Impact of Elevation on Vial Pressure Differential in Anticancer Drug Preparation

Exposure to anticancer drugs among healthcare professionals is a significant occupational safety concern. In our institution, instances of drug splatter during the initial puncture of the vials frequently occur despite adherence to preparation protocols. We hypothesized that elevation might contribute to this phenomenon. To investigate this, we compared the internal pressure of the vials and the amount of drug splatter between a low-elevation facility (reference facility) and our high-elevation institution. The results indicated that the pressure differential in the vials at the reference facility ranged from −2.7 to 1.6 kPa, whereas it ranged from 5.2 to 9.7 kPa at our institution, demonstrating a clear positive pressure in the vials at our facility compared to the reference facility. In addition, the total amount of drug splatter was significantly higher at our institution, ranging from 1,199 to 2,909 μg, compared to 0.124 – 183 μg at the reference facility. These findings suggest that increased elevation leads to positive pressure within the vials, which facilitates drug splatter. This phenomenon poses a considerable risk to the preparers. We believe that addressing this issue will contribute to the establishment of a safer preparation environment.