Assessing antineoplastic drug contamination in South African oncology pharmacies: Workplace and biological monitoring

IntroductionAntineoplastic drugs (ADs) are hazardous substances commonly used in medical oncology, posing health risks to pharmacy personnel through occupational exposure. Despite safety guidelines, contamination of surfaces in oncology pharmacies remains prevalent. In this study, we assessed surface contamination and biological uptake of ADs in selected South African oncology pharmacies.MethodsSix pharmacies (three from each of two medical oncology service providers, SP1 and SP2) participated. Surface wipe samples were collected from three areas in each pharmacy (containment-primary engineering control (C-PEC), floor, adjacent surface) before and after decontamination procedures. Nine ADs were quantified, using high-pressure liquid chromatography tandem mass spectrometry (HPLC-MS/MS). 24-h urine samples were collected from six pharmacy personnel. The DeRmal Exposure Assessment Method (DREAM) was used to estimate exposure risks. The results were compared with those from an observational study that assessed compliance with safety protocols in the same six pharmacies.ResultsSurface contamination was higher in SP1 than in SP2 pharmacies, with 5-fluorouracil (5-FU) being the most frequently detected AD. Post-decontamination samples showed a 17.4% reduction in 5-FU contamination, although SP1 pharmacies still had higher post-decontamination concentrations than SP2 pharmacies, especially on floors. Cyclophosphamide and ifosphamide were detected in the urine of two participants from SP1.ConclusionWe demonstrated higher contamination and occupational exposure risks in SP1 than in SP2 pharmacies, indicating a need for strict decontamination protocols and better use of personal protective equipment in the SP1 pharmacies. The SP2 pharmacies may serve as a model for oncology pharmacy safety in South Africa.