Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar;30(2):257-262.
doi: 10.1177/10781552231173878. Epub 2023 May 7.

A simple and inexpensive method to monitor and minimize exposure from manipulation of cytotoxic drugs

Nuro Ali  1   2 , Helena Carmo  1   2 , Raquel Robalo  3 , Luísa Rocha  3 , Cristina Fernandes  3 , Fernando Moreira  4   5
Affiliations

A simple and inexpensive method to monitor and minimize exposure from manipulation of cytotoxic drugs

Nuro Ali et al. J Oncol Pharm Pract. 2024 Mar.

Abstract

Pharmacy personnel that manipulate cytotoxic drugs are under continuous exposure risk. Therefore, training and strict adherence to recommended practices should always be promoted. The main objective of this study was to develop and apply a safe, effective and low-cost method for the training and assessment of the safe handling of cytotoxic drugs, using commercially available tonic water. To evaluate the potential of tonic water as a replacement marker for quinine hydrochloride, deliberate spills of 1 mL of four different tonic waters (one coloured and three non-coloured) were analysed under ultraviolet light (300-400 nm). The pigmented sample did not produce fluorescence under ultraviolet (UV) light. The three commercially available tonic waters that exhibited fluorescence were further analysed by UV/Vis spectrophotometry (300-500 nm). Afterwards, a protocol of simulated manipulation of cytotoxic drugs was developed and applied to 12 pharmacy technicians, that prepared 24 intravenous bags according to recommended routine procedures using tonic water. Participants responded to a brief questionnaire to evaluate the adequacy and applicability of the activity. Seven of the participants had spillages during manipulation, the majority of which recorded during manipulation with needles. All participants scored the tonic water manipulation simulation with 4 or 5 points for simplicity, efficiency and feasibility. The obtained results suggest that tonic water can be used to simulate the manipulation of cytotoxic drugs in training and assessment programs. By using this replacement marker for quinine hydrochloride, it is possible to perform a more cost-effective, yet equally effective, assessment.

Keywords: Cytotoxic drugs; antineoplastic; hazardous drugs; occupational exposure.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Absorbance of quinine solutions (0.005 mol/L and 0.1 mol/L) and three commercially available tonic waters, determined by ultraviolet/visible (UV-Vis) spectrophotometry.
Figure 2.
Figure 2.
Positive control obtained by applying ultraviolet (UV) light in an intravenous fluid administration bag containing tonic water.
Figure 3.
Figure 3.
Detection of tonic water spills under ultraviolet (UV) light during manipulation simulation.
Figure 4.
Figure 4.
Evaluation of the suitability of the simulated manipulation protocol of tonic water by the study participants (n = 12).
See this image and copyright information in PMC

References

    1. Fazel SS, Keefe A, Shareef A, et al. Barriers and facilitators for the safe handling of antineoplastic drugs. J Oncol Pharm Pract 2022; 28: 1709–1721. - PubMed
    1. Undeğer U, Başaran N, Kars A, et al. Assessment of DNA damage in nurses handling antineoplastic drugs by the alkaline COMET assay. Mutat Res 1999; 439: 277–285. - PubMed
    1. Aristizabal-Pachon AF, Castillo WO. Genotoxic evaluation of occupational exposure to antineoplastic drugs. Toxicol Res 2020; 36: 29–36. - PMC - PubMed
    1. Villarini M, Gianfredi V, Levorato S, et al. Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: a systematic review of the literature and meta-analysis. Mutat Res Rev Mutat Res 2016; 770: 35–45. - PubMed
    1. Burgaz S, Karahalil B, Bayrak P, et al. Urinary cyclophosphamide excretion and micronuclei frequencies in peripheral lymphocytes and in exfoliated buccal epithelial cells of nurses handling antineoplastics. Mutat Res 1999; 439: 97–104. - PubMed