Nygren, O., Gustavsson, B., Strom, L., Eriksson, R., Jarneborn, L., and Friberg, A. (2002). Exposure to anti-cancer drugs during preparation and administration. Investigations of an open and a closed system   Journal of Environmental Monitoring, 4(5):739-42.

The sample population consisted of ten nurses’ at Ostra Hospital from the surgical clinic. They were selected based upon their experience and inexperience as nurses. All subjects were non-smoking females being 20–55 years of age. The study required all ten nurses to make six preparations and administrations and six vials that contained approximately 1.5 mL solution with 99mTc and Pt, using both the traditional technique and a closed system transfer device (CSTD), PhaSeal. Platinum (Pt), determined using adsorptive voltammetry, was used as the tracer for airborne emission. For determination of spills and leakage onto surfaces the radioisotope 99m-technetium (Tc) was used as a tracer.

The experiments were carried out in a drug preparation room using a special set-up. During the preparation phase, a 9 mL aliquot of saline, pre-filled into a 10mL syringe, was injected into one of the spiked 10 mL vials, which could hold a volume up to 12 mL. Following the mixing, 6 mL was withdrawn back into the syringe, which then was released from the vial and placed in a kidney dish. Throughout the administration phase, the syringe was connected to the infusion system using a Luer-lock coupling and a three-way valve mounted on the tubing to the infusion bag. The valve was opened and the 6 mL solution was injected into the infusion bag. Then the valve was closed and the syringe disconnected. After each preparation and administration, the gloves and covers were changed and the used ones were placed in a plastic bag and saved for radiation measurement. Stationary air sampling was performed at six places around the set-up. Air was sampled during the whole experiment at flow rates of about 10 L min_1 using vacuum pumps and each subject carried a personal sampling device, and air was sampled at a flow rate of 2 L min -1   using a portable pump. Each nurse generated approximately 12 plastic bags with gloves and covers and seven filter samples. The results from the preparation and administration, using the two different techniques were, the mean airborne emission was 6 ng m(-3) with PhaSeal  and 15 ng m(-3) with the traditional pump technique. The average surface spillage using the PhaSeal system, a closed technique was 0.005 microL. This is significantly smaller than with the traditional technique, which resulted in an average spillage of 64 microL. Concluding that traditional technique results in significant exposure when compared to using a CSTD, PhaSeal, where the exposure is significantly lower.

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