Spatial and Temporal Variability in Antineoplastic Drug Surface Contamination in Cancer Care Centers in Alberta and Minnesota

Abstract The health risks of exposure to antineoplastic drugs (ADs) are well established, and healthcare professionals can be exposed while caring for cancer patients receiving AD therapy. Studies conducted worldwide over the past two decades indicate continuing widespread surface contamination by ADs. No occupational limits have been established ADs, but concerns exposures led development guidelines, such as United States Pharmacopeia (USP) General Chapter <800> Hazardous Drugs—Handling in Healthcare. While recommending regular surveillance ADs these guidelines do not provide guidance on sampling strategies. Better characterization spatial temporal variability multidrug would help inform We surface-wipe monitoring nine care centers Alberta, Canada Minnesota, USA, with each center sampled eight times a 12-month period. Twenty surfaces from within pharmacy drug administration areas were sampled, 11 analyzed wipe sample. Exposure data highly left-censored which restricted analysis; we examined prevalence samples above limit detection (LOD), used 90th percentile distribution measure level contamination. collected 1984 total 75 days resulting 21 824 observations. Forty-five percent detected at least one LOD, only three had more than 10% observations LOD: gemcitabine (GEM) (24%), cyclophosphamide (CP) (16%), paclitaxel (13%). Of 741 60% single 19% drugs, 21% or more; maximum number found LOD was 8. Surfaces compounding area patient showed highest including work surface, fridge handle, clean room cart, passthrough tray, hazardous temperature storage, IV pump keypad, washroom toilet door nurses’ storage shelf/tray, side table. Over course study, both percentiles varied without clear patterns, although some appeared show decreasing levels time. Within centers, degree high, showing changes orders magnitude concentrations month month. A difference observed between six located Alberta Minnesota having substantially higher percentages CP GEM. Other factors that associated significant volume, size center, seen, age center. hope demonstrating drug, clinic-factors, time will aid better understanding nature contamination, improved