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Sequential Wipe Testingfor Hazardous Drugs:
A Quality Improvement Project
Seth Eisenberg, ASN, RN, OCN®, BMTCN®

BACKGROUND: Monitoring for the presence of

hazardous drug (HD) residue is recommended
as part of a comprehensive HD safety program.
However, a single wipe test provides limited
information without the ability to evaluate interventions.
OBJECTIVES: This quality improvement project

was designed to evaluate the benefits of performing sequential HD wipe testing during a six-month
period in an ambulatory cancer center.
METHODS: Four areas in the pharmacy department and two areas in the infusion department
were selected for testing, which was conducted atthree time points. Cyclophosphamide, doxorubicin, 5-fluorouracil, methotrexate, and paclitaxel
were tested using liquid chromatography coupledwith tandem mass spectrometry.
FINDINGS: The initial test demonstrated HD

contamination on the legs of the IV pole and thepharmacy transport bin. All other areas were below
the limit of detection. Changes were made tocleaning practices in the pharmacy and infusion
departments prior to the subsequent tests at thethree- and six-month time points, which produced
levels below the limit of detection.

KEYWORDS

chemotherapy; hazardous drugs; safety;
USP <800>; nursing; contamination
DIGITAL OBJECT IDENTIFIER

10.1188/23.CJON.267-273

WWW.ONS.ORG/CJONDDANGERS ASSOCIATED WITH OCCUPATIONAL EXPOSURE to hazardous drugs (HDs)have been well documented and include reproductive toxicities (spontaneous abortions, fetal abnormalities, impaired fertility, learning disabilities
in offspring of exposed mothers), acute toxicities (nausea, vomiting, nasal
irritation, rash), and an increased risk of cancer development (Connor et al.,2014; Fransman et al., 2014; Nassan et al., 2021; Ratner et al., 2010; Roussel etal., 2019; Valanis et al., 1993a, 1993b). During the compounding of HDs, handling contaminated vials and using vial pressurization techniques can resultin environmental contamination, particularly inside the containment primary engineering control (C-PEC) or biologic safety cabinet (BSC) (Power &Coyne, 2018). During drug administration, the priming, connecting, and disconnecting of IV tubing, along with spills and loose connections, significantly
contribute to the presence of contamination in patient care areas (Eisenberg,
2016, 2018; Hon & Abusitta, 2016; Polovich & Olsen, 2018; Power et al., 2014).

HD Guidelines and Standards
Because of these risks, safe handling guidelines have been published by the
National Institute for Occupational Safety and Health, the American Societyof Health-System Pharmacists, and the Oncology Nursing Society (ONS)(National Institute for Occupational Safety and Health, 2016; Polovich &Olsen, 2018; Power & Coyne, 2018; U.S. Pharmacopeial Convention [USP],
2019). In 2016, the USP, a nonprofit scientific organization focused on medication standards, published the USP General Chapter <800> (referred
to as USP <800>), with best practice recommendations and standards
addressing HD safety for compounding and administration (USP, 2020).
USP standards are enforceable, although the specific enforcement agency
or entity depends on the state (Polovich, 2017). A summary of USP <800>
can be found in Table 1.
However, despite practice guidelines and the use of closed-system drugtransfer devices (CSTDs), studies continue to demonstrate HD contamination in pharmacy and drug administration areas (Bartel et al., 2018;
Chauchat et al., 2019; Palamini, Gagné, et al., 2020; Salch et al., 2019; Walton
et al., 2020). Surface contamination is a significant concern because dermal
absorption may lead to uptake, as evidenced by subsequent urinary excretion(Hon et al., 2014, 2015). In one study, contamination was found on the handsof hospital employees who were not directly involved in patient care, with
55% testing above the limit of detection (LOD) for HDs in their urine (Honet al., 2015).

