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Objectives 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/cm2, 0.0012 ng/cm2 and 0.0060 ng/cm2. 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/cm2 vs. 0.03[0.02−0.05], p Conclusion 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.

Objectives: To evaluate environmental contamination with methotrexate, cyclophosphamide, and ifosfamide in Quebec, Canada, community pharmacies and to describe hazardous drug handling practices in these pharmacies. Methods: Three standardized sites were sampled in each participating community pharmacy. Samples were analyzed for the presence of cyclophosphamide, ifosfamide, and methotrexate by high-performance liquid chromatography tandem mass spectrometry. The limits of detection were 0.10, 0.12, and 0.41 ng/mL for cyclophosphamide, ifosfamide, and methotrexate, respectively. Nine working practices were assessed. Results: 20 community pharmacies participated in the study, and 60 samples were analyzed. No traces of cyclophosphamide or ifosfamide were detected. Traces of methotrexate were found in 12 of 20 pharmacies (60%). Of the 20 pharmacies, 8 (40%) had a storage space reserved for hazardous drugs and none had a preparation area reserved for handling methotrexate tablets. All of the participating community pharmacies had a tablet counter reserved for the handling of hazardous drugs, and all pharmacies cleaned their tablet counter reserved for handling hazardous drugs after use. None of the pharmacies cut or crushed methotrexate tablets. Conclusion: The growing number of hazardous drugs represents a challenge for community pharmacies. Community pharmacists must be made aware of their presence and the need to comply with personal protection measures to reduce staff occupational exposure to hazardous drugs.

No occupational exposure limit exists for antineoplastic drugs. The main objective of this study was to describe environmental contamination with cyclophosphamide, ifosfamide and methotrexate in pharmacy and patient care areas of Canadian hospitals in 2012. The secondary objective was to compare the 2012 environmental monitoring results with the 2008–2010 results. Six standardized sites in the pharmacy and six sites on patient care areas were sampled in each participating center. Samples were analyzed for the presence of cyclophosphamide, ifosfamide and methotrexate by UPLC-MS-MS. The limit of detection (LOD) was 1.8 pg/cm2 for cyclophosphamide, 2.2 pg/cm2 for ifosfamide and 8.0 pg/cm2 for methotrexate. The comparison of surface contamination between the 2008–2010 and 2012 studies was made with the 75th percentile of cyclophosphamide concentration. A total of 33 hospitals participated in the study and 363 samples were collected. Overall, 40 % (147/363) of the samples were positive for cyclophosphamide, 18 % (68/363) were positive for ifosfamide and 5 % (17/363) were positive for methotrexate. In 2012, the 75th percentile value of cyclophosphamide surface concentration was of 9.4 pg/cm2, which is four times lower than the 2008–2010 75th percentile of 40 pg/cm2. In both studies, the 75th percentile for ifosfamide and methotrexate concentration was lower than the LOD. Surface contamination by cyclophosphamide, ifosfamide and methotrexate in Canadian hospitals is improving both in terms of the proportions of positive samples and in terms of the surface concentration of antineoplastic drugs. A local 75th percentile value should be use to assess local contamination and interpret local results.

Background During a one-year internship in a Quebec teaching hospital, a group of French pharmacy interns explored the similarities and differences in training. Purpose To compare the training required for hospital pharmacy practise in France and in Quebec. Materials and Methods This is a descriptive comparative study. A list of relevant themes was established by consensus after a review of key websites and literature. A panel of three French interns, a Quebec hospital pharmacy resident and two teaching hospital pharmacists was assembled. Similarities and differences for each theme were identified and discussed. Results Twenty-seven themes were selected with seven similarities and twenty differences between France and Quebec. In both countries, post-graduate training included a selection process, a structured programme with pre-identified topics, lectures and experiential courses. While post-graduate training is perceived as a plus-value, it is not mandatory. Amongst the differences identified, the two post-graduate systems have been offered for a different period of time (1815-France vs. 1961-Quebec), French interns are not working as pharmacists while Quebec residents are, French internship lasts 4 years vs. 16 months in Quebec, French annual scholar fees are lower (500 euros/year vs. 3840 euros/18 months in Quebec), both programmes offers two paths (hospital/industry in France; hospital/community pharmacy in Quebec), French internship locations includes healthcare agencies, laboratories, research units, hospitals while Quebec residency focuses on patient care locations in hospitals/retail pharmacy and admission capacity differs. Other differences were identified in geographic mobility, resident status, obligations and responsibilities, modalities of supervision, compensation, on-call shifts and evaluation. Conclusions There are significant differences between French and Quebec post-graduate training although both require work in hospital settings. A better understanding of these similarities and differences may contribute to reciprocal improvement of these programmes and favour exchanges between the two countries. No conflict of interest.