Wick C, Slawson, M.H., Jorgenson, J.A., Tyler, L.S. (2003).Using a closed-system protective device to reduce personnel exposure to antineoplastic agents.  American Journal of Health-System Pharmacy; 60: 2314-2320.

This study was conducted at University of Utah, a newly constructed comprehensive cancer center with state of the art Class II biological safety cabinets and customary procedures. Samples were collected before and six months after implementation of PhaSeal, a closed-system transfer device for preventive exposure to antineoplastic agents during preparation and administration. Personnel exposure was evaluated by collecting 24-hour urine samples from pharmacists, pharmacy technicians, and nurses working fulltime in a chemotherapy drug infusion center and pharmacy. Surface contamination was evaluated by wiping potentially contaminated surfaces. Both surface and urine samples were examined for cyclophosphamide and ifosfamide by high-performance liquid chromatography–electrospray ionization–tandem mass spectrometry. A total of 17 wipe samples were collected before implementation of PhaSeal and detectable levels of cyclophosphamide were identified, and 11 were positive for ifosfamide. Six months after the PhaSeal system was implemented, 7 of 21 wipe samples had detectable levels of cyclophosphamide and 15 were positive for ifosfamide. Of the eight employees who provided urine samples, six were positive for cyclophosphamide and two for ifosfamide before implementation, and none were positive for either drug after implementation. The implications for this study conclude that the PhaSeal system reduced exposure of health care personnel to cyclophosphamide and ifosfamide and that Class II BSCs alone is insufficient to reduce exposure of hazardous drugs to health care personnel.

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