Gustavsson B. Evaluation of technetium assay for monitoring of occupational exposure to cytotoxic drugs. J Oncol Pharm Practice 1997; 3: 46

Occupational exposure to drugs is considered to be a health problem. The systems for preparation and administration of drugs are designed to protect the patient and to see that the drug is not contaminated, but do not fully consider the work environment for the medical staff. Closed preparation systems are therefore desirable. We have therefore compared a new closed system (PhaSeal®) with the ordinary traditional technique for preparation and administration of drugs with respect to airborne emission and surface leakage of the drug.

Methods: Ordinary drug vials were filled with 500µL of Te91 solution. The vials were then sealed using ordinary drug vial septum caps. Ten nurses were invited on a voluntary basis to participate in the experiments, and in each experiment, six preparations and administrations were used.
The experiments were carried out in a drug preparation room using a special set-up, and after each preparation or administration the gloves and covers were changed and saved for radiation measurements. Stationary air sampling was performed at six places around the set-up. In all experiments a commercial platinol standard was also used.

Results: The mean airborne platinol levels for each subject and techniques were calculated, and the concentration of platinol in the air was below 65 ng × m -3 for all test subjects. The use of pump technique gave about 2-3 times higher mean values compared with the PhaSeal® system. The mean leakage using the pump technique was about 3-4 orders of magnitude lower using the closed system, in comparison with the pump technique. With the PhaSeal® the leakage for all test subjects was never larger than 500nL for any single preparation or administration. All subjects succeeded to perform three or more leakage free preparations and administrations.

Conclusions: This study shows that the traditional technique for preparation and administration of cytotoxic drugs result in high average leakage even for skilled nurses, while the closed system resulted in almost non-detectable leakage even when handled by inexperienced subjects.

Department of Surgery, Östra sjukhuset, Göteborg, Sweden

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