Skip to main content
NCBI home page
The Canadian Journal of Hospital Pharmacy logoLink to The Canadian Journal of Hospital Pharmacy
. 2023 Mar 1;76(2):87–93. doi: 10.4212/cjhp.3275

Side-by-Side Comparison of Methods for Environmental Monitoring for Hazardous Drug Contamination

Chun-Yip Hon 1,✉
PMCID: PMC10049775  PMID: 36998748

Abstract

Background

Exposure to hazardous drugs is known to have deleterious effects on health care workers. To assess risk, environmental monitoring is conducted to ascertain drug contamination on surfaces, as dermal contact is the main route of exposure. Conventional monitoring employs wipe sampling whereby the wipe must be sent to a laboratory for analysis. This means that quantitative results are not available for some time, during which the risk remains unknown. A new device, the HD Check system, developed by BD, which uses lateral-flow immunoassay technology, allows for near real-time qualitative assessment of contamination (positive or negative); however, its sensitivity relative to the traditional method is unknown.

Objective

To evaluate the ability of this novel device to detect drug contamination relative to the conventional method.

Methods

Five sets of different known drug concentrations were compared between the conventional wipe sampling method and the HD Check systems for methotrexate (MTX) and cyclophosphamide (CP). Stainless steel surfaces were tested, and the drug concentrations ranged from 0 ng/cm2 to twice the limit of detection (LOD) of each HD Check system.

Results

For MTX, positive results were obtained in every test trial at all drug concentrations examined with the HD Check system (LOD = 0.93 ng/cm2). For CP, test results with the HD Check system (LOD = 4.65 ng/cm2) were all positive at the LOD and twice the LOD; however, at 50% and 75% of the LOD, the result was positive in only 90% (9/10) of the trials. The conventional method was able to quantify the test drug concentrations with a high level of accuracy and reproducibility.

Conclusions

These results suggest the potential utility of the novel device as a screening tool for higher levels of drug contamination with MTX and CP, but additional research is needed to determine its suitability for lower concentrations, especially of CP.

Keywords: hazardous drugs, wipe sampling, surface contamination, HD Check system, risk assessment

INTRODUCTION

The risk of occupational exposure to hazardous drugs, also known as cytotoxic or antineoplastic drugs, has been documented since the 1970s.1,2 The adverse health effects associated with occupational exposure to hazardous drugs include reproductive toxicities and genotoxic effects, as well as a higher risk for certain cancers.3–5 According to CAREX Canada (a multi-institution team of experts providing knowledge about exposure to carcinogens), approximately 75 000 Canadians are exposed to hazardous drugs in the course of their work.6 One of the most common means to assess the risk of health care workers’ exposure to hazardous drugs is environmental monitoring or surface wipe sampling.7 This is because the route of exposure to hazardous drugs for health care workers is believed to be dermal uptake or skin contact.8,9 Essentially, workers can be exposed if they touch a drug-contaminated surface. As such, environmental monitoring is recommended in many best practice documents, including the US Pharmacopeial Convention’s General Chapter <800>,10 the International Society of Oncology Pharmacy Practitioners’ standards of practice for the safe handling of cytotoxics,11 and the National Association of Pharmacy Regulatory Authorities’ Model Standards for Pharmacy Compounding of Hazardous Sterile Preparations.12

At present, environmental monitoring typically involves using a moistened wipe material to wipe a surface in a predetermined pattern. The surface area that is commonly sampled is 10 cm × 10 cm (or 100 cm2).13 After sample collection, the wipe material is placed into a container such as a vial, which is then sealed, labelled, and sent to a laboratory for analysis. The gold standard laboratory analytical method is liquid chromatography with tandem mass spectrometry (LC-MS/MS) and the results are usually reported in units of nanograms per square centimetre (ng/cm2).13 Because the wipes must be sent to a laboratory, the results are typically not available until days or weeks after the sample collection date. Surface contamination levels may change during this lag period, and, in turn, the level of risk may also evolve.14

Recently, monitors based on lateral flow immunoassay (LFIA) have been developed to allow for near real-time detection of hazardous drugs on surfaces.15,16 These monitors consist of a test line and a control line. The colour of the test line changes in intensity based on the concentration of the drug, while the control line serves to indicate that the monitor is working properly (i.e., a form of quality control). The user then inserts the monitor into a digital reader, which indicates whether drug is present (i.e., the result is either positive or negative). The advantage of this novel technology is that analysis in a laboratory is not required, and therefore the results indicate the presence of drug contamination within a few minutes after sampling. However, to the author’s knowledge, this novel technology has never been evaluated in terms of its ability to detect surface contamination relative to the conventional wipe method described above.

