title: Verification of surface contamination of Japanese cyclophosphamide vials and an example of exposure by handling.
abstract: OBJECTIVE
  Cyclophosphamide (CP) contamination has been detected in Japanese hospitals. In other countries, the surface contamination of CP vials has been reported; however, the manufacturing process of Japanese CP vials is unknown, so the conditions are not necessarily the same as in other countries. This study aimed to establish whether vial surface contamination also occurs in Japan.
  
  
  METHODS
  Contamination of vial surfaces was examined with a wipe test. Urine samples were taken from a pharmacist, engaged solely in dispensing work, for 29 h. It was also investigated whether CP vials were dispensed during the urine sampling period. In addition, vial surfaces, purposely coated with CP and then washed, were examined using wipe tests.
  
  
  RESULTS
  CP was detected at 30-60% in vials, which was 11-62 ng (0.10-0.54 ng/cm(2)). One of the urine samples was contaminated (CP 13.5 ng); this was taken on Day 2 (11:35 AM). CP was not detected among the washed vials.
  
  
  CONCLUSIONS
  This study shows that the surface of Japanese CP vials was contaminated and that it was probable that healthcare workers were exposed to CP. CP absorption by the pharmacist was probably due to dermal uptake while dispensing. Washing the vial is considered effective to avoid CP exposure. Manufacturers should be more proactive to prevent contamination and healthcare workers should comply with exposure prevention rules. Cytotoxic drugs should be included in institution monitoring lists.
authors.affiliation: Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Hyogo, Japan. hama-k@kcho.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Hama
authors.forename: Koichi
authors.initials: K
authors.lastname: Fukushima
authors.forename: Masaki
authors.initials: M
authors.lastname: Hirabatake
authors.forename: Tohru
authors.initials: T
authors.lastname: Hashida
authors.forename: Kazusaburo
authors.initials: K
authors.lastname: Kataoka
mesh_terms: D003520:Cyclophosphamide / Q000032:analysis / Q000652:urine*; D004349:Drug Packaging / Q000592:standards; D004784:Environmental Monitoring / Q000379:methods* / Q000592:standards; D006801:Humans; D007564:Japan; D016273:Occupational Exposure / Q000032:analysis*; D010595:Pharmacists / Q000592:standards; D015203:Reproducibility of Results; D013499:Surface Properties
chemical_list: D003520:Cyclophosphamide