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Despite significant advances in cancer treatment with targeted therapies and immunotherapies, cytotoxic chemotherapies are still extensively used. Potential cytotoxic contamination in preparing and administrating cytotoxics is still a major source of concern. Besides advanced protections including biological safety cabinets, work surface contamination needs to be continuously controlled to ensure that handling procedures and cleaning were appropriate. Contamination monitoring needs to be standardized.The study searched Pubmed/Medline and Embase with"hazardous drug”, “cytotoxic drug”, “surface contamination”, “environmental contamination”, “wipe sample”, “pharmacy”, “care unit”, and selected studies reporting contamination results in work environment for pharmacy technicians and nurses, from 1 January 2017 to 31 December 2022.The 29 studies totalized 16,196 samples and 189,571 assays. Contamination results showed 39.8% sample positivity, and 8.2% assay positivity. Multicentric studies gathering at least 500 samples or up to 800 samples would limit heterogeneity in sample positivity. In addition, monitoring of an appropriate tracer selection including at least the 7 tracers with the highest contamination frequencies (cyclophosphamide, gemcitabine, fluorouracile, ifosfamide, platinum derivatives, paclitaxel and methotrexate) would facilitate contamination comparisons amongst studies and local results. Most recent studies reported thresholds for cyclophosphamide close to 0.1 ng/cm² at the 90th percentile.The overall risk of exposure for healthcare professionals is a major concern. Sample size in multicentric studies would require at least 500 samples; quantification of all tracers with the highest contamination frequencies need to be quantified. This approach would provide a basis to develop guidelines to appropriately monitor contamination in pharmacies and patient care area managers. [ABSTRACT FROM AUTHOR]

Training and regular evaluation of technicians involved in the preparation of antineoplastic agents seems essential to reduce occupational exposure. In this way, a continuous training program was established. Technicians were asked to prepare a safe simulated liquid cytotoxic drug with a fluorescein solution (10 mg/L). After, occupational exposure with this solution was simulated. Ultra-violet light (365 nm) was employed to determine surface contamination. This continuous training program is tested and validated with pharmacy technicians. All people handling these drugs (physicians, nurses, pharmacy staff) can use this program. Short mandatory training courses are stimulating and well appreciated.

The first study in which amounts of cyclophosphamide were found in the urine of nurses handling cytotoxic drugs using gas chromatography was published in 1984. We carried out a similar investigation on six pharmacy technicians involved in the preparation of antineoplastic agents (25,000 doses per year) but the analysis was performed with a more sensitive method: gas chromatography-mass spectrometry (LOQ = 0.1 ng/ml). Cyclophosphamide was found in two urine samples (out of 104) from two different workers. The rates detected were just above the limit of quantification. No correlation was found between the amounts of cyclophosphamide handled and the urinary excretion. The mean urinary levels measured in this study are lower than those reported by other investigators. In addition, only 1.9% of the collected samples are positive to cyclophosphamide. The drug was detected for two different technicians during two different sampling periods, suggesting that pollution is not repeated. No relationship could be seen between urinary detection of cyclophosphamide and individual or general work in the cytotoxic preparation unit. As supported by recent datas, transdermal resorption seems to be the most important way of incorporation. Further investigations are necessary to prove this hypothesis if we want to prevent occupational exposure of people handling these drugs.