The presence of hazardous drug (HD) residue in work areas where chemotherapy is prepared can present a harmful situation for health care staff. If these areas are not properly and thoroughly cleaned and disinfected, pharmacists, technicians, nurses, and other clinical staff are at risk for exposure to residual HD contamination, which can lead to serious health complications.
At Providence Sacred Heart Medical Center and Children’s Hospital—a 628 bed, non-profit facility—we conduct a significant amount of compounding, including a wide variety of chemotherapy agents; our chemotherapy compounding volume comprises approximately 100 doses per week, which translates to 400 doses per month or 4,800 doses per year.
Given this high volume of chemotherapy compounding, it is imperative that we ensure the work area is clean and safe for our personnel. We have always relied on regular cleaning of the compounding workstations to mitigate the risk of staff exposure to residual HD contamination, and this responsibility is tasked to the same pharmacy technicians that are compounding the chemotherapeutic agents. Our original method for cleaning these areas was lengthy and labor intensive, which wasted time that could have been spent on other important clinical duties. We needed a cleaning process that was quicker and less complicated to conduct, but equally effective in removing hazardous drug residue.
Traditional Cleaning Method
Previously, our process for cleaning HD work areas consisted of wiping the surfaces with sodium thiosulfate (the mixture was diluted from crystals), followed by a 1:1 mixture of sodium hypochloride and water. We would then wipe with 70% isopropyl alcohol, and finally use water to remove any remaining residue. Each cleaning solution was kept in a labeled spray bottle and the work surfaces were wiped with steri-wipes, a lint free paper product. Conducting all of these steps was time intensive; it took approximately 20 minutes to apply the four different solutions to the work area, and this process was conducted twice a day—before the preparation of the first batch of chemotherapy for the day and after the last batch was prepared at the end of the day. These activities required 40 minutes a day, 280 minutes a week, or 4.6 hours every month dedicated to cleaning the work area, and this does not account for the time spent mixing the cleaning solutions, or restocking the storage space with undiluted materials.
A Faster, Simpler Way to Clean
In our effort to improve technician cleaning efficiency, we investigated a prepackaged towelette solution. Among the various products we tested, the HDClean wipes from ChemoGLO were deemed best for our practice as they cleaned well and did not leave any residue on the equipment. HDClean contains two different packets for a two-step wiping process. The area is thoroughly wiped from back to front starting with the first towelette, followed by the second towelette. A second pack of two towelettes is used, again in numerical order, to wipe the same area, and this procedure is repeated for each 2-foot by 2-foot area cleaned (although larger towelettes are available to expand the cleaning area). This cleaning and disinfecting process is still conducted twice a day; however, it now takes just half the time of our previous approach. Of note, the towelettes cannot be reused and must be discarded in a chemotherapy waste bin after use.
Using HDClean towelettes in lieu of the more tedious traditional cleaning method has saved us valuable time, allowing staff to increase their productivity. In addition, the wipes deliver peace of mind, as we are confident that the working environment is safe for our staff, and this in turn impacts patient safety. From the clinician’s standpoint, the towelettes are much easier to use, the mess of leaking spray bottles is avoided, and staff is not left wondering if the correct dilution was used during the preparation of the cleaning solutions. An unexpected benefit is that we now have more space available in our storage area for needed supplies.
Based on the successful experience we have had with HDClean, we plan to include this process in our standard policies and procedures for cleaning chemotherapy compounding areas so that all of the facilities in our health system can enjoy the same improvements in efficiency and safety.
Catherine L. Sugimura, CPhT, is a nationally certified pharmacy technician at Providence Sacred Heart Medical Center and Children’s Hospital in Spokane, Washington. With over 26 years experience, Catherine specializes in compounding chemotherapeutic agents for adults and children.