Development and validation of a quantitative wipe sampling method to determine platinum contamination from antineoplastic drugs on surfaces in workplaces at Swedish hospitals.

INTRODUCTION: Antineoplastic drugs (ADs) are frequently used pharmaceuticals in the healthcare, and healthcare workers can be occupationally exposed to ADs. Monitoring of surface contamination is a common way to assess occupational exposure to ADs. The objective was to develop and validate a sensitive and quantitative monitoring method to determine surface contaminations of Pt as a marker for Pt-containing ADs. The surface contaminations of Pt-containing ADs were monitored at four Swedish hospital workplaces. METHODS: An analytical method was developed based on inductively coupled plasma mass spectrometry. The wipe sampling procedure was validated regarding different surface materials. The stability of collected wipe samples was investigated. Workplace surfaces were monitored by wipe sampling to determine contaminations of Pt-containing ADs. RESULTS: A wipe sampling and analytical method with a limit of detection of 0.1 pg Pt/cm2 was developed. Pt was detected in 67% of the wipe samples collected from four workplaces, and the concentrations ranged from <0.10 to 21100 pg/cm2. In 4% of samples, the detected surface contaminations of Pt in three hospital wards were above proposed hygienic guidance value (HGV) of Pt. In the hospital pharmacy, 9% of the detected surface contaminations of Pt were above lowest proposed HGV. CONCLUSIONS: A user-friendly, specific, and sensitive method for determination of surface contaminations of Pt from ADs in work environments was developed and validated. A large variation of contaminations was observed between detected surface contaminations of Pt in samples collected in wards, and it likely reflects differences in amounts handled and work practices between the wards.

Stability and transmissibility of SARS-CoV-2 in the environment.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing the ongoing global coronavirus disease 2019 (COVID-19) pandemic, is believed to be transmitted primarily through respiratory droplets and aerosols. However, reports are increasing regarding the contamination of environmental surfaces, shared objects, and cold-chain foods with SARS-CoV-2 RNA and the possibility of environmental fomite transmission of the virus raises much concern and debate. This study summarizes the current knowledge regarding potential mechanisms of environmental transmission of SARS-CoV-2, including the prevalence of surface contamination in various settings, the viability and stability of the virus on surfaces or fomites, as well as environmental factors affecting virus viability and survival such as temperature and relative humidity. Instances of fomite transmission, including cold-chain food transmission, and the importance of fomite transmission in epidemics, are discussed. The knowledge gaps regarding fomite transmission of SARS-CoV-2 are also briefly analyzed.

Evaluation of long-term data on surface contamination by antineoplastic drugs in pharmacies.

PURPOSE: The handling of antineoplastic drugs represents an occupational health risk for employees in pharmacies. To minimize exposure and to evaluate cleaning efficacy, wipe sampling was used to analyze antineoplastic drugs on surfaces. In 2009, guidance values were suggested to facilitate the interpretation of results, leading to a decrease in surface contamination. The goal of this follow-up was to evaluate the time trend of surface contamination, to identify critical antineoplastic drugs and sampling locations and to reassess guidance values. METHODS: Platinum, 5-fluorouracil, cyclophosphamide, ifosfamide, gemcitabine, methotrexate, docetaxel and paclitaxel were analyzed in more than 17,000 wipe samples from 2000 to 2021. Statistical analysis was performed to describe and interpret the data. RESULTS: Surface contaminations were generally relatively low. The median concentration for most antineoplastic drugs was below the limit of detection except for platinum (0.3 pg/cm2). Only platinum and 5-fluorouracil showed decreasing levels over time. Most exceedances of guidance values were observed for platinum (26.9%), cyclophosphamide (18.5%) and gemcitabine (16.6%). The most affected wipe sampling locations were isolators (24.4%), storage areas (17.6%) and laminar flow hoods (16.6%). However, areas with no direct contact to antineoplastic drugs were also frequently contaminated (8.9%). CONCLUSION: Overall, the surface contaminations with antineoplastic drugs continue to decrease or were generally at a low level. Therefore, we adjusted guidance values according to the available data. The identification of critical sampling locations may help pharmacies to further improve cleaning procedure and reduce the risk of occupational exposure to antineoplastic drugs.