This study aimed to compare the novel LFIA technology with an established surface wipe sampling and analysis method to assess the suitability of LFIA monitors to screen for hazardous drug contamination on work surfaces in health care settings. In other words, the goal was to ascertain whether the sensitivity of an LFIA monitor is suitable for employment of such devices as a substitute for conventional wipe sampling, to allow for near real-time detection of hazardous drugs on work surfaces. If deemed adequate, LFIA monitors could be considered for routine use in Canada and other jurisdictions for the purposes of environmental monitoring, assessment of exposure risk, and training, to name a few applications that would aid in reducing hazardous drug exposure among health care workers.

METHODS

In this controlled laboratory study, 2 methods—LFIA monitoring and conventional wipe sampling and analysis—were tested side by side with various known concentrations of hazardous drugs on stainless steel surfaces. This method of comparison has been used previously in the occupational hygiene domain for assessing direct-reading instruments relative to an established sampling method for chemical hazards.17–22 The LFIA monitors evaluated were from the HD Check system line of products, which are manufactured by BD and are currently the only lateral flow devices commercially available.23 Specifically, the HD Check assays for methotrexate (MTX) and cyclophosphamide (CP) were evaluated. The conventional wipe sampling method employed was developed by members of the author’s team and is suitable for analyzing both MTX and CP.24

Test Surface

Stainless steel plates were chosen as the test surface, because stainless steel is the material used for biological safety cabinets, the typical location of drug preparation within health care facilities. Because 100 cm2 is the typical surface area for wipe samples,16 each stainless steel plate had dimensions of 10 cm × 10 cm.

Drug Concentrations

For both MTX and CP, the following 5 concentrations were assessed: 0 ng/cm2 (control/blank), 50% of the limit of detection (LOD) of the corresponding HD Check system, 75% of the LOD of the HD Check system, the LOD of the HD Check system, and twice (200%) the LOD of the HD Check system. The manufacturer’s LOD was 0.93 ng/cm2 for the MTX HD Check system and 4.65 ng/cm2 for the CP HD Check system.

Replicate Samples

For each drug (MTX and CP), 10 replicate samples of each of the aforementioned concentrations were evaluated by the 2 methods. This resulted in 20 samples (10 for the HD Check system and 10 for the conventional method) for each of the 5 drug concentrations tested. Overall, 100 test plates were examined for each drug, 50 for the HD Check system and 50 for the conventional wipe method. The total number of pairs of samples is consistent with other side-by-side tests17,18,20 and allows for an understanding of the variability within each method.

Sample Collection

Two sets of plates were set up for each sampling round per test drug concentration (20 altogether). One set of samples (n = 10) was collected using conventional wipe sampling for laboratory analysis, and the other set of samples (n = 10) was collected using the HD Check system. A small volume (50 μl) of known drug concentration (as detailed above) was placed on each test of the plates. After the surface was allowed to dry naturally (for about 15 min), the residual drug was wiped by a single individual (C.Y.H.) using the conventional method.24 Briefly, this method involved use of a Whatman filter moistened with a solution of water/methyl alcohol 20:80 with 0.1% formic acid. Subsequently, the wipe samples were analyzed by high-performance liquid chromatography tandem mass spectroscopy (HPLC-MS/MS), as described by Colombo and others,24 at the Occupational and Environmental Hygiene laboratory, University of British Columbia, Vancouver, British Columbia.

After the first 10 plates were wiped via conventional testing, the same individual (C.Y.H.) sampled the remaining 10 plates with the HD Check system (to minimize the likelihood of inter-individual variability). Subsequently, the HD Check results were read using the system’s digital reader, according to the manufacturer’s instructions, and the findings, either positive or negative, were documented.

The wiping pattern for both conventional wipe sampling and HD Check sampling involved a back-and-forth motion in the vertical direction, followed by a back-and-forth motion in the horizontal direction. For the conventional wipe method, the wipe material was folded over to reveal a “fresh” side before wiping in the horizontal direction.

The sample collection procedure was repeated for every test drug concentration for each of the 2 HD Check assays (for MTX and CP). Between test drug concentrations, each set of plates was cleaned as described by Jeronimo and others.25

RESULTS

With the HD Check assay for MTX, positive results were obtained in every test trial at all drug concentrations examined. In other words, the assay was able to detect positive contamination at concentrations less than its LOD (specifically, 50% and 75% of 0.93 ng/cm2). The corresponding average MTX concentrations detected by conventional wipe sampling and analysis were as follows: 0.457 ng/cm2 at 50% of the LOD, 0.690 ng/cm2 at 75% of the LOD, 0.919 ng/cm2 at 100% of the LOD, and 1.854 ng/cm2 at 200% of the LOD (Table 1).

