Antineoplastic Drugs Preparation Using Compounding Aseptic Containment Isolators and Robotic Systems

Recent guidelines issued by the Japanese Society of Hospital Pharmacists recommend the use of biological safety cabinets (BSCs) and personal protective equipment (PPE) to prevent medical staff from being exposed to antineoplastic drugs during drug preparation. However, wearing PPE costs pharmacists additional time and labor during the preparation process. Since 2012, Nagoya City University Hospital has instituted the use of compounding aseptic containment isolators (CACIs, ChemoSHIELD) and a robotic system (CytoCare) for use during antineoplastic drug preparation. We investigated the effects of introducing CACIs and CytoCare on preventing antineoplastic drug exposure and on pharmacist efficiency. To evaluate workplace contamination, antineoplastic drug residues were measured using the wipe method. We also measured antineoplastic drug urine levels in pharmacists involved in the work. The levels of three antineoplastic drugs (cyclophosphamide, ifosfamide, gemcitabine) were measured using ultra-performance liquid chromatography-tandem mass spectrometry. Further, we investigated the stand-by time of pharmacists involved in the preparation of chemotherapeutic drugs. The results demonstrated that, compared with conventional class II BSCs, CACIs demonstrated decreased workplace contamination. Before CACIs introduction, antineoplastic drugs were detected in 3 of 12 urine samples, whereas after CACIs introduction, antineoplastic drugs were not detected in the urine of pharmacists. Additionally, the CACI and CytoCare systems significantly reduced the stand-by time of pharmacists, compared with BSCs (P < 0.001). Therefore, a combination of CACIs and robotic systems allows safe and efficient chemotherapeutic preparation.