Assessing floor contamination by antineoplastic agents in a Japanese medical institution specializing in cancer treatment.

INTRODUCTION: This study investigated the extent of contamination with antineoplastic agents on floor surfaces of the ward and the outpatient chemotherapy center of a Japanese cancer center to evaluate healthcare workers' risk of occupational exposure to antineoplastic agents outside of the designated drug preparation areas. METHODS: In this study conducted at Aichi Cancer Center, the amount of fluorouracil detected on various floor surfaces was measured using liquid chromatography-tandem quadrupole mass spectrometry. Areas around the toilets were cleaned with a surfactant two or three times a day, whereas other floor surfaces were cleaned only with dry and wet mops. RESULTS: Fluorouracil was detected on all surveyed floor surfaces, with particularly high amounts detected around the toilet areas in the ward. Additionally, areas with more human traffic tended to have higher fluorouracil contamination. CONCLUSIONS: This survey suggested that antineoplastic agent contamination occurring through patient excretions might spread throughout the hospital with human traffic. Therefore, controlling the spread of antineoplastic agent contamination in hospitals should include the review of measures to mitigate contamination around toilets and to implement effective cleaning methods for floor surfaces.

Longitudinal evaluation of environmental contamination with hazardous drugs by surface wipe sampling.

INTRODUCTION: Exposure of healthcare workers to hazardous drugs can lead to adverse health effects supporting the importance of a continuous monitoring program, for example, by taking surface wipe samples. The objective was to describe the results of repeated monitoring of contamination with hazardous drugs on multiple surfaces in a hospital pharmacy and at two wards using standardized preparation techniques and cleaning procedures. METHODS: Twelve surfaces in the hospital pharmacy and at two wards were sampled and analyzed for contamination with the hazardous drugs cyclophosphamide, doxorubicin, 5-fluorouracil, gemcitabine, methotrexate, and paclitaxel. The drugs were prepared with a closed-system drug transfer device (CSTD). Sampling of the drugs was performed in four trials during eight months. Liquid chromatography tandem mass spectrometry was used for the analysis of the drugs. RESULTS: During the four trials, contamination with five of the six hazardous drugs was found on half of the surfaces in the pharmacy and in a ward. Seventeen out of 288 possible outcomes were positive (6%), with the biological safety cabinet grate (n = 6) and scanner (n = 5) most frequently contaminated. The highest level of contamination was observed on the pass-thru window (cyclophosphamide: 2.90 ng/cm2) and the touch screen of the Diana device (5-fluorouracil: 2.38 ng/cm2). Both levels were below the action level of 10 ng/cm2. CONCLUSIONS: The long-term use of a CSTD in combination with appropriate cleaning has proven effective in achieving low levels of surface contamination with hazardous drugs.

Further development and application of a method for assessing radionuclide surface activity distribution and source location based on measurements of ambient dose equivalent rate.

A method has been developed for solving the Fredholm equation in the barrier geometry for reconstructing the surface activity density (SAD) from the results of measuring the ambient dose equivalent rate (ADER). Inclusion of the barrier geometry means that the method takes into account the shielding effect of buildings and structures on the contaminated site. The method was based on the representation of the industrial site, buildings and radiation fields in the form of a raster and the use of the visibility matrix (VM) of raster cells to describe the barrier geometry. The developed method was applied to a hypothetical industrial site with a size of 200 × 200 conventional units for four types of SAD distribution over the surface of the industrial site: 'fragmentation', 'diffuse', 'uniform' and 'random'. The method of Lorentz curves was applied to estimate the compactness of the distributions of SAD and the ADER for the considered radiation sources. It was shown that the difference between the Lorentz curve for SAD and ADER means that the determination of the spatial distribution of SAD over the industrial site by solving the integral equation is essentially useful for determining the location of radiation source locations on the industrial site. The accuracy of SAD reconstruction depends on the following parameters: resolution (fragmentation) of the raster, the height of the radiation detector above the scanned surface, and the angular aperture of the radiation detector. The measurement of ADER is simpler and quicker than the direct measurement of SAD and its distribution. This represents a significant advantage if SAD distribution needs to be determined in areas with high radiation dose-rate during limited time. The developed method is useful for supporting radiation monitoring and optimizing the remediation of nuclear legacies, as well as during the recovery phase after a major accident.

