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Protecting Healthcare Workers by Detecting Contamination from Hazardous Antineoplastic Drugs

Antineoplastic drugs, also known as anti-cancer drugs or chemotherapy, are used in the treatment of many types of cancer. Currently, an estimated 8 million U.S. healthcare workers are potentially exposed to antineoplastic drugs. Workers prepare, administer, or dispose of antineoplastic drugs when providing chemotherapy to cancer patients. Others provide direct patient care and may come in contact with contaminated surfaces. Exposure of healthcare workers to antineoplastic drugs from contaminated surfaces and drug vials in hospitals and pharmacies is a continuing problem since the drugs can cause both acute and long-term health effects. They can cause skin problems, birth defects, and reproductive issues as well as increase the risk of various cancers. Chemical residues from antineoplastic drugs can quietly contaminate clinics and labs, exposing pharmacists, nurses, doctors, and other healthcare providers to harmful toxins.  

Safety standards require routine testing to check for hazardous residues on work surfaces. Unfortunately, the existing techniques used to detect such contamination take several weeks, use expensive equipment, and must be performed in specialized laboratories by trained analysts. In the meantime, the staff continues to be exposed to harmful antineoplastic chemicals.

Centers for Disease Control and Prevention (CDC) researchers at the National Institute for Occupational Safety and Health (NIOSH) developed a technology to detect three commonly used antineoplastic drugs. CDC initially developed the lateral flow immunoassay (LFIA) that allows sampling of surfaces to assess drug contamination. CDC NIOSH’s partners at Becton, Dickinson, and Company (BD) licensed, further developed and incorporated the technology into a portable device. The resulting tool, the BD® HD Check system, can analyze samples and provide reliable results quickly.

The HD Check system includes a collection kit, assay cartridges for doxorubicin or methotrexate, an analyzer, and a surface area template. The analyzer detects hazardous drugs at a very low threshold of 0.1 ng/cm2. It produces a positive result on contaminated surfaces at or above the detection threshold with 95% certainty, and a surface free of contamination is 95% certain to produce a negative result. As the HD Check system detects the presence of hazardous drugs, it can log the results and compile contamination trends each time the area is checked. The HD Check system facilitates routine testing, evaluates the effectiveness of safe handling processes, and offers a simple way to help justify quality control investments and safe handling compliance efforts (e.g., protective equipment and closed system drug-transfer devices). The system can be used to quickly assess decontamination procedures. The system can also be used for environmental sampling and detection for surface contamination by antineoplastic drugs in hospitals, pharmacies, and other healthcare institutions. Lastly, kits can aid in the development of work practices to lower healthcare worker exposure to antineoplastic drugs from contaminated surfaces. Kits for several other antineoplastic agents are in development.

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Southeast