title: Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents.
abstract: OBJECTIVE
  To evaluate the effectiveness of a closed system drug-transfer device, EquaShield®, at reducing surface contamination with antineoplastic agents throughout an ambulatory cancer chemotherapy infusion center.
  
  
  METHODS
  Surfaces throughout the cancer center were sampled three times. The first samples were obtained in June 2010 without prior cleaning to measure baseline levels of contamination of the current technique (Chemo Dispensing Pin, B. Braun Medical Inc.). The second samples were obtained in August 2010 after the implementation of the closed system drug-transfer device and cleaning to evaluate if the contamination was removed. The third samples were obtained in August 2011. Wipe samples were taken from five positions in the pharmacy and from five positions in the infusion suite. Wipe samples were also collected from two positions in office areas. Samples were analyzed for cyclophosphamide and 5-fluorouracil.
  
  
  RESULTS
  The results from the first two sets of samples showed contamination with cyclophosphamide on about half of the positions at all locations during both collection periods. However, levels of contamination were very low and mostly just above the detection limit of the analytical method. The highest level of contamination was found on the door and handle in the pharmacy. Contamination with 5-fluorouracil was only observed on the dispensing counter in the pharmacy during the second collection period. The results from the third and final collection period showed no contamination with cyclophosphamide or 5-fluorouracil in the pharmacy, the infusion suite or in offices of the cancer center.
  
  
  CONCLUSIONS
  Implementation of the closed system drug-transfer device for preparing and administering chemotherapy eliminated surface contamination with cytotoxic agents at the ambulatory cancer chemotherapy infusion center.
authors.affiliation: Oncology, Cleveland Clinic Cancer Center, Fairview Hospital, OH 44111, USA. beclar@ccf.org
authors.forename: Bernadette A
authors.initials: BA
authors.lastname: Clark
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: Sessink
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D000964:Antimetabolites, Antineoplastic / Q000032:analysis; D018906:Antineoplastic Agents, Alkylating / Q000032:analysis; D002173:Cancer Care Facilities; D003520:Cyclophosphamide / Q000032:analysis*; D004339:Drug Compounding / Q000295:instrumentation* / Q000379:methods; D004866:Equipment Contamination; D005472:Fluorouracil / Q000032:analysis*; D006801:Humans; D016273:Occupational Exposure / Q000032:analysis / Q000517:prevention & control*; D010593:Pharmaceutical Services / Q000458:organization & administration; D010594:Pharmacies / Q000458:organization & administration
chemical_list: D000964:Antimetabolites, Antineoplastic; D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide; D005472:Fluorouracil
keywords: Antineoplastic agents; closed-system drug transfer device; cyclophosphamide; drug preparation; environmental contamination; fluorouracil; surface contamination