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BRUCE R. HARRISON, M.S., BCOP, was Clinical Pharmacy Specialist, Department of Veterans Affairs Medical Center, St. Louis, MO, and was Clinical Pharmacy Specialist, Division of Hematology/Oncology, St. Louis University School of Medicine, at the time of this study. BYRON G. PETERS, B.S.PHARM., is Director of Pharmacy, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis. MICHAEL R. BING, B.S.PHARM., is Oncology Staff Pharmacist, Department of Pharmacy, St. John’s Mercy Medical Center, St. Louis and was Oncology Pharmacist, St. Louis University Cancer Center, at the time of this study.
Address correspondence to Mr. Harrison at Gateway Medical Research, 400 Fountain Lakes Boulevard, St. Charles, MO 63301 (harrisonbr{at}charter.net).
Methods. Wipe samples of the various surfaces in each pharmacy were obtained biweekly for 12 weeks (six samples) to establish a baseline. Following implementation of the CSTD, an additional six biweekly samples were collected. The CSTD was then removed, and a final six samples were collected again using standard preparation techniques. During the CSTD Phase, fluorouracil was prepared on the countertop outside the BSC.
Results. During the 36-week study, 342 samples were collected. A total of 8% positive fluorouracil wipe samples were found in the three pharmacies. The proportion of positive fluorouracil samples was significantly less in the CSTD Phase than in the control phases (p = 0.0002). There were 324 (95%) positive cyclophosphamide wipe samples. The median surface contamination was significantly different across the three phases (p < 0.00001). This was consistent at all sites, for both the BSC work surfaces and countertops. Contamination on floors adjacent to the BSCs was not consistently reduced.
Conclusion. The use of a CSTD in the BSC in conjunction with standard HD preparation techniques significantly reduced cyclophosphamide surface contamination as compared to standard techniques alone. Preparation of fluorouracil outside the BSC using the CSTD did not result in significant analytically detectable contamination on the countertops.
Index terms: Antineoplastic agents; Compounding; Contamination; Cyclophosphamide; Equipment; Fluorouracil; Pharmacy, institutional, hospital
Purpose. A comparison was conducted of the levels of surface contamination with two commonly used antineoplastic drugs, cyclophosphamide and fluorouracil, on countertops, floors, and hood surfaces in three oncology pharmacies following preparation with standard hazardous drug (HD) preparation techniques, or a closed-system drug transfer device (CSTD) in conjunction with standard HD preparation techniques, or a CSTD in conjunction with standard HD preparation techniques but prepared on a countertop outside the biological safety cabinet (BSC).
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 Section 7 Special devices Journal of Oncology Pharmacy Practice, September 1, 2007; 13(3_suppl): 27 - 30. [PDF]
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