Further development and application of a method for assessing radionuclide surface activity distribution and source location based on measurements of ambient dose equivalent rate. Examples for Andreeva Bay, Chernobyl NPP and Istiklol.

A method for reconstructing surface activity density (SAD) maps based on the solution of the Fredholm equation has been developed and applied. The construction of SAD maps was carried out for the site of the temporary storage (STS) of spent fuel and radioactive waste (RW) in Andreeva Bay using the results of measuring campaign in 2001-2002 and for the sheltering construction of the solid RW using the results of measurements in 2021. The Fredholm equation was solved in two versions: under conditions of a barrier-free environment and taking into account buildings and structures located on the industrial site of the STS Andreeva Bay. Lorenz curves were generated to assess the compactness of the distributions of SAD and ambient dose equivalent rate (ADER) for the industrial site and the sheltering construction at STS Andreeva Bay, the area of the IV stage uranium tailing site near the city of Istiklol in the Republic of Tajikistan, and for roofs of the Chernobyl nuclear power plant. The nature of impact of the resolution (fragmentation) of the raster, the value of the radius of mutual influence of points (contamination sites), the height of the radiation detector above the scanned surface and the angular aperture of the radiation detector on the accuracy of the SAD reconstruction is shown. The method developed allows more accurate planning of decontamination work when only ADER measurements data is available. The proposed method can be applied to support the process of decontamination of radioactively contaminated territories, in particular during the remediation of the STS Andreeva Bay.

Exposure to cisplatin in the operating room during hyperthermic intrathoracic chemotherapy.

PURPOSE: Hyperthermic intrathoracic chemotherapy (HITOC) is an additive, intraoperative treatment for selected malignant pleural tumors. To improve local tumor control, the thoracic cavity is perfused with a cisplatin-containing solution after surgical cytoreduction. Since cisplatin is probably carcinogenic to humans, potential contamination of surfaces and pathways of exposure should be systematically investigated to enable risk assessments for medical staff and thus derive specific recommendations for occupational safety. METHODS: Wipe sampling was performed at pre-selected locations during and after ten HITOC procedures, including on the surgeon's gloves, for the quantitation of surface contaminations with cisplatin. After extraction of the samples with hydrochloric acid, platinum was determined as a marker for cisplatin by voltammetry. RESULTS: High median concentrations of cytostatic drugs were detected on the surgeons' (1.73 pg Cis-Pt/cm2, IQR: 9.36 pg Cis-Pt/cm2) and perfusionists' (0.69 pg Cis-Pt/cm2, IQR: 1.73 pg Cis-Pt/cm2) gloves. The display of the perfusion device showed partially elevated levels of cisplatin up to 4.92 pg Cis-Pt/cm2 and thus could represent an origin of cross-contamination. In contrast, cisplatin levels on the floor surfaces in the area of the surgeon and the perfusion device or in the endobronchial tube were relatively low. CONCLUSION: With a correct use of personal protective equipment and careful handling, intraoperative HITOC appears to be safe to perform with a low risk of occupational exposure to cisplatin.

Surface contamination with nine antineoplastic drugs in 109 canadian centers; 10 years of a monitoring program.