TABLE 1.

Side-by-Side Comparison of Results for Methotrexate

graphic file with name cjhp-76-87t1.jpg

Concentrationa Sample ID Wipe Sampling Result (ng/cm2)b HD Check Result
50% of device LOD BD-T-M-50-1 0.472 Positive
BD-T-M-50-2 0.460 Positive
BD-T-M-50-3 0.594 Positive
BD-T-M-50-4 0.495 Positive
BD-T-M-50-5 0.360 Positive
BD-T-M-50-6 0.414 Positive
BD-T-M-50-7 0.422 Positive
BD-T-M-50-8 0.483 Positive
BD-T-M-50-9 0.402 Positive
BD-T-M-50-10 0.468 Positive
Overallc 0.457 (0.064) 100%
75% of device LOD BD-T-M-75-1 0.517 Positive
BD-T-M-75-2 0.888 Positive
BD-T-M-75-3 1.014 Positive
BD-T-M-75-4 0.085 Positive
BD-T-M-75-5 0.626 Positive
BD-T-M-75-6 0.701 Positive
BD-T-M-75-7 0.978 Positive
BD-T-M-75-8 0.575 Positive
BD-T-M-75-9 0.784 Positive
BD-T-M-75-10 0.733 Positive
Overallc 0.690 (0.269) 100%
100% of device LOD BD-T-M-100-1 1.152 Positive
BD-T-M-100-2 0.399 Positive
BD-T-M-100-3 0.072 Positive
BD-T-M-100-4 0.658 Positive
BD-T-M-100-5 0.478 Positive
BD-T-M-100-6 0.889 Positive
BD-T-M-100-7 0.896 Positive
BD-T-M-100-8 1.615 Positive
BD-T-M-100-9 1.133 Positive
BD-T-M-100-10 1.899 Positive
Overallc 0.919 (0.558) 100%
200% of device LOD BD-T-M-200-1 1.609 Positive
BD-T-M-200-2 1.275 Positive
BD-T-M-200-3 2.135 Positive
BD-T-M-200-4 1.919 Positive
BD-T-M-200-5 2.009 Positive
BD-T-M-200-6 1.983 Positive
BD-T-M-200-7 1.978 Positive
BD-T-M-200-8 1.902 Positive
BD-T-M-200-9 1.540 Positive
BD-T-M-200-10 2.188 Positive
Overallc 1.854 (0.288) 100%
Open in a new tab
a

LOD = limit of detection of the BD HD Check system. For methotrexate, LOD = 0.93 ng/cm2.

b

All wipe sampling results have been corrected for the blank.

c

Overall results presented as average (standard deviation) for conventional wipe sampling and as percent positive for HD Check system.

With the HD Check assay for CP, test results were all positive at 100% and 200% of the assay LOD (where LOD = 4.65 ng/cm2). The corresponding average CP concentrations determined by conventional wipe sampling were 4.542 ng/cm2 at 100% of the LOD and 9.224 ng/cm2 at 200% of the LOD. However, at 50% and 75% of the LOD, the HD Check results were positive in only 9 of the 10 test trials. At these 2 concentrations, the corresponding average CP concentrations detected by the conventional wipe sampling method were 2.235 ng/cm2 and 3.374 ng/cm2, respectively (Table 2).

TABLE 2.