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SEQUENTIAL WIPE TESTING FOR HAZARDOUS DRUGSUSP <800> recommends routine environmental surface wipe
testing for HD residue. An initial test should be performed toestablish a baseline, followed by subsequent testing at a minimum of every six months (USP, 2020). Repeated or sequential
wipe testing is also recommended by a panel of international
experts (Gabay et al., 2021). Surface wipe testing is a method ofquantifying contamination in a given area (typically 100 cm2).
Healthcare organizations are able to perform their own testing
because user-friendly kits are now offered by laboratories. Usinga laboratory-supplied kit helps reduce cost, which continues tobe a significant barrier. A study by Eisenberg et al. (2021) that
tested for only two drugs in a patient bathroom and a staff bathroom for five days cost $20,000. Therefore, it is not surprisingthat a one-time wipe test may be preferred from a financial
perspective.
However, conducting a wipe test as an isolated event, evenin multiple locations, affords only a snapshot of contamination
during a specific time point and may not provide sufficient information for evaluating CSTDs, policies and procedures, or staff
adherence (Gabay et al., 2021). For example, a chemotherapy spillfrom a dislodged IV catheter or a broken drug vial during compounding can produce measurable HD contamination but does
not imply a systemic problem. In contrast, testing performed at
multiple time points provides a broader overview of the organization’s HD safety program and the impact of changes to practice,policies, and equipment. Sequential wipe testing aligns with thePlan-Do-Check-Act model for continuous quality improvement(Comfere et al., 2020).

PurposeAs part of the organization’s HD safety program, a quality
improvement wipe-testing protocol was jointly developed by thenursing and pharmacy departments to evaluate the benefits ofperforming sequential HD wipe testing. Prior to this initiative,
the institution had performed random wipe testing in the pharmacy and nursing areas.

Methods
Project Design and Setting
Testing occurred in an ambulatory National Cancer Institute–designated comprehensive cancer center during a six-month
period. Members of the HD team determined that testing would
occur at three time points in six specific locations (four areas in
the pharmacy and two areas in the infusion department). Bothdepartments were open seven days per week, for 15 hours per
day from Monday through Friday and for 10 hours per day on
Saturday and Sunday. On average, between 150 and 200 patientswere seen for a variety of infusions during the week, and between
70 and 120 patients were seen on each weekend day. Depending
on regimen acuity, nurses cared for two to three patients at atime. During the six-month study period, a total of 20,619 HDs

268 CLINICAL JOURNAL OF ONCOLOGY NURSING JUNE 2023, VOL. 27, NO. 3“Hazardous drug
contamination isan invisible safetyconcern that canaffect the healthcare
team, visitors, andpatients.”
were compounded in the pharmacy and administered in the infusion department. The pharmacy technicians and infusion nurses
received annual HD safety training as required by state law and inaccordance with professional guidelines and USP <800> requirements. Given the varying work schedules and the number of staff,
different pharmacy technicians were involved in compounding,and different nurses cared for patients in the selected infusionbay.
The following four specific pharmacy locations were chosen
for testing: the floor of the negative pressure HD buffer cleanroom where personal protective equipment (PPE) is doffed, aplastic bin for transporting HDs and finished preparations in andout of the cleanroom, the floor in front of a class II type A2 BSC/
C-PEC, and the C-PEC airfoil grate. These areas were chosen
based on known locations where contamination has been foundin published studies (Gabay et al., 2021; Hilliquin et al., 2019;
Power & Coyne, 2018).
In the infusion department, a telephone handset at a nursing
station and the legs of an IV pole in a patient bay were selected
for testing. The pole was labeled for identification in case it
was inadvertently moved to another patient bay. The telephone(located in close proximity to the infusion bay with the IV pole)
was specifically chosen by nursing leadership because staff are
not permitted to wear gloves when making telephone calls andtelephones had been identified as a source of contamination inprior studies (Ladeira et al., 2014; Palamini, Hilliquin, et al., 2020;
Salch et al., 2019; Viegas et al., 2018; Walton et al., 2020).
SampleThe drugs selected for testing were based on frequency of use andincluded cyclophosphamide, doxorubicin, 5-fluorouracil, methotrexate, and paclitaxel. These drugs are common treatments fordifferent cancers and are well represented in wipe-testing studies

