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Application of an Environmental Monitoring to Assess the Practices and Control the Risk of Occupational Exposure to Cyclophosphamide in Two Sites of a French Comprehensive Cancer Center.

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Title: Application of an Environmental Monitoring to Assess the Practices and Control the Risk of Occupational Exposure to Cyclophosphamide in Two Sites of a French Comprehensive Cancer Center.
Authors: Acramel, Alexandre1,2 alexandre.acramel@gmail.com, Fouque, Julien3, Blondeel-Gomes, Sandy4, Huguet, Samuel3, Rezai, Keyvan3, Madar, Olivier3,4, Escalup, Laurence1
Source: Annals of Work Exposures & Health. Nov2022, Vol. 66 Issue 9, p1215-1223. 9p.
Subjects: Hospitals, Professional practice, Environmental monitoring, Scientific observation, Blood vessels, Liquid chromatography, Medical equipment contamination, Occupational exposure, Antineoplastic agents, Intravenous therapy equipment, Risk assessment, Cyclophosphamide, Mass spectrometry, Descriptive statistics, Automation, Drug adulteration, Collection & preservation of biological specimens, Sterilization (Disinfection), Dosage forms of drugs, Personnel management, Medical equipment
Geographic Terms: France
Abstract: Objectives The risk of chronic exposure to antineoplastic agents in hospitals, mainly by skin contact with contaminated surfaces, is well established. The aim of this study was to assess indirectly the risk of occupational exposure to antineoplastics drugs at two hospitals by using an environmental monitoring, and to suggest ways of improving the exposure to healthcare workers. Methods An observational study of care practices on both sites was carried out. A wipe sampling campaign was then designed to study environmental contamination throughout the chemotherapy process: receipt, storage, compounding, transport, administration, and elimination areas. Samples were analyzed by a validated LC-MS/MS method allowing trace quantification of cyclophosphamide. A guidance 'safe value' of 0.10 ng/cm2 was considered. Results A total of 293 samples were analyzed, of which 58% were found to be positive. In the compounding units, the drug vials were contaminated before [range = (non-quantifiable [NQ]-0.71) ng/cm2] and after cleaning procedure [(NQ-0.62) ng/cm2], particularly when the flip-off lid was removed during cleaning. The contamination found on manual preparations was operator-dependent: [non-detectable (ND)-3.51] ng/cm2 on infusion bag surfaces; (780.61–24 698.98) ng/cm2 on medication ports. In the case of automated preparations, the average contamination was higher on infusion bag surfaces [(2.43–36.86) ng/cm2] and lower on medication ports [(0.43–7.65) ng/cm2] than manual preparations. Contamination of the analytical control area was also highlighted. In the daily care unit, the contamination was located near the infusion area (armchairs, infusion stands, floor, and patient toilets), and varied somewhat between the two sites, especially on the floor with (0.46–27.32) compared to (ND-0.18) ng/cm2. We did not detect contamination on the transport boxes, on the door handles or in the disposal areas. Conclusions The variability of contamination observed between the two sites can be explained in part by the difference in routine practices, especially training of the staff, and cleaning procedures. Findings were communicated to healthcare workers, and news interventions were implemented based on wipe sampling results. This study demonstrated a method for routine environmental monitoring and worker education as a strategy to reduce occupational exposure. [ABSTRACT FROM AUTHOR]
Copyright of Annals of Work Exposures & Health is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Application of an Environmental Monitoring to Assess the Practices and Control the Risk of Occupational Exposure to Cyclophosphamide in Two Sites of a French Comprehensive Cancer Center.
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  Data: <searchLink fieldCode="AR" term="%22Acramel%2C+Alexandre%22">Acramel, Alexandre</searchLink><relatesTo>1,2</relatesTo><i> alexandre.acramel@gmail.com</i><br /><searchLink fieldCode="AR" term="%22Fouque%2C+Julien%22">Fouque, Julien</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Blondeel-Gomes%2C+Sandy%22">Blondeel-Gomes, Sandy</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Huguet%2C+Samuel%22">Huguet, Samuel</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Rezai%2C+Keyvan%22">Rezai, Keyvan</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Madar%2C+Olivier%22">Madar, Olivier</searchLink><relatesTo>3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Escalup%2C+Laurence%22">Escalup, Laurence</searchLink><relatesTo>1</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Annals+of+Work+Exposures+%26+Health%22">Annals of Work Exposures & Health</searchLink>. Nov2022, Vol. 66 Issue 9, p1215-1223. 9p.