Side-by-Side Comparison of Results for Cyclophosphamide

graphic file with name cjhp-76-87t2.jpg

Concentrationa Sample ID Wipe Sampling Result (ng/cm2)b HD Check Result
50% of device LOD BD-T-C-50-1 2.181 Positive
BD-T-C-50-2 2.434 Positive
BD-T-C-50-3 1.405 Positive
BD-T-C-50-4 2.587 Positive
BD-T-C-50-5 2.416 Positive
BD-T-C-50-6 2.512 Positive
BD-T-C-50-7 2.208 Negative
BD-T-C-50-8 2.341 Positive
BD-T-C-50-9 2.134 Positive
BD-T-C-50-10 2.131 Positive
Overallc 2.235 (0.333) 90%
75% of device LOD BD-T-C-75-1 3.814 Positive
BD-T-C-75-2 2.778 Positive
BD-T-C-75-3 3.187 Negative
BD-T-C-75-4 4.114 Positive
BD-T-C-75-5 3.519 Positive
BD-T-C-75-6 3.263 Positive
BD-T-C-75-7 3.153 Positive
BD-T-C-75-8 3.402 Positive
BD-T-C-75-9 2.889 Positive
BD-T-C-75-10 3.625 Positive
Overallc 3.374 (0.410) 90%
100% of device LOD BD-T-C-100-1 4.217 Positive
BD-T-C-100-2 3.949 Positive
BD-T-C-100-3 4.541 Positive
BD-T-C-100-4 4.625 Positive
BD-T-C-100-5 4.757 Positive
BD-T-C-100-6 5.096 Positive
BD-T-C-100-7 3.954 Positive
BD-T-C-100-8 4.535 Positive
BD-T-C-100-9 5.284 Positive
BD-T-C-100-10 4.463 Positive
Overallc 4.542 (0.437) 100%
200% of device LOD BD-T-C-200-1 9.381 Positive
BD-T-C-200-2 9.266 Positive
BD-T-C-200-3 9.439 Positive
BD-T-C-200-4 7.394 Positive
BD-T-C-200-5 10.407 Positive
BD-T-C-200-6 10.199 Positive
BD-T-C-200-7 9.837 Positive
BD-T-C-200-8 8.250 Positive
BD-T-C-200-9 8.313 Positive
BD-T-C-200-10 9.752 Positive
Overallc 9.224 (0.955) 100%
Open in a new tab
a

LOD = limit of detection of the BD HD Check system. For cyclophosphamide, LOD = 4.65 ng/cm2.

b

All wipe sampling results have been corrected for the blank.

c

Overall results presented as average (standard deviation) for convention wipe sampling and as percent positive for HD Check system.

DISCUSSION

The objective of this study was to ascertain whether a novel direct-reading device based on LFIA technology, the HD Check system, can detect hazardous drug contamination levels to the same extent as the conventional wipe sampling method. By conducting side-by-side comparisons of the 2 methods, the investigator found that the MTX assay was capable of detecting drug contamination from stainless steel surfaces at all (100%) concentrations tested, including at 50% of the LOD of 0.93 ng/cm2. However, the CP assay was able to detect the presence of drug concentration in all instances only for contamination with solutions at 100% and 200% of the LOD of 4.65 ng/cm2; at 50% and 75% of the LOD, the assay detected the drug on the surface in only 90% of the test trials.

Relatively speaking, the LODs of the HD Check assays are higher than average or median concentrations found in previous surface contamination studies conducted in Canada. Hon and others26 evaluated surface contamination levels on more than 400 surfaces and objects found throughout the hospital medical system in health care facilities in British Columbia and reported an average CP concentration of 0.201 ng/cm2. In their study of Quebec hospitals, Bussières and others27 reported median concentrations of 0.0035 ng/cm2 for CP and less than 0.0060 ng/cm2 for MTX. In a more recent Canadian study involving 83 centres,28 the same author group found that the 75th percentile concentration for CP was 0.004 ng/cm2, whereas the 75th percentile concentration for MTX was less than 0.0020 ng/cm2. Moreover, surface contamination levels in Canadian facilities are showing a downward trend over time.29

Of note, the US Pharmacopeial Convention’s General Chapter <800>,10 a best practice document that is widely referenced for use by hospital pharmacies in North America, has indicated a maximum threshold level of 1 ng/cm2 for CP to reduce the risk of uptake among exposed individuals. Therefore, the promising results offered by the HD Check system must be tempered by the recognition that even though the device yielded positive findings at 50% of the LOD, that value is still higher than the drug concentrations typically found on hospital surfaces.

That being said, all of the maximum values reported in the aforementioned surface contamination studies were greater than 0.93 ng/cm2 and 4.65 ng/cm2, the LODs of the MTX and CP HD Check assays, respectively. As such, HD Check systems could be of value to screen for those surfaces likely to be highly contaminated, such as biological safety cabinets after drug preparation or after a spill or leak of drugs. If the HD Check system yields a positive result, then cleaning of the surfaces would be needed, or it might be necessary to sample the surface with a conventional wipe method to quantify the amount of contamination. In fact, this scheme was proposed following the 2020 Safe to Touch Conference, composed of experts with experience in hazardous drug handling, monitoring, and research. The consensus statement issued by conference attendees included the recommendation to “employ both qualitative and quantitative tests for ongoing surface contamination monitoring”.30

Some limitations of this study should be noted. The results are applicable only to the 2 assay systems evaluated (for MTX and CP). Other assays that are commercially available were not evaluated, and their results may differ from those reported here. The LODs listed in product materials of the HD Check systems are actually 0.1 ng/cm2 for MTX and 0.5 ng/cm2 for CP; however, these values are based on a sampling area of 1 ft2 or 930 cm2 (Product Manager, BD, written personal communication, July 27, 2021). Had this larger wipe sampling area been tested, rather than the typical 100 cm2 employed in the current study, the findings might have been different. Finally, only stainless steel surfaces were examined, and the results might differ for other types of surfaces found in health care facilities (e.g., laminate, metal, plastic).