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(Chauchat et al., 2019; Fleury-Souverain et al., 2014; Salch et al.,2019; Viegas et al., 2014).
Except for the doxorubicin syringes, which were compounded and dispensed with the ChemoClave™ CSTD, theremaining drugs were compounded using the ChemoLock™
CSTD and administered as IV piggyback infusions using a shortsecondary tubing containing a CSTD on both ends. A CSTD was
also placed on the distal (patient) end of the primary tubing.
Based on nursing policy, the doxorubicin syringes were connected directly to the IV pump cassette or manually pushed into
the Y-site of the primary IV tubing for patients with peripheral
IVs.
Project Outcomes
The goals of the project were to evaluate the benefits ofperforming sequential wipe testing by obtaining baseline HDcontamination measurements in the selected areas, implementing any necessary changes, and evaluating the effectiveness of
those changes based on subsequent test results.
Data Collection and Procedures
Surface sampling kits were obtained from ChemoGLO™.
Pharmacy wipe samples were performed by the quality assurancecompounding pharmacist, and nursing samples were obtained by
the author. Areas were sampled between 7 am and 8 am in both
departments. In the pharmacy, wipe testing was done prior to themorning decontamination procedures. The two areas in the infusion department were tested prior to patient arrival. HD gloves
were changed between each wipe sample to prevent inadvertentcross-contamination. The initial wipe test (referred to as test
day 1 [TD1]) occurred in December 2020. The process was thenrepeated in March and June 2021 for a total of three sequential
tests over six months.
The ChemoGLO wipe-sampling procedure requires twosponge swabs for covering an area of 30.48 cm by 30.48 cm (929cm2), which is significantly larger than the more typical 100 cm2
area specified by other laboratories (Gabay et al., 2021). One swab
is used vertically and the other horizontally over the same area.
Each swab is placed into its own vial containing a proprietary
solution before beginning the vertical or horizontal wipe. Two of
the pharmacy areas (the working surface of the BSC and the floorof the doffing area) were sampled using a 929 cm2 template provided by ChemoGLO. For the airfoil grate and the transport bin,an area of 929 cm2 was measured and sampled.
Because the area of the telephone receiver was 116 cm2, only
one swab was used vertically to obtain a sample. The IV pole
had six legs, each leg totaling 194 cm2. For TD1, a swab was usedvertically and another horizontally to obtain a sample from all
six legs. However, after further telephone consultation with
ChemoGLO, it was recommended that TD1 be repeated using
one vertical swab and one horizontal swab for each of the six

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legs. This was performed one week later, and results for both of
those TD1 sampling techniques are reported here. The revised
IV pole technique was used for test day 2 (TD2). Because of an
insufficient number of available swabs, for test day 3 (TD3), one
vertical and one horizontal sponge was used for a pair of legs
(total combined surface area of 232 cm2). This approach was
also approved by ChemoGLO.
Data Analysis
All collected samples were stored overnight in a refrigerator
until shipped. Sample analysis was subsequently performedby ChemoGLO using liquid chromatography–tandem mass

TABLE 1.

SUMMARY OF USP <800> GUIDELINESGUIDELINE

DEPARTMENT
AFFECTED

Maintain a list of HDs and provide access to all affected staff.

P, N

Establish written policies and procedures covering all
aspects of HD handing.

P, N

Conduct annual HD training based on job responsibility toinclude compounding, decontamination procedures, drug
administration and disposal, and spill management.

P, N

Obtain written confirmation from personnel of reproductive
capacity regarding the risks associated with HD handlingprior to HD-handling activities.

P, N

Follow specific requirements for unpacking and storage of
HD vials.

P

Establish a designated individual to be responsible foroverseeing the organization’s HD program.

P or N

Provide HD safety education and training to all staff who
handle or may come in contact with HDs.

P, N

Provide engineering controls for compounding (e.g.,containment primary engineering control such as biologic
safety cabinet) and supplemental engineering controls (e.g.,closed-system drug transfer devices for administration).

P, N

Recommend environmental wipe testing.

P or NUse appropriate PPE based on HD-handling activities,
including the following: HD receipt, transport, compounding, administration, deactivation, decontamination,cleaning, disinfecting, spill management, and disposal.

P, N

Institute proper disposal of used PPE during the previously
mentioned activities.

P, N

Review HD policies and procedures at least annually.

P, N

HD—hazardous drug; N—nursing; P—pharmacy; PPE—personal protective equipment;
USP—U.S. Pharmacopeial Convention
Note. Based on information from USP, 2020.

