Demand clean vials

In 1979, Finnish researchers reported that they had discovered mutagenic substances in the urine of nurses preparing and administering chemotherapy to hospital patients.1 Subsequent researchers found that open laminar-airflow equipment and traditional techniques used to manipulate vials, ampuls, and syringes could allow drugs to enter the work environment and personnel handling the drugs. Groups developed safe-drug-handling guidelines to encourage the avoidance of equipment and admixture practices believed to be the source of exposure to these drugs. See also page 475. In the 1990s, a number of European researchers reported continuing exposure of personnel handling chemotherapy agents, despite implementation of the guidelines of the 1980s. Subsequent attempts to mitigate poor drug-handling practices have included the implementation of closed-system transfer devices, which have been shown to be an effective, but expensive, solution. Background contamination, however, is still detected in institutional admixture settings, where employers have invested heavily in safety equipment and supplies and where workers adhere to the recommended and cumbersome drug-handling practices. Why? Possibly because of a factor that institutional pharmacists cannot control: surface contamination of vials.