INTRODUCTION: Healthcare workers exposure to antineoplastic drugs can lead to adverse health effects. Guidelines promote the safe handling of antineoplastic drugs, but no safe exposure limit was determined. Regular surface sampling contributes to ensuring workers safety. METHODS: A cross-sectional monitoring is conducted once a year with voluntary Canadian centers, since 2010. Twelve standardized sampling sites were sampled. Samples were analyzed by high performance mass coupled liquid chromatography. The limits of detection (in ng/cm2) were: 0.001 for cyclophosphamide and gemcitabine; 0.3 for docetaxel and ifosfamide; 0.04 for 5-fluorouracil and paclitaxel; 0.003 for irinotecan; 0.002 for methotrexate; 0.01 for vinorelbine. RESULTS: The surfaces from 109 centers were sampled between 01/01/2020-18/06/2020. Twenty-six centers delayed their participation because of the COVID-19 pandemic. 1217 samples were analyzed. Surfaces were frequently contaminated with cyclophosphamide (34% positive, 75th percentile 0.00165 ng/cm2) and gemcitabine (16% and <0.001 ng/cm2). The armrest of patient treatment chairs (84% to at least one drug), the front grille inside the biological safety cabinet (BSC) (73%) and the floor in front of the BSC (55%) were frequently contaminated. Centers that prepared ≥5000 antineoplastic drugs annually had higher concentration of cyclophosphamide on their surfaces (p < 0.0001). Contamination measured on the surfaces was reduced from 2010 to 2020. CONCLUSIONS: This large-scale study showed reproducible long term follow up of the contamination of standardized sites of Canadian centers and a reduction in surface contamination from 2010 to 2020. Periodic surface sampling help centers meet their continuous improvements goals to reduce exposure as much as possible. The COVID-19 pandemic had a limited impact on the program.

Surface sterilization for isolation of endophytes: Ensuring what (not) to grow.

Endophytic microbiota opens a magnificent arena of metabolites that served as a potential source of medicines for treating a variety of ailments and having prospective uses in agriculture, food, cosmetics, and many more. There are umpteen reports of endophytes improving the growth and tolerance of plants. In addition, endophytes from lifesaving drug-producing plants such as Taxus, Nothapodytes, Catharanthus, and so forth have the ability to produce host mimicking compounds. To harness these benefits, it is imperative to isolate the true endophytes, not the surface microflora. The foremost step in endophyte isolation is the removal of epiphytic microbes from plant tissues, called as surface sterilization. The success of surface sterilization decides "what to grow" (the endophytes) and "what not to grow" (the epiphytes). It is very crucial to use an appropriate sterilant solution, concentration, and exposure time to ensure thorough surface disinfection with minimal damage to the endophytic diversity. Commonly used surface sterilants include sodium hypochlorite (2%-10%), ethanol (70%-90%), mercuric chloride (0.1%), formaldehyde (40%), and so forth. In addition, the efficiency could further be improved by pretreatment with surfactants such as Triton X-100, Tween 80, and Tween 20. This review comprehensively deals with the various sterilants and sterilization methods for the isolation of endophytic microbes. In addition, the mechanisms and rationale behind using specific surface sterilants have also been elaborated at length.

A quantitative LC-MS method to determine surface contamination of antineoplastic drugs by wipe sampling.

