Efficiency of four solutions in removing 23 conventional antineoplastic drugs from contaminated surfaces

BACKGROUND: Residual contamination by intravenous conventional antineoplastic drugs (ICAD) is still a daily issue in hospital facilities. This study aimed to compare the efficiency (Eff(Q)) of 4 different solutions to remove 23 widely used ICADs from surfaces. METHOD AND FINDINGS: A solution containing 23 ICADs (4 alkylating agents, 8 antimetabolites, 2 topo-I inhibitors, 6 topo-II inhibitors and 3 spindle poisons) was spread over 100 cm(2) stainless steel. After drying, decontamination was carried out using 10×10 cm wipes moistened with 300 μL of one of the following solutions: 70% isopropanol (S1); ethanol-hydrogen peroxide 91.6–50.0 mg/g (S2); 10(−2) M sodium dodecyl sulphate/isopropanol 80/20 (S3) or 0.5% sodium hypochlorite (S4). Six tests were performed for each decontamination solution. Two modalities were tested: a single wipe motion from top to bottom or vigorous wiping (n = 6 for each modality). Residual contamination was measured with a validated liquid chromatography with tandem mass spectrometry detection method. Solution efficiency (in %) was computed as follows: Eff(Q) = 1–(quantity after decontamination/quantity before decontamination), as median (min–max) for the 23 ICADs. The overall decontamination efficiency (Eff(Q)) of the 4 solutions was compared by a Kruskall-Wallis test. Decontamination modalities were compared for each solution and per ICAD with a Mann-Whitney test (p<0.05). Eff(Q) were significantly different from one solution to the next for single wipe motion decontamination: 79.9% (69.3–100), 86.5% (13.0–100), 85.4% (56.5–100) and 100% (52.9–100) for S1, S2, S3 and S4 (p<0.0001), respectively. Differences were also significant for vigorous decontamination: Eff(Q) of 84.3% (66.0–100), 92.3% (68.7–100), 99.6% (84.8–100) and 100% (82.9–100) for S1, S2, S3 and S4, respectively (p<0.0001). Generally, vigorous decontamination increased Eff(Q) for all tested solutions and more significantly for the surfactant. CONCLUSION: Decontamination efficiency depended on the solution used but also on the application modality. An SDS admixture seems to be a good alternative to sodium hypochlorite, notably after vigorous chemical decontamination with no hazard either to materials or workers.