Harrison, B., Peters, B., and Bing, M. (2006). Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques.  American Journal of Health-System Pharmacy, 63(18):1736-1744

A total of 342 samples were collected over a 36 week period to compare the levels of surface contamination with two antineoplastic drugs, cyclophosphamide and fluorouracil. Wipe sampling was conducted on countertops, floors, and hood surfaces inside three oncology pharmacies following these various drug preparation techniques: drug preparation with standard hazardous drug (HD) preparation techniques; a closed-system drug transfer device (CSTD) in conjunction with standard HD preparation techniques; a CSTD in conjunction with standard HD preparation techniques however, drug preparation was conducted on a countertop outside the biological safety cabinet (BSC). 

The wipe samples of the various surfaces in each pharmacy were obtained biweekly for 12 weeks to establish a baseline level. Following implementation of the CSTD, an additional six biweekly samples were collected. The CSTD was then removed and the final six samples were collected once more using standard preparation techniques. During the CSTD period, fluorouracil was prepared on the countertop outside the BSC. The results of the study were, with the use of a CSTD in the BSC in conjunction with standard HD preparation techniques significantly reduced cyclophosphamide surface contamination as compared to standard techniques alone. Preparation of fluorouracil outside the BSC using the CSTD did not result in significant methodically detectable contamination on the countertops. The clinical implications suggest that the use of the CSTD whether used in conjunction with a BSC or alone is sufficient to protect health care workers and their working environment from the incidental exposure to hazardous drugs during mixing and administration.

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