title: Environmental contamination, product contamination and workers exposure using a robotic system for antineoplastic drug preparation.
abstract: Environmental contamination, product contamination and technicians exposure were measured following preparation of iv bags with cyclophosphamide using the robotic system CytoCare. Wipe samples were taken inside CytoCare, in the clean room environment, from vials, and prepared iv bags including ports and analysed for contamination with cyclophosphamide. Contamination with cyclophosphamide was also measured in environmental air and on the technicians hands and gloves used for handling the drugs. Exposure of the technicians to cyclophosphamide was measured by analysis of cyclophosphamide in urine. Contamination with cyclophosphamide was mainly observed inside CytoCare, before preparation, after preparation and after daily routine cleaning. Contamination outside CytoCare was incidentally found. All vials with reconstituted cyclophosphamide entering CytoCare were contaminated on the outside but vials with powdered cyclophosphamide were not contaminated on the outside. Contaminated bags entering CytoCare were also contaminated after preparation but non-contaminated bags were not contaminated after preparation. Cyclophosphamide was detected on the ports of all prepared bags. Almost all outer pairs of gloves used for preparation and daily routine cleaning were contaminated with cyclophosphamide. Cyclophosphamide was not found on the inner pairs of gloves and on the hands of the technicians. Cyclophosphamide was not detected in the stationary and personal air samples and in the urine samples of the technicians. CytoCare enables the preparation of cyclophosphamide with low levels of environmental contamination and product contamination and no measurable exposure of the technicians.
authors.affiliation: Exposure Control Sweden AB, Bohus-Björkö, Sweden info@exposurecontrol.nl.
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: Sessink
authors.affiliation: Pharmacy, University Hospital Saint-Luc, Brussels, Belgium.
authors.forename: Gisèle M
authors.initials: GM
authors.lastname: Leclercq
authors.affiliation: Pharmacy, University Hospital Saint-Luc, Brussels, Belgium.
authors.forename: Dominique-Marie
authors.initials: DM
authors.lastname: Wouters
authors.affiliation: Pharmacy, University Hospital Saint-Luc, Brussels, Belgium.
authors.forename: Loïc
authors.initials: L
authors.lastname: Halbardier
authors.affiliation: Pharmacy, University Hospital Saint-Luc, Brussels, Belgium.
authors.forename: Chaïma
authors.initials: C
authors.lastname: Hammad
authors.affiliation: Pharmacy, University Hospital Saint-Luc, Brussels, Belgium.
authors.forename: Nassima
authors.initials: N
authors.lastname: Kassoul
mesh_terms: D000395:Air Pollutants, Occupational / Q000009:adverse effects / Q000032:analysis*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis* / Q000652:urine; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis* / Q000652:urine; D004339:Drug Compounding / Q000009:adverse effects / Q000295:instrumentation*; D004340:Drug Contamination / Q000517:prevention & control*; D004780:Environment, Controlled; D004784:Environmental Monitoring / Q000379:methods; D004866:Equipment Contamination / Q000517:prevention & control*; D004867:Equipment Design; D017575:Gloves, Protective; D006801:Humans; D007262:Infusions, Intravenous; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control*; D010607:Pharmacy Service, Hospital; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics
chemical_list: D000395:Air Pollutants, Occupational; D018906:Antineoplastic Agents, Alkylating; D003520:Cyclophosphamide
keywords: Antineoplastic agents; cyclophosphamide; drug preparation; hospital pharmacies; robotic systems; surface contamination; workers exposure