Hospital Pharmacy - September 2017 - 551

722870
research-article2017

HPXXXX10.1177/0018578717722870Hospital PharmacyCall et al

Article

Hazardous Drug Contamination of
Drug Preparation Devices and Staff:
A Contamination Study Simulating the
Use of Chemotherapy Drugs in a Clinical
Setting

Hospital Pharmacy
2017, Vol. 52(8) 551-558
© The Author(s) 2017
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https://doi.org/10.1177/0018578717722870
DOI: 10.1177/0018578717722870
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Evan Call1*, Brian Bill1, Chad McLean1, Nathan Call1,
Allyn Bernkopf1, and Craig Oberg1*

Abstract
Background: Hazardous drug contamination (HD) in healthcare environments continues, placing healthcare staff at
risk of significantly chronic health problems, despite the use of personal protective equipment (PPE) and closed system
transfer device systems (CSTDs). Objective: This study's aim was to determine how HD might spread through touch
after handling contaminated vials in simulated pharmacy and nursing environments. Methods: UV fluorescent powder
Glo Germ (Glo Germ Co., Moab, UT), composed of melamine resin, was used to simulate HD. Following manufacturer's
exact usage specifications, five commercially available CSTDs were tested in the simulated pharmaceutical preparation
environment under controlled conditions. UV fluorescence was used to detect the test medium powder that simulated
HD following each trial. Photographs, using a Nikon D40X (10.2 mp) camera, were taken at selected stages of testing to
document the presence of HD. Results: Transfer of the HD testing medium (Glo Germ) to IV sets, pharmacy PPE, and
nursing PPE was observed in 4 of 5 CSTDs tested. The only CSTDs that showed no observable contamination was the
Allison Medical Safety Enclosed Vial Adapter (SEVA) system (Littleton, CO). Conclusions: Results show residue from
HD vials spread as vial was handled in a pharmacy environment in 4 of 5 CSTDs, contaminating pharmacy PPE, ancillary
products, and nursing PPE. No HD residue was detected on PPE, ancillary products, or nursing PPE in the pharmacy after
using the SEVA system, providing an effective means to contain HD for drug transfer from vial to delivery system.
Keywords
antineoplastic drugs, surface contamination, cleaning, health care, pilot study

Introduction
Health care worker exposure to hazardous drugs (HDs), such
as an agent with antineoplastic properties, antiviral agents,
biological modifiers, and hormones, can cause workers to
experience adverse reactions, including asthma, birth defects,
miscarriages, and cancer.1 Chemotherapy treatment for cancer, specifically the agents with antineoplastic properties, has
been shown to potentially produce physiological and DNAdamaging effects since the late 1970s.2 Contamination of
work surfaces3 and personnel4 continues to create a health
risk for pharmacy staff involved in antineoplastic drug preparation and for nurses involved in delivery of those drugs to
cancer patients. Kiffmeyer et al demonstrated this issue's
significance by testing 1269 drug preparation surfaces, and
finding HD contamination on 744 of those surfaces.3 Their
study most likely understated the issue, as the assay was

done for only 5 antineoplastic drugs, leaving the contamination created by alternative drugs undetected. Buschini et al
reported 63 potentially exposed nurses at multiple centers in
Italy.4 The comet assay study showed a significantly lower
mean value for the percentage of DNA in the comet trial than
a comparable group, suggesting chronic exposure to crosslinking antineoplastic drugs.4 Testa et al found a significant
increase in chromosomal damage and aberrations in nurses
1

Weber State University, Ogden, UT, USA

*Evan Call & Craig Oberg were the authors from the Weber State
University microbiology department.
Corresponding Author:
Evan Call, Department of Microbiology, Weber State University, Ogden,
UT 84102, USA.
Email: evan@ec-service.net
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