparation techniques but prepared on a countertop outside the biological safety cabinet (BSC).
  
  
  METHODS
  Wipe samples of the various surfaces in each pharmacy were obtained biweekly for 12 weeks (six samples) to establish a baseline. Following implementation of the CSTD, an additional six biweekly samples were collected. The CSTD was then removed, and a final six samples were collected again using standard preparation techniques. During the CSTD Phase, fluorouracil was prepared on the countertop outside the BSC.
  
  
  RESULTS
  During the 36-week study, 342 samples were collected. A total of 8% positive fluorouracil wipe samples were found in the three pharmacies. The proportion of positive fluorouracil samples was significantly less in the CSTD Phase than in the control phases (p = 0.0002). There were 324 (95%) positive cyclophosphamide wipe samples. The median surface contamination was significantly different across the three phases (p < 0.00001). This was consistent at all sites, for both the BSC work surfaces and countertops. Contamination on floors adjacent to the BSCs was not consistently reduced.
  
  
  CONCLUSIONS
  The use of a CSTD in the BSC in conjunction with standard HD preparation techniques significantly reduced cyclophosphamide surface contamination as compared to standard techniques alone. Preparation of fluorouracil outside the BSC using the CSTD did not result in significant analytically detectable contamination on the countertops.
authors.affiliation: Department of Veterans Affairs Medical Center, St. Louis, MO, USA. harrisonbr@charter.net
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Harrison
authors.forename: Byron G
authors.initials: BG
authors.lastname: Peters
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bing
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000032:analysis; D002173:Cancer Care Facilities / Q000592:standards*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000032:analysis*; D004339:Drug Compounding; D004866:Equipment Contamination; D005430:Floors and Floorcoverings; D005472:Fluorouracil / Q000009:adverse effects / Q000032:analysis*; D015386:Hazardous Substances / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D008495:Medical Oncology; D016273:Occupational Exposure; D010607:Pharmacy Service, Hospital / Q000592:standards*; D011482:Protective Devices; D012449:Safety
chemical_list: D000970:Antineoplastic Agents; D015386:Hazardous Substances; D003520:Cyclophosphamide; D005472:Fluorouracil