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SEQUENTIAL WIPE TESTING FOR HAZARDOUS DRUGS

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spectrometry (LC-MS/MS). Based on the results of each sequential test, the HD team determined that the pharmacy and nursing
departments would discuss necessary changes in procedures, education, or equipment and would reevaluate those changes after thesubsequent test(s). Potential improvement opportunities included
revisions to the staff training plan regarding decontamination or
cleaning processes and whether the CSTDs were providing the
expected level of safety.

Results
ChemoGLO establishes the LOD for the tested drugs as 0.01 ng/
cm2. Results from TD1 revealed HD contamination greater thanthe LOD in two of the six locations. Neither TD2 nor TD3 (atthree months and six months) found results greater than the
LOD at any of the areas in either the pharmacy department or thenursing department. Overall, 2 of the 18 total wipes exceeded theLOD. A summary of all tests is presented in Table 2.
Pharmacy Department
HD residue from 5-fluorouracil was found on the transport bin in
the pharmacy (0.10 ng/cm2). It is difficult to determine the originof the TD1 transport bin contamination, although, after discussion, the institution’s pharmacists believe it may have been the
result of a contaminated vial that had been placed in the bin.
Studies have found that many HD vials arrive from the distributor with exterior contamination (Cotteret et al., 2022; Redic et al.,2016). The department had also recorded a broken 5-fluorouracil
vial in the week prior to TD1, although it was unclear whether thiswas related to the bin contamination. Although decontaminationand cleaning procedures included the transport bin, inconsistent
staff adherence was identified. Additional education was provided,and procedural changes were implemented by including the transport bins in the tracking system for decontamination and cleaning
procedures. These changes appear to have been effective because
HD residue was less than the LOD at TD2 and TD3.

The pharmacy department has defined HD work practiceprocesses as described in USP <800>. These processes include
the use of appropriate PPE, C-PECs and containment-controlledenvironments for HD sterile compounding, CSTDs during drug
preparation whenever possible, and appropriately scheduled
decontamination and cleaning procedures. Because wipe testing
was performed prior to morning decontamination procedures,the use of CSTDs may have played a role in the negative tests, asevidence suggests that compounding with a needle, even within
a C-PEC, still results in contamination (McDiarmid et al., 2018;
Power & Coyne, 2018; USP, 2020).
Infusion Department
The legs of the IV pole were positive for paclitaxel (0.03 ng/
cm2) using the initial TD1 technique, although the results were
below the LOD when the legs were retested a week later using
the revised technique. The presence of a low concentration of
paclitaxel at TD1 on the IV pole legs using the first technique but
not with the revised technique raises several possibilities. Normal
infusion bay cleaning procedures include wiping the surfaces ofall equipment with germicidal wipes after each patient discharge.
The polished chrome (vertical) section of the IV pole was wiped
down with special attention to areas of patient contact, butcleaning practices did not routinely include the legs attached to
the wheels. In addition, the cleaning process is intended as aninfection prevention measure and not for HD remediation. The
use of disinfectant wipes has not been shown to be effective inremoving HD residue, although no studies have been publishedon the optimal cleaning product for use outside of pharmacy
surfaces. However, recommendations to nursing leadership were
subsequently made for routine cleaning of the IV pole legs using
bleach wipes because strong oxidizers can neutralize some HDs(Soubieux et al., 2020).
The most likely source of IV pole leg contamination wasfrom a loose secondary tubing connection at the pump. The

TABLE 2.

SUMMARY OF RESULTS FROM SEQUENTIAL WIPE TESTING OF HAZARDOUS DRUGSTIME POINT

CLEANROOM FLOOR

TRANSPORT BIN

FLOOR IN FRONTOF BSC

C-PEC AIRFOIL GRATETELEPHONE HANDLE

IV POLE LEGS

Less than LOD

0.10 ng/cm2 (5fluorouracil)Less than LOD

Less than LOD

Less than LOD

0.03 ng/cm2(paclitaxel)ɔ Less than LOD
on repeat test

TD2 (March 2021)

Less than LOD

Less than LOD

Less than LOD

Less than LOD

Less than LOD

Less than LOD

TD3 (June 2021)

Less than LOD

Less than LOD

Less than LOD

Less than LOD

Less than LOD

Less than LOD

ɔ

TD1 (December
2020)

BSC—biologic safety cabinet; C-PEC—containment primary engineering control; LOD—limit of detection; TD1—test day 1; TD2—test day 2; TD3—test day 3
Note. The LOD for hazardous drugs in this study was established as 0.01 ng/cm2.