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  Label: Subjects
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Hospitals%22">Hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Professional+practice%22">Professional practice</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+monitoring%22">Environmental monitoring</searchLink><br /><searchLink fieldCode="DE" term="%22Scientific+observation%22">Scientific observation</searchLink><br /><searchLink fieldCode="DE" term="%22Blood+vessels%22">Blood vessels</searchLink><br /><searchLink fieldCode="DE" term="%22Liquid+chromatography%22">Liquid chromatography</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+equipment+contamination%22">Medical equipment contamination</searchLink><br /><searchLink fieldCode="DE" term="%22Occupational+exposure%22">Occupational exposure</searchLink><br /><searchLink fieldCode="DE" term="%22Antineoplastic+agents%22">Antineoplastic agents</searchLink><br /><searchLink fieldCode="DE" term="%22Intravenous+therapy+equipment%22">Intravenous therapy equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Cyclophosphamide%22">Cyclophosphamide</searchLink><br /><searchLink fieldCode="DE" term="%22Mass+spectrometry%22">Mass spectrometry</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Automation%22">Automation</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+adulteration%22">Drug adulteration</searchLink><br /><searchLink fieldCode="DE" term="%22Collection+%26+preservation+of+biological+specimens%22">Collection & preservation of biological specimens</searchLink><br /><searchLink fieldCode="DE" term="%22Sterilization+%28Disinfection%29%22">Sterilization (Disinfection)</searchLink><br /><searchLink fieldCode="DE" term="%22Dosage+forms+of+drugs%22">Dosage forms of drugs</searchLink><br /><searchLink fieldCode="DE" term="%22Personnel+management%22">Personnel management</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+equipment%22">Medical equipment</searchLink>
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  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22France%22">France</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives The risk of chronic exposure to antineoplastic agents in hospitals, mainly by skin contact with contaminated surfaces, is well established. The aim of this study was to assess indirectly the risk of occupational exposure to antineoplastics drugs at two hospitals by using an environmental monitoring, and to suggest ways of improving the exposure to healthcare workers. Methods An observational study of care practices on both sites was carried out. A wipe sampling campaign was then designed to study environmental contamination throughout the chemotherapy process: receipt, storage, compounding, transport, administration, and elimination areas. Samples were analyzed by a validated LC-MS/MS method allowing trace quantification of cyclophosphamide. A guidance 'safe value' of 0.10 ng/cm2 was considered. Results A total of 293 samples were analyzed, of which 58% were found to be positive. In the compounding units, the drug vials were contaminated before [range = (non-quantifiable [NQ]-0.71) ng/cm2] and after cleaning procedure [(NQ-0.62) ng/cm2], particularly when the flip-off lid was removed during cleaning. The contamination found on manual preparations was operator-dependent: [non-detectable (ND)-3.51] ng/cm2 on infusion bag surfaces; (780.61–24 698.98) ng/cm2 on medication ports. In the case of automated preparations, the average contamination was higher on infusion bag surfaces [(2.43–36.86) ng/cm2] and lower on medication ports [(0.43–7.65) ng/cm2] than manual preparations. Contamination of the analytical control area was also highlighted. In the daily care unit, the contamination was located near the infusion area (armchairs, infusion stands, floor, and patient toilets), and varied somewhat between the two sites, especially on the floor with (0.46–27.32) compared to (ND-0.18) ng/cm2. We did not detect contamination on the transport boxes, on the door handles or in the disposal areas. Conclusions The variability of contamination observed between the two sites can be explained in part by the difference in routine practices, especially training of the staff, and cleaning procedures. Findings were communicated to healthcare workers, and news interventions were implemented based on wipe sampling results. This study demonstrated a method for routine environmental monitoring and worker education as a strategy to reduce occupational exposure. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Annals of Work Exposures & Health is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/annweh/wxac035
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1215
    Subjects:
      – SubjectFull: Hospitals
        Type: general
      – SubjectFull: Professional practice
        Type: general
      – SubjectFull: Environmental monitoring
        Type: general
      – SubjectFull: Scientific observation
        Type: general
      – SubjectFull: Blood vessels
        Type: general
      – SubjectFull: Liquid chromatography
        Type: general
      – SubjectFull: Medical equipment contamination
        Type: general
      – SubjectFull: Occupational exposure
        Type: general
      – SubjectFull: Antineoplastic agents
        Type: general
      – SubjectFull: Intravenous therapy equipment
        Type: general
      – SubjectFull: Risk assessment
        Type: general
      – SubjectFull: Cyclophosphamide
        Type: general
      – SubjectFull: Mass spectrometry
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Automation
        Type: general
      – SubjectFull: Drug adulteration
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      – SubjectFull: Collection & preservation of biological specimens
        Type: general
      – SubjectFull: Sterilization (Disinfection)
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      – SubjectFull: Dosage forms of drugs
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      – SubjectFull: Medical equipment
        Type: general
      – SubjectFull: France
        Type: general
    Titles:
      – TitleFull: Application of an Environmental Monitoring to Assess the Practices and Control the Risk of Occupational Exposure to Cyclophosphamide in Two Sites of a French Comprehensive Cancer Center.
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              Text: Nov2022
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