Controversy over the safe handling of cytotoxic dose forms has been around since the mid 1970s. Since then, many guidelines on the safe handling of cytotoxic agents in the workplace have evolved. Many healthcare workers believe these guidelines have diminished the risk to the worker. However, two recent publications have once again raised concerns.^1,2 Therefore, the question remains – should we be concerned? Two Australian studies have shown detectable levels of cytotoxic drug contamination in drug preparation areas on a variety of surfaces.^3,4 Contamination was found within the cytotoxic suite including the cytotoxic drug safety cabinet (CDSC), clean room, and anteroom. Of more concern was the finding of detectable levels of cytotoxic drugs on the checking areas and surfaces outside the controlled environment. Detectable levels of contamination have also been found on the outer surface of cytotoxic infusion bags prepared by in-house pharmacy departments and external providers of chemotherapy.^3,5 Quantifiable levels of external contamination on the outer surface of cytotoxic vials have also been well reported.^6,7 Interpretation of these results is interesting. Institutions must ensure their workers are protected and appropriate safe handling strategies are in place. These include adherence to safe practice guidelines, workplace audits, staff health monitoring, rigorous cleaning procedures, and the use of closed-systems to reduce contamination before it occurs.

1. Lawson C, Rocheleau C, Whelan E, et al. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obs Gyn 2012; 206:327.e1-e8

2. McDiarmid M, Oliver M, Roth T, Rogers B, Escalante C. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. JOEM 2010; 52:1028-34

3. Siderov J, Kirsa S, McLauchlan R. Surface contamination of chemotherapy preparation areas with antineoplastic agents in Australian hospital pharmacy departments. J Pharm Pract Res 2009; 39;95-9

4. Lee S, Tkaczuk M, Jankewicz G, Ambados F. Surface contamination from cytotoxic chemotherapy following preparation and administration. J Pharm Pract Res 2007; 37:271-6

5. Siderov J, Kirsa S, McLauchlan R. External surface contamination of cytotoxic admixtures – caveat emptor. J Pharm Pract Res 2011; 41:181-2

6. Gilbar PJ. External contamination of cytotoxic drug vials. [Editorial] J Pharm Pract Res 2005; 35:264-5

7. Connor TH Sessink PJM, Harrison BM, et al. Surface contamination of chemotherapy drug vials and evaluation of new vial-cleaning techniques: Results of three studies. Am J Health-Syst Pharm 2005; 62:475-84