Environmental contamination with fluorouracil on floors and ceilings in antineoplastic drug preparation and nonpreparation areas of a Japanese cancer center

Introduction Environmental monitoring of antineoplastic drug contamination has primarily focused on medication preparation areas and frequently touched surfaces. Consequently, contamination in nonpreparation areas and on infrequently touched surfaces, such as ceilings, remains poorly characterized. This study evaluated fluorouracil contamination on floors and ceilings in preparation and nonpreparation areas. Methods This study was conducted at Aichi Cancer Center, Japan. Samples were collected from floor and ceiling surfaces in the hospital pharmacy, outpatient chemotherapy center, and inpatient ward. Cleaning practices at the sampling sites were also assessed. Fluorouracil concentrations were measured using liquid chromatography–tandem mass spectrometry. At the time of sampling, closed-system drug-transfer devices (CSTDs) were not used for fluorouracil preparation or administration. Results Fluorouracil was detected on all sampled floor and ceiling surfaces, including those in nonpreparation areas where antineoplastic drugs were not handled. The highest contamination levels were detected on the preparation room floor (3.104 ng/cm 2 ) and the pharmacy break room ceiling (2.440 ng/cm 2 ). In the outpatient chemotherapy center, relatively high contamination levels were detected on the nursing station floor (0.622 ng/cm 2 ) and nursing break room ceiling (0.419 ng/cm 2 ). Conclusions Fluorouracil contamination was detected in nonpreparation areas and on ceiling surfaces near air-conditioning units that were not routinely touched or cleaned. These findings suggest that contamination may spread through the movement of healthcare workers and materials and may accumulate on infrequently cleaned surfaces. As part of contamination control, the use of CSTDs may need to be implemented and environmental monitoring may need to be extended beyond medication preparation areas.