title: Evaluation of the efficacy of additional measures introduced for the protection of healthcare personnel handling antineoplastic drugs.
abstract: OBJECTIVE
  Due to their adverse effects, antineoplastic drugs are considered as a potential health risk to healthcare personnel. The objective of the study was to compare the surface contamination level of the conventional preparation room and outpatient clinic before and after the implementation of a set of additional protective measures.
  
  
  METHODS
  The measures were targeted at eliminating potential sources of environmental contamination, and modification of the cleaning procedure. The measures introduced into the preparation room consisted of (i) the introduction of manual cleaning of drug vials before they enter the preparation room, (ii) the modification of the routine cleaning procedure performed at the end of each working day (i.e. shifting the cleaning of the isolators as the most contaminated objects from the beginning of the cleaning process to the end), and (iii) the introduction of regular cleaning of the work table every 2 h. The measures introduced into the outpatient clinic consisted of (i) replacement of the standard infusion sets with multichannel sets for safe drug administration, (ii) the introduction of self-cleaning seats to the patient lavatories supporting hygienic and contamination-free seated urination, and (iii) replacement of standard infusion stands with wall-mounted stands, supporting the regular and proper cleaning of the floor beneath. To determine the surface contamination level with antineoplastic drugs, cyclophosphamide and platinum were determined in wipe samples with high performance liquid chromatography with tandem mass spectrometry and inductively coupled plasma mass spectrometry.
  
  
  RESULTS
  In the preparation room, depending on the sampling spot and analyte, median concentrations ranged from 5 to 267 pg cm(-2) and from 2 to 368 pg cm(-2) before and after implementation of the measures, respectively. In the outpatient clinic, median concentrations ranged from 5 to 5310 pg cm(-2) and from <0.2 to 574 pg cm(-2) before and after implementation of the measures, respectively. Depending on the sampling spot, median contamination of the outpatient clinic with cyclophosphamide and platinum was reduced by 57-99% and 61-98%, respectively.
  
  
  CONCLUSIONS
  The measures implemented in the outpatient clinic were shown to reduce workplace contamination effectively. Therefore, they can be recommended also for other workplaces where antineoplastic drugs are administered. In contrast, measures implemented in the preparation room, where relatively strict regulations had already been adopted before the study, were less effective. To decrease the actual contamination of the preparation room, other protective measures (e.g. closed-system transfer devices) should be considered.
authors.affiliation: Masaryk Memorial Cancer Institute Zluty kopec 7 Brno, Czech Republic, CZ65653. odraska@centrum.cz
authors.forename: Pavel
authors.initials: P
authors.lastname: Odraska
authors.forename: Lenka
authors.initials: L
authors.lastname: Dolezalova
authors.forename: Jan
authors.initials: J
authors.lastname: Kuta
authors.forename: Michal
authors.initials: M
authors.lastname: Oravec
authors.forename: Pavel
authors.initials: P
authors.lastname: Piler
authors.forename: Ludek
authors.initials: L
authors.lastname: Blaha
mesh_terms: D000970:Antineoplastic Agents / Q000032:analysis* / Q000737:chemistry; D004784:Environmental Monitoring / Q000379:methods; D015386:Hazardous Substances / Q000032:analysis / Q000592:standards; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis / Q000517:prevention & control* / Q000706:statistics & numerical data; D016272:Occupational Health; D011482:Protective Devices / Q000706:statistics & numerical data*; D012107:Research Design; D013048:Specimen Handling / Q000379:methods* / Q000592:standards
chemical_list: D000970:Antineoplastic Agents; D015386:Hazardous Substances