CONCLUSION

Despite its limitations, this study showed that the HD Check system was able to positively identify hazardous drug contamination at concentrations below the listed LODs with a fair degree of repeatability, relative to a conventional wipe sampling method. To confirm these findings, it is suggested that future studies examine the HD Check system to detect drug contamination at lower gradients of the LOD (i.e., less than 50% of the LOD). It would also be important to test the ability to detect drug contamination on other types of surfaces, as well as uneven surfaces such as keyboards and calculators, which have been found to have drug contamination in prior studies.14 If the HD Check system is able to reliably detect positive drug contamination at lower concentrations (i.e., closer to the average reported in surface contamination studies), as well as from different types of surface materials, it could be considered an extremely useful tool for health care facilities to qualitatively assess drug contamination through environmental monitoring and, in turn, minimize the risk (though actual quantification of exposure levels will still not be possible with this device).

Acknowledgement

The author acknowledges the contributions of Matty Jeronimo of the Occupational and Environmental Hygiene laboratory at the University of British Columbia (Vancouver Campus).

Footnotes

Competing interests: Other than study funding (see below), no competing interests were declared.

Funding: This study was funded by Becton Dickinson and Company (BD), which also provided the HD Check assays. The funder did not influence the design of the study nor the analysis and interpretation of the data.

