PS-013 Multicentre study of environmental contamination with cyclophosphamide, ifosfamide and methotrexate in 66 canadian hospitals: a 2016 follow-up study

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Oncology workers are occupationally exposed to antineoplastic drugs. This exposure can induce adverse health effects. In order to reduce their exposure, contamination on surfaces should be kept as low as possible.


To monitor environmental contamination with cyclophosphamide, ifosfamide and methotrexate in oncology pharmacy and patient care areas in Canadian hospitals. To describe the impact of some factors that may limit contamination.

Material and methods

This was a descriptive study. 12 standardised sites were sampled in each participating centre (6 in the pharmacy and 6 in patient care areas). Samples were analysed for the presence of cyclophosphamide, ifosfamide and methotrexate by ultra performance liquid chromatography-tandem mass spectrometry technology. Descriptive statistical analyses were done and results were compared with a Kolmogorov–Smirnov test for independent samples.


In 2016, 66 hospitals from Canada participated in this study (66/202, 33%). A total of 752 samples were quantified. Overall, 43% (326/752) of the samples were positive for cyclophosphamide, 13% (99/752) for ifosfamide and 7% (52/752) for methotrexate. The 75th percentile value of cyclophosphamide surface concentration was 6.8 pg/cm2. For ifosfamide and methotrexate, they were lower than the LOD. The most frequently contaminated sites were the arm rest, the floor in front of the hood, the front grille of the hood and on the counter used for priming. Centres who prepared more antineoplastic drugs per year (p<0.0001), centres who used more cyclophosphamide per year (p<0.0001) and centres who primed antineoplastic IV tubing in patient care unit by nurses (p=0.004) showed significantly higher surface contamination. Over the years, we observed stabilisation in surface contamination.


Environmental surveillance is one part of a comprehensive approach for minimising hazardous exposures in healthcare. By repeating this multicentre study annually and systematically, it increases all stakeholders’ awareness about the level of traces of hazardous drugs and the potential strategies that can minimise contamination. This study highlights a low level of contamination of three hazardous drugs among 66 Canadian hospitals. Regular environmental monitoring is a good practice to maintain contamination as low as reasonably achievable. As long as no health based limit is known, we are encouraging centres to monitor their contamination.


No conflict of interest

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