From compounding to admin: How drug contamination spreads in a hospital

A study in a UK hospital has found contamination for 5-fluorouracil (5FU) and cyclophosphamide (CP) on the products compounded in the isolators, which then extends towards the administration department, affecting surfaces in between.

Contamination with docetaxel and 5FU is also observed in environmental air in front of the isolators, above the bench top, and around healthcare providers, but the concentrations are all below the official occupational exposure limit (OEL).

“Drug release in the isolators during compounding by using the open needle and syringe technique has resulted in contamination of the compounded syringes, infusion bags, and elastomeric pumps,” the researchers said. “Contamination is further spread and transferred to the administration department.”

Specifically, 5FU and CP contaminations were seen on isolator surfaces, bench top, trays, and compounded products, while lower levels of contamination were found in the administration department, particularly on trays, trolley arms, and gloves of the nurses. [J Oncol Pharm Pract 2026;doi:10.1177/10781552241285138]

The researchers also found contaminations for paclitaxel and docetaxel. They noted air contamination for paclitaxel in the compounding department in one trial and 5FU in front of an isolator, as well as docetaxel in one air sample of a nurse.

“In general, the results show that if contamination starts at the beginning of the workflow (compounding) it will be found on all following stages of the workflow supporting the need of prevention of contamination during compounding,” the researchers said.

Closed system

The use of needle and syringe technique for compounding is considered as an open technique that causes spillage by overpressure in and during withdrawal from drug vials. Only effective cleaning can remove this spillage, according to the researchers.

However, guidelines recommend contamination prevention by applying closed handling techniques such as closed-system drug transfer devices, which have been shown to significantly reduce environmental contamination. [J Oncol Pharm Practice 2024;30:1181-1185; Ann Occup Hyg 2009;53:153-160; Pharm Technol Hosp Pharm 2022;7:e20220004; PLoS ONE 2016;11:e0159052; Hosp Pharm 2013;48:204-212]

OEL

In the UK, official OELs for hazardous drugs are not available. Instead, Occupational Exposure Bands (OEBs) may be used, according to the researchers.

CP is considered a genotoxic carcinogen and can be classified in OEB 5, with a corresponding OEL <1 µg/m³. On the other hand, 5FU, docetaxel, and paclitaxel are non-carcinogens, but they are deemed hazardous and can also be classified in OEB 5. [J Appl Toxicol 2022;42:154-167]

In the current study, the researchers collected surface wipe samples from potentially contaminated surfaces in the compounding and the administration departments. They also monitored the outside of drug vials, compounded syringes, bags, elastomeric pumps, and gloves used by the nurses.

Moreover, stationary air samples near the isolators and above the bench top, as well as personal air samples from pharmacy technicians, pharmacists, and nurses, were collected. The researchers performed monitoring in three trials for 2 months. They then analysed samples for CP, 5FU, docetaxel, and paclitaxel using liquid chromatography tandem mass spectrometry.