References

  • 1. Connor TH, McDiarmid MA. Preventing occupational exposures to antineoplastic drugs in health care settings. CA Cancer J Clin. 2006;56(6):354–65. doi: 10.3322/canjclin.56.6.354. [DOI] [PubMed] [Google Scholar]; Connor TH, McDiarmid MA. Preventing occupational exposures to antineoplastic drugs in health care settings. CA Cancer J Clin. 2006; 56(6):354–65. [DOI] [PubMed]
  • 2. Connor TH. Hazardous anticancer drugs in health care: environmental exposure assessment. Ann N Y Acad Sci. 2006;1076(1):615–23. doi: 10.1196/annals.1371.021. [DOI] [PubMed] [Google Scholar]; Connor TH. Hazardous anticancer drugs in health care: environmental exposure assessment. Ann N Y Acad Sci. 2006;1076(1):615–23. [DOI] [PubMed]
  • 3. Elshaer NS. Adverse health effects among nurses and clinical pharmacists handling antineoplastic drugs: adherence to exposure control methods. J Egypt Public Health Assoc. 2017;92(3):144–55. doi: 10.21608/epx.2017.16392. [DOI] [PubMed] [Google Scholar]; Elshaer NS. Adverse health effects among nurses and clinical pharmacists handling antineoplastic drugs: adherence to exposure control methods. J Egypt Public Health Assoc. 2017;92(3):144–55. [DOI] [PubMed]
  • 4. Ursini CL, Omodeo Salè E, Fresegna AM, Ciervo A, Jemos C, Maiello R, et al. Antineoplastic drug occupational exposure: a new integrated approach to evaluate exposure and early genotoxic and cytotoxic effects by no-invasive Buccal Micronucleus Cytome Assay biomarker. Toxicol Lett. 2019;316:20–6. doi: 10.1016/j.toxlet.2019.08.022. [DOI] [PubMed] [Google Scholar]; Ursini CL, Omodeo Salè E, Fresegna AM, Ciervo A, Jemos C, Maiello R, et al. Antineoplastic drug occupational exposure: a new integrated approach to evaluate exposure and early genotoxic and cytotoxic effects by no-invasive Buccal Micronucleus Cytome Assay biomarker. Toxicol Lett. 2019;316:20–6. [DOI] [PubMed]
  • 5. Moretti M, Grollino MG, Pavanello S, Bonfiglioli R, Villarini M, Appolloni M, et al. Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach. Int Arch Occup Environ Health. 2015;88(6):683–95. doi: 10.1007/s00420-014-0993-y. [DOI] [PubMed] [Google Scholar]; Moretti M, Grollino MG, Pavanello S, Bonfiglioli R, Villarini M, Appolloni M, et al. Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach. Int Arch Occup Environ Health. 2015;88(6):683–95. [DOI] [PubMed]
  • 6.Antineoplastic agents profile. CAREX Canada; 2019. [cited 2019 Dec 12]. Available from: https://www.carexcanada.ca/profile/antineoplastic_agents/ [Google Scholar]; Antineoplastic agents profile. CAREX Canada; 2019 [cited 2019 Dec 12]. Available from: https://www.carexcanada.ca/profile/antineoplastic_agents/
  • 7. Connor TH, DeBord G, Pretty JR, Oliver MS, Roth TS, Lees PSJ, et al. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med. 2010;52(10):1019–27. doi: 10.1097/JOM.0b013e3181f72b63. [DOI] [PubMed] [Google Scholar]; Connor TH, DeBord G, Pretty JR, Oliver MS, Roth TS, Lees PSJ, et al. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med. 2010; 52(10):1019–27. [DOI] [PubMed]
  • 8. Fransman W, Kager H, Meijster T, Heederik D, Kromhout H, Portengen L, et al. Leukemia from dermal exposure to cyclophosphamide among nurses in the Netherlands: quantitative assessment of the risk. Ann Occup Hyg. 2014;58(3):271–82. doi: 10.1093/annhyg/met077. [DOI] [PubMed] [Google Scholar]; Fransman W, Kager H, Meijster T, Heederik D, Kromhout H, Portengen L, et al. Leukemia from dermal exposure to cyclophosphamide among nurses in the Netherlands: quantitative assessment of the risk. Ann Occup Hyg. 2014;58(3):271–82. [DOI] [PubMed]
  • 9. Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D. Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes. Epidemiology. 2007;18(1):112–9. doi: 10.1097/01.ede.0000246827.44093.c1. [DOI] [PubMed] [Google Scholar]; Fransman W, Roeleveld N, Peelen S, de Kort W, Kromhout H, Heederik D. Nurses with dermal exposure to antineoplastic drugs: reproductive outcomes. Epidemiology. 2007;18(1):112–9. [DOI] [PubMed]
  • 10.United States Pharmacopeia and National Formulary. (USP 40-NF 35) United States Pharmacopeial Convention; 2013. USP general chapter <800>: hazardous drugs — handling in healthcare settings. [cited 2023 Jan 16] Available from: https://www.usp.org/compounding/general-chapter-hazardous-drugs-handling-healthcare. [Google Scholar]; USP general chapter <800>: hazardous drugs — handling in healthcare settings. In: United States Pharmacopeia and National Formulary (USP 40-NF 35). United States Pharmacopeial Convention; 2013 [cited 2023 Jan 16]. Available from: https://www.usp.org/compounding/general-chapter-hazardous-drugs-handling-healthcare