270 CLINICAL JOURNAL OF ONCOLOGY NURSING JUNE 2023, VOL. 27, NO. 3

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Implement routine sequential wipe testing in areas where hazardous
drugs are handled.
ɔ Review testing results with an interprofessional team consisting of
nursing, pharmacy, and environmental services.
ɔ Educate nurses regarding the need for detailed documentation of any
hazardous drug spills.

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ɔdepartment recorded three HD spills during the six-monthwipe-testing period, and although one was because of a loose
connection, the affected bay and drug were not specified in thereport. That missing information highlighted a gap in the spill
reporting procedure and the need for further staff education. It isalso unknown how long the contamination might have remainedon the IV pole legs because HD residue can persist for extended
periods of time (Connor et al., 2002).
ChemoGLO hypothesizes that the three subsequent negative
results on the IV pole legs (including the retest one week afterTD1) could have occurred because the amount of contaminationon the first TD1 wipe was marginally higher than the LOD (0.03
ng/cm2 versus 0.01 ng/cm2). Although it is generally difficult toremove HD residue from surfaces (Anastasi et al., 2015; Böhlandt
et al., 2015; Roberts et al., 2006), the friction and proprietary
solvent used with the initial TD1 swab may have removed theresidue.

Discussion
Based on best practice guidelines, organizations should consistently evaluate the effectiveness of safety procedures andequipment as part of their HD exposure program (Olsen et al.,2019; Power & Coyne, 2018). Because no acceptable levels for HD
exposure have been established, the ALARA (as low as reasonably
achievable) principle has been suggested (Connor et al., 2016).
Because HD contamination is always a possibility, monitoring forcontamination is recommended in USP <800> (USP, 2019).
Several factors can contribute to the presence of HD residue
in healthcare facilities. Studies have demonstrated that HD vials
can arrive from the distributor already contaminated and that thisresidue can be spread through the pharmacy and beyond (Power& Coyne, 2018; Power et al., 2014). Spills can occur at the bedsideas a result of loose connections, accidental peripheral IV dislodgement, and defective equipment (Eisenberg, 2018; Friese etal., 2015). Practice drift can occur over time, which can affect theculture of safety within an organization (Polovich & Clark, 2012).

Implications For Practice
HD contamination is an invisible safety concern that can affectthe healthcare team, visitors, and patients. Determining the presence of HD contamination has a particular benefit for nurses andsupportive personnel because HD PPE is not used for all patientcare activities. Although wipe testing is not a requirement, USP<800> recommends it as a quality indicator for evaluating theeffectiveness of staff education, policy adherence, and engineering controls such as CSTDs. In this study, the sequential testingprocess provided an opportunity to identify two specific areas
in need of improvement and allowed for the validation of subsequent changes. Contamination did not recur in either of thetwo previously positive areas, nor was it detected in any otherlocations. Repeatability and sustainability are key components

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of ongoing quality improvement processes. The identification
and remediation of two vulnerabilities within the system helped
validate the goal of the project, which could not have been
attained with a single wipe test. The concept of sequential testing is transferable to any healthcare organization where HDs arecompounded and administered and can assist in benchmarking
improvements. Deficiencies in equipment or decontamination
procedures must be identified to initiate corrective action.
As HD safety awareness has increased over the years, so has
the desire to better understand the safety risks within areas where
nurses are employed. Over the past four decades, the author has
spoken to nurses at ONS Congress® and other nursing conferences, as well as at ONS chapter meetings across the country,
who have expressed concerns about the safety of their work environment. Sequential testing can provide valuable information
about areas where improvements are needed and communicate
to staff that the work environment is being evaluated. The relatively low amount of HD contamination identified in this projectsuggests that although there was room for some improvement,
most of the safety measures and procedures were working as
intended, which served to reinforce a positive message to staff
about their environment and practices. In light of the continued
nursing shortage, this messaging is universally valuable in all clinical settings.
Limitations
Although functioning as a quality improvement component of theHD safety program, several weaknesses in the testing protocol
itself were subsequently identified. First, the project included only
six wipe-sampling areas. Although commonly referenced areas in
the pharmacy department were tested (Bartel et al., 2018; Janes etal., 2015; Roland et al., 2017), only two areas in the infusion department were chosen, although the department has 40 bays, 6 nursing
stations, and more than 24 telephones. Lack of HD residue on one
telephone may not be representative of the nursing unit as a whole,and similarly, a single IV pole may not be indicative of the remaining 39. The computer keyboards in the bays and the IV pumps were
not wiped, but other studies have reported HD contamination inthese areas (Hon et al., 2013; Janes et al., 2015; Roland et al., 2017;
Walton et al., 2020). Although testing these additional locations
would have provided a more robust picture, it would have also
added to the cost and labor involved in the project.
Because of a change in computer systems during the course of
the study, the authors were unable to track the individual numberof HDs administered. However, based on the overall volume of