The main objective was to develop a wipe sampling test to measure surface contamination of the most frequently used antineoplastic drugs (ADs) in Swedish healthcare and, furthermore, to develop an analysis method sensitive enough to assess low levels of contamination. Two wipe sampling tests with separate sample processing methods assessing (i) cyclophosphamide (CP), ifosfamide (IF), 5-fluorouracil (5-FU), etoposide (ETO), gemcitabine (GEM) and cytarabine (CYT) (Wipe Test 1); and (ii) GEM, CYT and methotrexate (MTX) (Wipe Test 2), respectively, were developed by optimization of absorption and extraction efficiencies using different wipe tissue materials, tissue wetting solution, and extraction solvents. A fast liquid chromatography tandem mass spectrometry method was developed for simultaneous detection of the studied ADs. The limit of quantification for the method was between 0.04 to 2.4 ng/wipe sample (0.10 to 6.1 pg/cm2 for an area of 400 cm2) and at 50 ng/sample the within-day precision was between 1.3 and 15%, and the accuracy between 102 and 127%. Wipe Test 1 was applied in an assessment of cleaning efficiency of five different cleaning solutions (formic acid, water, sodium hydroxide, ethanol, and sodium dodecyl sulfate (SDS) for removal of ADs from surfaces made of stainless steel or plastic. For CP, IF, 5-FU, GEM, and CYT 92% of the AD were removed regardless of surface and cleaning solution. In conclusion, a user-friendly assessment method to measure low levels of seven ADs in the work environment was developed and validated. Assessment of the decontamination efficiency of cleaning solutions concerning removal of ADs from stainless steel showed that efficiencies differed depending on the AD with water being the least effective cleaning agent. The results suggests that a combination of different cleaning agents including detergent and a solution with an organic component would be optimal to efficiently remove the measured ADs from surfaces in the workplace.

Surface-clearance levels for the normal reuse of objects for 413 radionuclides.

This paper provides surface-clearance levels for 413 radionuclides for the normal reuse of objects leaving the controlled area of a nuclear facility. Four sets of surface-specific clearance levels are derived based on choices of dose coefficients (DCs) in probabilistic dose assessments using the SUrface DOse QUantification model (SUDOQU; van Dillen and van Dijk 2018J. Radiol. Prot.381147-203). The general dose criteria for clearance, extended with a suitable dose constraint for the concept of the representative person, are applied in the derivations. These clearance levels apply to the total of fixed and removable radioactive contamination on the surface of objects. The results are discussed in the context of conservatism of the exposure scenarios (parameters, DCs), and guidance is given on the selection and application of the values.

EVALUATION OF BACTERIAL CONTAMINATION IN THE INANIMATE ENVIRONMENT SURFACES IN ACUTE CARE HOSPITALS IN KYIV, UKRAINE.

OBJECTIVE: The aim: To evaluate the quality of cleaning and disinfection of surfaces scheduled for daily cleaning and degree of bacterial contamination of hospital rooms and the patients' inanimate environment in Kyiv acute care hospitals, Ukraine. PATIENTS AND METHODS: Materials and methods: We performed a multicenter prospectively study of the quality of cleaning and disinfection of surfaces scheduled for daily cleaning in 9 acute care hospitals by use of an ultraviolet fluorescence targeting method and microbial methods. RESULTS: Results: A total 9,104 environmental samples from were collected and tested. The cleaning and disinfection of surfaces were not being performed properly in most cases. Complete removal of the mark was 49.1%, partial removal was 37,5%, and mark was still visible, i.e. this area had not been processed was 13,4% when the ultraviolet fluorescence targeting method procedures were used, respectively. The predominant bacterial agents in hospital environment surfaces were: Escherichia coli, Enterobacter spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus spp., Citrobacter spp., Acinetobacter spp., and Enterococcus spp. The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 31.5% and of methicillin-resistance in Staphylococcus aureus (MRSA) 14.9%. Vancomycin resistance was observed in 5.2% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 12.7% E.coli isolates and was in 11.2% K. pneumoniae isolates. Carbapenem resistance was identified in 24.7% of P.aeruginosa isolates and 59.3% of Acinetibacter spp. isolates. CONCLUSION: Conclusions: In a hospital rooms, patient environmental surfaces can be a vehicle for the transmission of multidrug-resistant (MDR) bacterial agents that cause healthcare-associated infections.

Investigating Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Surface and Air Contamination in an Acute Healthcare Setting During the Peak of the Coronavirus Disease 2019 (COVID-19) Pandemic in London.