  • 11. Connor T, McLauchlan R, Vandenbroucke J. ISOPP standards of practice – safe handling of cyototoxics. J Oncol Pharm Pract. 2007;13(3 Suppl):1–81. doi: 10.1177/1078155207082350. [DOI] [PubMed] [Google Scholar]; Connor T, McLauchlan R, Vandenbroucke J. ISOPP standards of practice – safe handling of cyototoxics. J Oncol Pharm Pract. 2007;13 (3 Suppl):1–81. [DOI] [PubMed]
  • 12.Model standards for pharmacy compounding of hazardous sterile preparations. National Association of Pharmacy Regulatory Authorities; 2016. [cited 2018 Oct 12]. Available from: https://napra.ca/sites/default/files/2017-09/Mdl_Stnds_Pharmacy_Compounding_Hazardous_Sterile_Preparations_Nov2016_Revised_b.pdf. [Google Scholar]; Model standards for pharmacy compounding of hazardous sterile preparations. National Association of Pharmacy Regulatory Authorities; 2016 [cited 2018 Oct 12]. Available from: https://napra.ca/sites/default/files/2017-09/Mdl_Stnds_Pharmacy_Compounding_Hazardous_Sterile_Preparations_Nov2016_Revised_b.pdf
  • 13. Connor TH, Zock MD, Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: methodology and recommendations. J Occup Environ Hyg. 2016;13(9):658–67. doi: 10.1080/15459624.2016.1165912. [DOI] [PMC free article] [PubMed] [Google Scholar]; Connor TH, Zock MD, Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: methodology and recommendations. J Occup Environ Hyg. 2016;13(9):658–67. [DOI] [PMC free article] [PubMed]
  • 14. Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374–84. doi: 10.1080/15459624.2013.789743. [DOI] [PubMed] [Google Scholar]; Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374–84. [DOI] [PubMed]
  • 15. Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, et al. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2016;22(3):396–408. doi: 10.1177/1078155215585187. [DOI] [PMC free article] [PubMed] [Google Scholar]; Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, et al. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2016;22(3):396–408. [DOI] [PMC free article] [PubMed]
  • 16. Connor TH, Smith JP. New approaches to wipe sampling methods for antineoplastic and other hazardous drugs in healthcare settings. Pharm Technol Hosp Pharm. 2016;1(3):107–14. doi: 10.1515/pthp-2016-0009. [DOI] [PMC free article] [PubMed] [Google Scholar]; Connor TH, Smith JP. New approaches to wipe sampling methods for antineoplastic and other hazardous drugs in healthcare settings. Pharm Technol Hosp Pharm. 2016;1(3):107–14. [DOI] [PMC free article] [PubMed]
  • 17. Coy JD, Bigelow PL, Buchan RM, Tessari JD, Parnell JO. Field evaluation of a portable photoionization detector for assessing exposure to solvent mixtures. Am Ind Hyg Assoc J. 2000;61(2):268–74. doi: 10.1202/0002-8894(2000)061&#x0003c;0268:FEOAPP&#x0003e;2.0.CO;2. [DOI] [PubMed] [Google Scholar]; Coy JD, Bigelow PL, Buchan RM, Tessari JD, Parnell JO. Field evaluation of a portable photoionization detector for assessing exposure to solvent mixtures. Am Ind Hyg Assoc J. 2000;61(2):268–74. [DOI] [PubMed]
  • 18. Lehocky AH, Williams PL. Comparison of respirable samplers to direct-reading real-time aerosol monitors for measuring coal dust. Am Ind Hyg Assoc J. 1996;57(11):1013–8. doi: 10.1080/15428119691014341. [DOI] [Google Scholar]; Lehocky AH, Williams PL. Comparison of respirable samplers to direct-reading real-time aerosol monitors for measuring coal dust. Am Ind Hyg Assoc J. 1996;57(11):1013–8.
  • 19. Kim JY, Magari SR, Herrick RF, Smith TJ, Christiani DC. Comparison of fine particle measurements from a direct-reading instrument and a gravimetric sampling method. J Occup Environ Hyg. 2004;1(11):707–15. doi: 10.1080/15459620490515833. [DOI] [PubMed] [Google Scholar]; Kim JY, Magari SR, Herrick RF, Smith TJ, Christiani DC. Comparison of fine particle measurements from a direct-reading instrument and a gravimetric sampling method. J Occup Environ Hyg. 2004;1(11):707–15. [DOI] [PubMed]
  • 20. Sleeth DK, Pahler LF, Larson RR. A comparison of direct-reading instruments for the measurement of hexavalent chromium during stainless steel welding. J Chem Health Saf. 2016;23(3):36–42. doi: 10.1016/j.jchas.2015.10.014. [DOI] [Google Scholar]; Sleeth DK, Pahler LF, Larson RR. A comparison of direct-reading instruments for the measurement of hexavalent chromium during stainless steel welding. J Chem Health Saf. 2016;23(3):36–42.
  • 21. Hirst DVL, Gressel MG, Flanders WD. Short-term monitoring of formaldehyde: comparison of two direct-reading instruments to a laboratory-based method. J Occup Environ Hyg. 2011;8(6):357–63. doi: 10.1080/15459624.2011.578499. [DOI] [PubMed] [Google Scholar]; Hirst DVL, Gressel MG, Flanders WD. Short-term monitoring of formaldehyde: comparison of two direct-reading instruments to a laboratory-based method. J Occup Environ Hyg. 2011;8(6):357–63. [DOI] [PubMed]
