Category: Professional Posters
Purpose: Decontamination of hazardous drugs from surfaces in compounding areas is essential to reduce the risk of cross-contamination and occupational exposure, and is required by several regulatory guidance documents. Results of previous studies suggest that high concentrations of sodium hypochlorite can decontaminate surfaces such as stainless steel, but there are concerns about corrosion of material surfaces and the lack of disinfectant registration for these formulations. To explore alternatives, studies were conducted to determine the feasibility of a registered sporicidal disinfectant to decontaminate hazardous drugs from stainless steel and to understand the roles of physical removal versus degradation of the parent drugs.
Methods: Coupons of 316 stainless steel were spiked with compounding-relevant doses of several hazardous drugs. After allowing the drug solutions to dry or waiting at least 30 minutes, the surfaces were wiped twice with sterile pads or wipers saturated with a formulated mixture of peracetic acid, hydrogen peroxide and surfactants. After allowing the solution to remain wet on the surface for 3 minutes (enough for sporicidal efficacy), the surfaces were wiped with 70% sterile isopropanol. After drying, the coupons were sampled for residual contamination using a swabbing technique, extraction and analysis with chromatography. Residual drugs on the coupons (mass per 100 square centimeters) were compared to initial levels. Additional experiments examined the recovery efficiency of the sampling technique and whether degradation of the parent drugs played a role in the decontamination effect.
Results: After conducting the wiping protocol with the peracetic acid/hydrogen peroxide disinfectant solution followed by 70% isopropanol, drug residues on the surface of stainless steel were reduced up to 99.99% compared to initial levels. Most drugs, including common antineoplastics, hormones and penicillin were reduced by >99.8%, but somewhat lower efficacy (99%) was observed with two platinum-based drugs, cisplatin and carboplatin. The decontamination effect was similar when the drugs were tested individually or in combinations of up to three drugs on the same coupons. Recovery efficiency of residual drugs from control coupons using a commercial sampling kit ranged from 50-78% for cyclophosphamide, 5-fluorouracil, estradiol and progesterone but was substantially lower with platinum-based drugs. Results of separate studies where penicillin was exposed to the solution of peracetic acid/hydrogen peroxide without the wiping procedure suggested that degradation of the parent compound contributed to the decontamination effect. Degradation may have been caused by the low pH and high oxidation potential of the disinfectant solution, but further research is needed to elucidate what specific chemical reactions are involved.
Conclusion: A wiping protocol utilizing a sporicidal disinfectant composed of peracetic acid/hydrogen peroxide followed by 70% isopropanol can effectively decontaminate drug residues from stainless steel. Results of experiments with penicillin indicate that dried residues of concentrated drug may require additional wiping steps with the disinfectant solution to remove visible residues and completely decontaminate the surface. The mixture of oxidizers was shown to degrade the penicillin molecular structure, thereby enhancing the decontamination effect. Further studies are needed to understand if this solution can degrade other hazardous drugs or if removal of residues by wiping is the primary mechanism of decontamination.