BACKGROUND: We evaluated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surface and air contamination during the coronavirus disease 2019 (COVID-19) pandemic in London. METHODS: Prospective, cross-sectional, observational study in a multisite London hospital. Air and surface samples were collected from 7 clinical areas occupied by patients with COVID-19 and a public area of the hospital. Three or four 1.0-m3 air samples were collected in each area using an active air sampler. Surface samples were collected by swabbing items in the immediate vicinity of each air sample. SARS-CoV-2 was detected using reverse-transcription quantitative polymerase chain reaction (PCR) and viral culture; the limit of detection for culturing SARS-CoV-2 from surfaces was determined. RESULTS: Viral RNA was detected on 114 of 218 (52.3%) surfaces and in 14 of 31 (38.7%) air samples, but no virus was cultured. Viral RNA was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (67 of 105 [63.8%] vs 29 of 64 [45.3%]; odds ratio, 0.5; 95% confidence interval, 0.2-0.9; P = .025, χ2 test). The high PCR cycle threshold value for all samples (>30) indicated that the virus would not be culturable. CONCLUSIONS: Our findings of extensive viral RNA contamination of surfaces and air across a range of acute healthcare settings in the absence of cultured virus underlines the potential risk from environmental contamination in managing COVID-19 and the need for effective use of personal protective equipment, physical distancing, and hand/surface hygiene.

A Systematic Review of Surface Contamination, Stability, and Disinfection Data on SARS-CoV-2 (Through July 10, 2020).

We conducted a systematic review of hygiene intervention effectiveness against SARS-CoV-2, including developing inclusion criteria, conducting the search, selecting articles for inclusion, and summarizing included articles. Overall, 96 268 articles were screened and 78 articles met inclusion criteria with outcomes in surface contamination, stability, and disinfection. Surface contamination was assessed on 3343 surfaces using presence/absence methods. Laboratories had the highest percent positive surfaces (21%, n = 83), followed by patient-room healthcare facility surfaces (17%, n = 1170), non-COVID-patient-room healthcare facility surfaces (12%, n = 1429), and household surfaces (3%, n = 161). Surface stability was assessed using infectivity, SARS-CoV-2 survived on stainless steel, plastic, and nitrile for half-life 2.3-17.9 h. Half-life decreased with temperature and humidity increases, and was unvaried by surface type. Ten surface disinfection tests with SARS-CoV-2, and 15 tests with surrogates, indicated sunlight, ultraviolet light, ethanol, hydrogen peroxide, and hypochlorite attain 99.9% reduction. Overall there was (1) an inability to align SARS-CoV-2 contaminated surfaces with survivability data and effective surface disinfection methods for these surfaces; (2) a knowledge gap on fomite contribution to SARS-COV-2 transmission; (3) a need for testing method standardization to ensure data comparability; and (4) a need for research on hygiene interventions besides surfaces, particularly handwashing, to continue developing recommendations for interrupting SARS-CoV-2 transmission.

Investigation of SARS CoV-2 virus in environmental surface.

The prevalent respiratory viruses such as SARS-CoV-2 probably persist for a long time on fomites and environmental surfaces. Some recent studies have detected SARS-CoV-2 RNA on the surface of cell phones, door handles and other items in the inhabited sites of confirmed cases. For the aim of this study, a total of 50 environmental surface samples of SARS-CoV-2 was collected from Imam Khomeini Hospital in Ardabil. Forty-one environmental surface samples were proved negative for SARS-CoV-2 RNA while nine surface samples were positive. Our findings regarding surfaces contaminated with the virus are consistent with the results of recent similar researches as it was revealed that a number of different samples taken from hospital surfaces such as handles, cupboards, light switches, and door handles were positive for the presence of SARS-Cov-2.

Study on the decay characteristics and transmission risk of respiratory viruses on the surface of objects.