  • 22. Taylor CD, Reynolds SJ. Comparison of a direct-reading device to gravimetric methods for evaluating organic dust aerosols in an enclosed swine production environment. Appl Occup Environ Hyg. 2001;16(1):78–83. doi: 10.1080/104732201456159. [DOI] [PubMed] [Google Scholar]; Taylor CD, Reynolds SJ. Comparison of a direct-reading device to gravimetric methods for evaluating organic dust aerosols in an enclosed swine production environment. Appl Occup Environ Hyg. 2001;16(1):78–83. [DOI] [PubMed]
  • 23.National Institutes of Health. Prospective grant of exclusive patent commercialization license: direct reading detection kits for surface contamination by antineoplastic drugs [notice] Fed Reg. 2017. [cited 2021 Oct 7];82 FR 53512. Available from: https://www.federalregister.gov/documents/2017/11/16/2017-24774/prospective-grant-of-exclusive-patent-commercialization-license-direct-reading-detection-kits-for.; National Institutes of Health. Prospective grant of exclusive patent commercialization license: direct reading detection kits for surface contamination by antineoplastic drugs [notice]. Fed Reg. 2017 [cited 2021 Oct 7];82 FR 53512. Available from: https://www.federalregister.gov/documents/2017/11/16/2017-24774/prospective-grant-of-exclusive-patent-commercialization-license-direct-reading-detection-kits-for
  • 24. Colombo M, Jeronimo M, Astrakianakis G, Apte C, Hon CY. Wipe sampling method and evaluation of environmental variables for assessing surface contamination of 10 antineoplastic drugs by liquid chromatography/tandem mass spectrometry. Ann Work Expo Health. 2017;61(8):1003–14. doi: 10.1093/annweh/wxx070. [DOI] [PubMed] [Google Scholar]; Colombo M, Jeronimo M, Astrakianakis G, Apte C, Hon CY. Wipe sampling method and evaluation of environmental variables for assessing surface contamination of 10 antineoplastic drugs by liquid chromatography/tandem mass spectrometry. Ann Work Expo Health. 2017;61(8):1003–14. [DOI] [PubMed]
  • 25. Jeronimo M, Colombo M, Astrakianakis G, Hon CY. A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers. Anal Bioanal Chem. 2015;407(23):7083–92. doi: 10.1007/s00216-015-8868-y. [DOI] [PubMed] [Google Scholar]; Jeronimo M, Colombo M, Astrakianakis G, Hon CY. A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers. Anal Bioanal Chem. 2015;407(23):7083–92. [DOI] [PubMed]
  • 26. Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374–83. doi: 10.1080/15459624.2013.789743. [DOI] [PubMed] [Google Scholar]; Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374–83. [DOI] [PubMed]
  • 27. Bussières JF, Tanguay C, Touzin K, Langlois É, Lefebvre M. Environmental contamination with hazardous drugs in Quebec hospitals. Can J Hosp Pharm. 2012;65(6):428–35. doi: 10.4212/cjhp.v65i6.1190. [DOI] [PMC free article] [PubMed] [Google Scholar]; Bussières JF, Tanguay C, Touzin K, Langlois É, Lefebvre M. Environmental contamination with hazardous drugs in Quebec hospitals. Can J Hosp Pharm. 2012;65(6):428–35. [DOI] [PMC free article] [PubMed]
  • 28. Chauchat L, Tanguay C, Caron NJ, Gagné S, Labrèche F, Bussières JF. Surface contamination with ten antineoplastic drugs in 83 Canadian centers. J Oncol Pharm Pract. 2019;25(5):1089–98. doi: 10.1177/1078155218773862. [DOI] [PubMed] [Google Scholar]; Chauchat L, Tanguay C, Caron NJ, Gagné S, Labrèche F, Bussières JF. Surface contamination with ten antineoplastic drugs in 83 Canadian centers. J Oncol Pharm Pract. 2019;25(5):1089–98. [DOI] [PubMed]
  • 29. Berruyer M, Tanguay C, Caron NJ, Lefebvre M, Bussières JF. Multicenter study of environmental contamination with antineoplastic drugs in 36 Canadian hospitals: a 2013 follow-up study. J Occup Environ Hyg. 2015;12(2):87–94. doi: 10.1080/15459624.2014.949725. [DOI] [PubMed] [Google Scholar]; Berruyer M, Tanguay C, Caron NJ, Lefebvre M, Bussières JF. Multicenter study of environmental contamination with antineoplastic drugs in 36 Canadian hospitals: a 2013 follow-up study. J Occup Environ Hyg. 2015;12(2):87–94. [DOI] [PubMed]
  • 30. Gabay M, Johnson P, Fanikos J, Amerine L, Kienle P, Olsen MK, et al. Report on 2020 Safe To Touch Consensus Conference On Hazardous Drug Surface Contamination. Am J Health Syst Pharm. 2021;78(17):1568–75. doi: 10.1093/ajhp/zxab134. [DOI] [PubMed] [Google Scholar]; Gabay M, Johnson P, Fanikos J, Amerine L, Kienle P, Olsen MK, et al. Report on 2020 Safe To Touch Consensus Conference On Hazardous Drug Surface Contamination. Am J Health Syst Pharm. 2021;78(17): 1568–75. [DOI] [PubMed]

Articles from The Canadian Journal of Hospital Pharmacy are provided here courtesy of Canadian Society of Healthcare-Systems Pharmacy

RESOURCES