Safe management of wastes from health-care activities , Safe management of wastes from health-care activities , کتابخانه دیجیتال جندی شاپور اهواز

https://www.scielosp.org/pdf/bwho/v79n2/v79n2a12.pdf

Safe management of wastes from health care activities

The toxicity of antineoplastic drugs has been well known since they were introduced in the 1940s. Because most antineoplastic drugs are nonselective in their mechanism of action, they affect noncancerous as well as cancerous cells, resulting in well-documented side effects. During the 1970s, evidence came to light indicating health care workers may be at risk of harmful effects from antineoplastic drugs as a result of occupational exposure. Since that time, reports from several countries have documented drug contamination of the workplace, identified drugs in the urine of health care workers, and measured genotoxic responses in workers. Evidence also exists of teratogenic and adverse reproductive outcomes and increased cancers in health care workers. During the past 30 years, professional organizations and government agencies have developed guidelines to protect health care workers from adverse effects from occupational exposure to antineoplastic drugs. Although many safety provisions were advanced to reduce worker exposure in the 1980s, recent studies have shown that workers continue to be exposed to these drugs despite safety policy improvements. In 2004, the National Institute for Occupational Safety and Health (NIOSH) published an alert reviewing the most recent information available and promoting a program of safe handling during their use.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.56.6.354

Preventing Occupational Exposures to Antineoplastic Drugs in Health Care Settings

Objective:This study evaluated health care worker exposure to antineoplastic drugs.Methods:A cross-sectional study examined environmental samples from pharmacy and nursing areas. A 6-week diary documented tasks involving those drugs. Urine was analyzed for two specific drugs, and blood samples were

Evaluation of Antineoplastic Drug Exposure of Health Care Workers at Three University-Based US Cancer Centers

Biological and environmental monitoring of hospital personnel exposed to antineoplastic agents: a review of analytical methods.

Surface contamination with and personnel exposure to antineoplastic agents before and after the implementation of a closed-system protective device were studied. Samples were collected before and six months after implementation of PhaSeal, a closed-system device for limiting exposure to antineoplastic agents during preparation and administration. Personnel exposure was evaluated by collecting 24-hour urine samples from pharmacists, pharmacy technicians, and nurses working full-time in a chemotherapy drug infusion center and pharmacy. Surface contamination was assessed by wiping potentially exposed surfaces. Both types of samples were analyzed for cyclophosphamide and ifosfamide by high-performance liquid chromatography-electrospray ionization-tandem mass spectrometry. All 17 wipe samples collected before implementation of PhaSeal had detectable levels of cyclophosphamide, and 11 were positive for ifosfamide. Six months after system implementation, 7 of 21 wipe samples had detectable levels of cyclophosphamide and 15 were positive for ifosfamide. Of eight employees who provided urine samples, six were positive for cyclophosphamide and two for ifosfamide before implementation, and none were positive for either drug after implementation. The PhaSeal system appeared to reduce exposure of health care personnel to cyclophosphamide and ifosfamide.

/pdf/using-a-closed-system-protective-device-to-reduce-personnel-2929unhc0w.pdf

Using a closed-system protective device to reduce personnel exposure to antineoplastic agents

The level of contamination by antineoplastic agents in drug preparation and administration areas in cancer treatment centers in Canada and the United States was determined. Sampling locations at three cancer treatment centers in Canada and three centers in the United States were selected (biological safety cabinets, countertops, and floors in and adjacent to preparation areas; tabletops, chairs, and floors in administration areas). A solution of sodium hydroxide (0.03 M) was spread over the surface of each area. The surface was wiped with one or two absorbent tissues, which were then stored in plastic screw-top containers. Samples were stored at -40 degrees C before analysis of ifosfamide content (U.S. centers only) and cyclophosphamide content by gas chromatography in tandem with mass spectroscopy-mass spectroscopy and fluorouracil content by reverse-phase high-performance liquid chromatography with ultraviolet-light detection. Measurable amounts of the antineoplastic agents were detected in 75% of the pharmacy samples and 65% of the administration samples. In general, the levels of contamination were higher in the pharmacy areas than in the drug administration areas. The pharmacy area at the site with the highest number of drug preparations had considerably more drug contamination than the other sites. The results were similar for Canadian and U.S. centers. Substantial levels of contamination from three antineoplastic agents were detected on a variety of surfaces in pharmacy drug preparation areas and drug administration areas in six cancer treatment centers in Canada and the United States.

Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States.

Purpose. The results of three studies that describe the external contamination of chemotherapy drug vials are presented. New techniques for the improved decontamination of vials containing cisplatin are also described.

Summary. Study 1 evaluated the external contamination of drug vials with cyclophosphamide and ifosfamide in a pharmacy setting. Widespread contamination of the outside of drug vials was found with each drug. Study 2 evaluated the surface contamination of drug vials with cyclophosphamide and fluorouracil in three pharmacies. Sporadic contamination with fluorouracil was detected, while cyclophosphamide was found on most vials. In study 3, investigators compared the decontamination abilities of a standard decontamination procedure at the manufacturer level with an improved decontamination procedure and the use of sleeves to further decrease contamination. Though the methods of each study reported herein differed, the outcomes were similar. All chemotherapy drug vials studied demonstrated levels of contamination with the drug well above the limit of detection. Improved decontamination procedures, combined with the use of protective sleeves, reduced the level of platinum contamination by 90%, suggesting that standard decontamination procedures should be reconsidered.

Conclusion. The results of these studies are consistent with several others that have reported contamination of the outside surface of drug vials for a number of chemotherapy drugs. Contamination can be reduced by using decontamination equipment and protective sleeves during the manufacturing process.

Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: results of three studies.

Purpose
Surface contamination with the antineoplastic drugs cyclophosphamide, ifosfamide, and 5-fluorouracil was compared in 22 US hospital pharmacies following preparation with standard drug preparation techniques or the PhaSeal® closed-system drug transfer device (CSTD).

/pdf/reduction-in-surface-contamination-with-antineoplastic-drugs-3ya07u21fz.pdf

Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device

Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area.

Purpose: 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. Conclusion: 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.

https://www.equashield.com/wp-content/uploads/2015/12/004-Equashield-Closed-System-Transfer-Device-CSTD.pdf

Paul J. M. Sessink

Papers

Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States.

Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: results of three studies.

Reduction in surface contamination with antineoplastic drugs in 22 hospital pharmacies in the US following implementation of a closed-system drug transfer device

Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area.

Use of a closed system drug-transfer device eliminates surface contamination with antineoplastic agents