title: Impact and appreciation of two methods aiming at reducing hazardous drug environmental contamination: The centralization of the priming of IV tubing in the pharmacy and use of a closed-system transfer device.
abstract: OBJECTIVE
  The main objective was to evaluate the impact of two methods aiming at reducing hazardous drug environmental contamination: the centralization of the priming of IV tubing in the pharmacy and the use of a closed-system transfer device. The secondary objective was to evaluate the satisfaction of pharmacy technicians using a survey.
  
  
  METHODS
  Sites in the hematology-oncology satellite pharmacy and care unit were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate before and after the centralization of the priming of IV tubing in the pharmacy and before and after using a closed-system transfer device. The limits of detection for cyclophosphamide, ifosfamide and methotrexate were, respectively, of 0.0015 ng/cm(2), 0.0012 ng/cm(2) and 0.0060 ng/cm(2). The pharmacy technician satisfaction was evaluated using a questionnaire.
  
  
  RESULTS
  A total of 225 samples was quantified. After the centralization of priming in the pharmacy, no significant difference was found in the proportion of positive samples for cyclophosphamide, ifosfamide and methotrexate. Traces of cyclophosphamide found on the floor in patient care areas was significantly reduced (median[min-max] 0.08[0.06-0.09]ng/cm(2) vs. 0.03[0.02-0.05], p < 0.0001). After using a closed-system transfer device, a significant difference was found for the proportion of cyclophosphamide positive samples (15/45(33%) vs. 0/45(0%), p < 0.0001), but no significant difference was found for ifosfamide (12/45(27%) vs. 5/45(11%), p = 0.059) and methotrexate (1/45(2%) vs. 2/45(4%), p = 0.557). Pharmacy technicians raised issues following the centralization of priming (e.g. workload) and the use of closed-system transfer devices (e.g. spills, particles, workload and handling difficulties).
  
  
  CONCLUSIONS
  The centralization of the priming of IV tubing in the pharmacy reduced floor contamination in patient care areas without increasing surface contamination in the pharmacy. Closed-system transfer devices reduced contamination in pharmacy, but handling issues were raised by pharmacy technicians.
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Guillemette
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada.
authors.forename: Hélène
authors.initials: H
authors.lastname: Langlois
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada.
authors.forename: Maxime
authors.initials: M
authors.lastname: Voisine
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada.
authors.forename: Delphine
authors.initials: D
authors.lastname: Merger
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada.
authors.forename: Roxane
authors.initials: R
authors.lastname: Therrien
authors.affiliation: Hematology-oncology Care Unit, CHU Sainte-Justine, Canada.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Mercier
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Lebel
authors.affiliation: Pharmacy Department, CHU Sainte-Justine, Canada Pharmacy Practice Research Unit, CHU Sainte-Justine, Canada Faculty of Pharmacy, University of Montreal, Canada jf.bussieres@ssss.gouv.qc.ca.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bussières
mesh_terms: D000970:Antineoplastic Agents / Q000032:analysis*; D003520:Cyclophosphamide / Q000032:analysis; D004339:Drug Compounding / Q000295:instrumentation / Q000379:methods*; D004784:Environmental Monitoring / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control; D006801:Humans; D007069:Ifosfamide / Q000032:analysis; D007262:Infusions, Intravenous / Q000295:instrumentation; D008727:Methotrexate / Q000032:analysis; D016273:Occupational Exposure / Q000032:analysis / Q000517:prevention & control*; D010607:Pharmacy Service, Hospital / Q000379:methods*; D010596:Pharmacy Technicians / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D003520:Cyclophosphamide; D007069:Ifosfamide; D008727:Methotrexate
keywords: Hazardous drugs; centralization; closed-system transfer device; priming of IV tubing