Contamination on inner walls of syringes used for compounding and administration of hazardous drugs

PurposeThe aim of the study was to measure contamination on inner walls of syringes used for compounding hazardous drugs. As the syringes have an open connection to the environment, evaporation of the drugs could result in environmental contamination and potential exposure of healthcare workers.MethodsForty-three 50 mL BD Plastipak luer lock syringes were collected after single use in compounding hazardous drugs. The inner wall of the barrel was wiped for each syringe. Potential remaining contamination was also measured by liquid extraction to verify the effectiveness of the wiping procedure. Six hazardous drugs were tested. Liquid chromatography tandem mass spectrometry was used for the analysis of cyclophosphamide, doxorubicin, 5-fluorouracil, ifosfamide, and methotrexate. Platinum analysis of cisplatin was performed with voltammetry.ResultsContamination was found for all cyclophosphamide, doxorubicin, ifosfamide, and methotrexate syringes, for eight out of ten 5-fluorouracil syringes, and for none of the cisplatin syringes. Contamination as part of the dose transferred differs between the drugs showing the highest contamination for doxorubicin (median 21.90 ppm) followed by cyclophosphamide (median 1.24 ppm), and ifosfamide (median 0.60 ppm). The lowest contamination was measured for 5-fluorouracil (median 0.02 ppm) and methotrexate (median 0.006 ppm).ConclusionContamination was found on almost all syringes and differs between the drugs indicating some drugs stick more to the inner walls and plunger shafts than others. Contamination implies a potential exposure risk as hazardous drugs could evaporate from the open syringes, contaminate the working environment, and expose healthcare workers.