Reduction of Contamination with Antibiotics on Surfaces and in Environmental Air in Three European Hospitals Following Implementation of a Closed-System Drug Transfer Device

Abstract

Purpose: Occupational exposure of nurses to antibiotics may result in adverse health effects such as hypersensitivity, allergic reactions, resistance, and anaphylactic shock. The purpose of this study was to measure surface and air contamination with antibiotics in three hospitals during the preparation of the drugs using conventional techniques or using the Tevadaptor® closed-system drug transfer device (CSTD). Methods: Surface contamination was measured by taking wipe samples. Stationary air samples were collected in preparation areas and personal air samples were collected in the working environment of the nurses. Contamination was reassessed after several weeks following implementation of the CSTD. Surface contamination was compared before and after CSTD introduction. Vancomycin, meronem, augmentin, ceftriaxone, cefotaxime, piperacillin, and benzylpenicillin were monitored. Wipe and air samples were analyzed using liquid chromatographytandem mass spectrometry (LC-MS/MS). Results: Using conventional preparation techniques, widespread contamination with antibiotics up to 767 ng cm-2 was detected. After implementation of the CSTD, contamination levels significantly decreased for the most frequently prepared antibiotics in the three hospitals. Using the conventional preparation technique, three antibiotics were detected in environmental air of seven nurses in two hospitals (0.01-5 μg m-3), and one antibiotic was found in environmental air above a preparation surface (0.02 μg m-3). After implementation of the CSTD, the same antibiotic was detected in environmental air above the same preparation surface (1.39 μg m-3) but no antibiotics were detected in environmental air of the nurses in the three hospitals. Conclusions: Using the conventional preparation techniques, surfaces and air were widely contaminated with antibiotics whereas the use of the CSTD significantly reduced contamination. Systematic use of a CSTD significantly reduces exposure to hazardous antibiotics and consequently reduces potential adverse health effects for healthcare providers.