Chemotherapy Residue on the Check-out Desk?

A recently published article described what happens during a National Institute of Occupational Safety and Health (NIOSH) health hazard evaluation (HHE). Apparently, employers, employees, or union representatives can request an HHE of their workplace to investigate health and safety concerns. My guess is that few people in the oncology community are aware of this. The article details the on-site review process, but in a nutshell, two site visits were made to an oncology clinic. During the first visit, NIOSH measured face velocity in the biological safety cabinet (BSC), which indicates airflow, and collected surface and hand wipe samples, which they analyzed for total platinum and would indicate platinum-containing drug contamination. As part of the HHE, 14 staff were interviewed and the practice’s safety log was reviewed. At the second visit, they again collected surface wipe samples at the beginning of the workday and again at the end of the day to detect cyclophosphamide, ifosfamide, and doxorubicin residue.

Most of the surface wipe samples from the first visit contained platinum, but hand wipe samples were negative. Surface wipe samples from locations throughout the clinic contained cyclophosphamide and ifosfamide, which suggests inadequate work practices and housekeeping. Cyclophosphamide was found in the check-out area, an area that should not have any drug contamination. One sample location remained positive for cyclophosphamide for all 3 days of the NIOSH’s second HHE visit, which suggests that cyclophosphamide was not being removed with one cleaning. The authors list suggestions for reducing chemotherapy contamination in the workplace; prevention of contamination if obviously the best way to approach this problem.

Reference Couch J, West C, Niemeier, MT What happens during a NIOSH HHE of an oncology clinic? Oncology Nurse Advisor May/June 2013, 20-24.