The complex and changeable environment is a brand-new living condition for the viruses and pathogens released by the infected people to the indoor air or deposited on the surface of objects, which is an important external condition affecting the decay and transmission risk of the viruses. Exposure to contaminated surfaces is one of the main routes of respiratory diseases transmission. Therefore, it is very important for epidemic prevention and control to study the law of virus decay and the environmental coupling effect on various surfaces. Based on the analysis of the influencing mechanism, a large amount of experimental evidence on the survival of viruses on the surface of objects were excavated in this paper, and the effects of various factors, such as surface peripheral temperature, relative humidity, virus-containing droplet volume, surface materials and virus types, on the decay rate constants of viruses were comprehensively analyzed. It was found that although the experimental methods, virus types and experimental conditions varied widely in different experiments, the virus concentrations on the surface of objects all followed the exponential decay law, and the coupling effect of various factors was reflected in the decay rate constant k. Under different experimental conditions, k values ranged from 0.001 to 100 h-1, with a difference of 5 orders of magnitude, corresponding to the characteristic time t99 between 500 and 0.1 h when the virus concentration decreased by 99%. This indicates a large variation in the risk of virus transmission in different scenarios. By revealing the common law and individuality of the virus decay on the surface of objects, the essential relationship between the experimental observation phenomenon and virus decay was analyzed. This paper points out the huge difference in virus transmission risk on the surface at different time nodes, and discusses the prevention and control strategies to grasp the main contradictions in the different situations.

The SARS-CoV-2 (COVID-19) pandemic in hospital: An insight into environmental surfaces contamination, disinfectants' efficiency, and estimation of plastic waste production.

The current COVID-19 pandemic that is caused by SARS-CoV-2 has led all the people around the globe to implement preventive measures such as environmental cleaning using alcohol-based materials, and social distancing in order to prevent and minimize viral transmission via fomites. The role of environmental surface contamination in viral transmission in within hospital wards is still debatable, especially considering the spread of new variants of the virus in the world. The present comprehensive study aims to investigate environmental surface contamination in different wards of a hospital as well as the efficacy of two common disinfectants for virus inactivation, and tries to produce an estimate of plastic residue pollution as an environmental side effect of the pandemic. With regard to environmental surface contamination, 76 samples were taken from different wards of the hospital, from which 40 were positive. These samples were taken from contaminated environmental surfaces such as patient bed handles, the nursing station, toilet door handles, cell phones, patient toilet sinks, toilet bowls, and patient's pillows, which are regularly-touched surfaces and can pose a high risk for transmission of the virus. The number of positive samples also reveals that SARS-CoV-2 can survive on inanimate surfaces after disinfection by ethanol 70 % and sodium hypochlorite (0.001 %). The results correspond to the time that the VOC 202012/01 (lineage B.1.1.7) had emerged in the hospital and this should be considered that this variant could possibly have different traits, characteristics, and level of persistence in the environment. The plastic waste as an environmental side effect of the pandemic was also investigated and it was confirmed that the amount of plastic residue for a single (RT) PCR confirmatory test for COVID-19 diagnosis is 821.778 g of plastic residue/test. As a result, it is recommended that for improving plastic waste management programs, considering challenges such as minimizing plastic waste pollution, optimization of gas control technologies in incinerators, process redesign, reduction of single-use plastics and PPE, etc. Is of utmost importance.

The efficiency of antineoplastic drug contamination removal by widely used disinfectants-laboratory and hospital studies.

