Abstract
We gradually introduced exposure control countermeasures for anticancer drugs from 2008 to 2013. Their utility was evaluated for cyclophosphamide (CP) and 5-fluorouracil (5-FU) detected by a wipe test.
The countermeasures included use of a closed system (CS) from preparation to administration, vial-washing just after delivery, infuser pump preparation using CS, and preparation with priming using infusion. Continuous study of CP and 5-FU by wipe tests was performed in a preparation room in the pharmacy and chemotherapy center.
In the preparation room, CP was detected in the range of ND-0.15, apart from 1.54 ng/cm2 in 11/2008. 5-FU was gradually reduced to ND-0.81 (1/2012), ND-1.54 (3/2012), and ND-0.06 (3/2013) ng/cm2. In the chemotherapy center, CP was detected in the range of ND-0.06 ng/cm2, apart from a high level (0.74 ng/cm2) in 3/2012. 5-FU was detected at a high level (26.53-61.22 ng/cm2) in 1-3/2012; however, it decreased to ND-2.65 ng/cm2 in 3/2012-12/2012.
It was shown that CS and vial-washing are useful to reduce occupational exposure to anticancer drugs during pharmacy preparation. The results that 5-FU was detected when CP was not showed that use of only CP alone as an exposure marker is insufficient. It was considered that reduction of 5-FU exposure resulted from infuser pump preparation using CS. Furthermore, the preparation procedure with priming using infusion and CS use for administration reduced chemotherapy center exposure. The preparation of a secure work environment for healthcare workers is necessary to maintain high motivation for patient support.