OBJECTIVE: Antineoplastic drugs (ADs) pose risks to healthcare staff. Surface disinfectants are used in hospitals to prevent microbial contamination but the efficiency of disinfectants to degrade ADs is not known. We studied nine disinfectants on ten ADs in the standardized laboratory and realistic in situ hospital conditions. METHODS: A survey in 43 hospitals prioritized nine most commonly used disinfections based on different ingredients. These were tested on inert stainless steel and in situ on contaminated hospital flooring. The effects against ten ADs were studied by LC-MS/MS (Cyclophosphamide CP; Ifosfamide IF; Capecitabine CAP; Sunitinib SUN; Methotrexate MET; Doxorubicin DOX; Irinotecan IRI; Paclitaxel PX; 5-Fluorouracil FU) and ICP-MS (Pt as a marker of platinum-based ADs). RESULTS: Monitoring of the floor contamination in 26 hospitals showed that the most contaminated are the outpatient clinics that suffer from a large turnover of staff and patients and have limited preventive measures. The most frequent ADs were Pt, PX, FU and CP with maxima exceeding the recommended 1 ng/cm2 limit by up to 140 times. IRI, FU, MET, DOX and SUN were efficiently removed by hydrolysis in clean water and present thus lower occupational risk. Disinfectants based on hydrogen peroxide were efficient against PX and FU (> 70% degradation) but less against other ADs, such as carcinogenic CP or IF, IRI and CAP. The most efficient were the active chlorine and peracetic acid-based products, which however release irritating toxic vapors. The innovative in situ testing of ADs previously accumulated in hospital flooring showed highly problematic removal of carcinogenic CP and showed that alcohol-based disinfectants may mobilize persistent ADs contamination from deeper floor layers. CONCLUSION: Agents based on hydrogen peroxide, peracetic acid, quaternary ammonium salts, glutaraldehyde, glucoprotamine or detergents can be recommended for daily use for both disinfection and AD decontamination. However, they have variable efficiencies and should be supplemented by periodic use of strong chlorine-based disinfectants efficient also against the carcinogenic and persistent CP.

Evaluation of decontamination efficacy of four antineoplastics (ifosfamide, 5-fluorouracil, irinotecan, and methotrexate) after deliberate contamination.

The main objective was to determine the decontamination efficacy of quaternary ammonium, 0.1% sodium hypochlorite, and water after deliberate contamination with four antineoplastics (ifosfamide, 5-fluorouracil, irinotecan, methotrexate). A stainless-steel surface was deliberately contaminated with ifosfamide (15 µg), 5-fluorouracil (10 µg), irinotecan (1 µg), and methotrexate (1 µg). First, a single decontamination step with either water, quaternary ammonium, or 0.1% sodium hypochlorite was tested. Then, the effect of up to four successive decontamination steps with either quaternary ammonium or 0.1% sodium hypochlorite was tested. Commercial wipes consisting of two layers of non-woven microfibers with an inner layer of highly absorbent viscose fibers were used. Triplicate surface samples were obtained and tested by ultra-performance liquid chromatography tandem mass spectrometry. The limits of detection were 0.004 ng/cm2 for ifosfamide, 0.040 ng/cm2 for 5-fluorouracil, 0.003 ng/cm2 for irinotecan, and 0.002 ng/cm2 for methotrexate. After a single decontamination step, the 0.1% sodium hypochlorite eliminated 100% of contamination with 5-fluorouracil, irinotecan, and methotrexate and 99.6 ± 0.5% of ifosfamide contamination. Quaternary ammonium and water also removed 100% of the 5-fluorouracil, and 99.5% to 99.9% of the other three antineoplastics. For ifosfamide, irinotecan, and methotrexate, the decontamination efficacy increased with successive decontamination steps with quaternary ammonium. 5-fluorouracil was undetectable after a single decontamination step. Methotrexate was the only drug for which decontamination efficacy was less than 100% after four decontamination steps. 100% decontamination efficacy was achieved from the decontamination step with 0.1% sodium hypochlorite for 5-fluorouracil, irinotecan, and methotrexate. For ifosfamide, 100% efficacy was achieved only after the third decontamination step. It was possible to make all traces of antineoplastic undetectable after deliberate contamination with 5-fluorouracil, irinotecan, and methotrexate with a 0.1% chlorine solution; up to three decontamination steps were needed to make ifosfamide undetectable. Water or quaternary ammonium removed more than 99.5% of deliberate contamination. In several scenarios, it was necessary to repeat the decontamination to eliminate residual traces. More work is needed to identify the optimal decontamination approach for all of the antineoplastic drugs used.