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SEQUENTIAL WIPE TESTING FOR HAZARDOUS DRUGS

drugs administered throughout the year, it was concluded thata sufficient number of the five agents were both compounded
and administered. The difference in sampling techniques used
for the IV pole legs is a potential variable. However, because
the initial TD1 sample was positive but all the subsequent wipe
tests (which covered less surface area per swab) were below theLOD, there was no concern about a false-negative result. Wipinga smaller area per swab typically produces a higher drug recovery
rate (Gabay et al., 2021). Finally, better tracking of spill data
might have provided more insight as to the cause of the IV polecontamination.

Connor, T.H., Anderson, R.W., Sessink, P.J., & Spivey, S.M. (2002). Effectiveness of a closedsystem device in containing surface contamination with cyclophosphamide and ifosfamide
in an I.V. admixture area. American Journal of Health-System Pharmacy, 59(1), 68–72.
Connor, T.H., Lawson, C.C., Polovich, M., & McDiarmid, M.A. (2014). Reproductive health risks
associated with occupational exposures to antineoplastic drugs in health care settings:
A review of the evidence. Journal of Occupational and Environmental Medicine, 56(9),901–910. https://doi.org/10.1097/jom.0000000000000249
Connor, T.H., Zock, M.D., & Snow, A.H. (2016). Surface wipe sampling for antineoplastic(chemotherapy) and other hazardous drug residue in healthcare settings: Methodology andrecommendations. Journal of Occupational and Environmental Hygiene, 13(9), 658–667.
Cotteret, C., Secretan, P.-H., Gilles-Afchain, L., Rousseau, J., Vidal, F., Salguero-Hernandez, G.,. . . Schlatter, J. (2022). External contamination of antineoplastic drug vials: An occupational

Conclusion
Surface wipe testing is a valuable component of an HD safety program as described in USP <800>. This project demonstrated thatsequential testing can identify HD safety vulnerabilities whileproviding the opportunity to validate the effectiveness of changes
over time. This project’s results suggest that there is value inorganizations establishing sequential testing projects, with anemphasis on areas where HDs are administered.

risk to consider. European Journal of Hospital Pharmacy, 29(5), 284–286. https://doi.org/10.1136/ejhpharm-2020-002440
Eisenberg, S. (2016). A call to action for hazardous drug safety: Where we have been and where
we are now. Clinical Journal of Oncology Nursing, 20(4), 377–384. https://doi.org/10.1188/16.CJON.20-04ap
Eisenberg, S. (2018). USP <800> and strategies to promote hazardous drug safety. Journal of
Infusion Nursing, 41(1), 12–23. https://doi.org/10.1097/nan.0000000000000257
Eisenberg, S., Ito, K., & Rodriguez, A. (2021). Hazardous drug contamination: Presence of bathroom contamination in an ambulatory cancer center. Clinical Journal of Oncology Nursing,25(2), 151–156. https://doi.org/10.1188/21.CJON.151-156

Seth Eisenberg, ASN, RN, OCN®, BMTCN®, is an oncology nurse consultant inSaint George, UT. Eisenberg can be reached at setheisenberg@comcast.net, withcopy to CJONEditor@ons.org. (Submitted September 2022. Accepted December
4, 2022.)

Fleury-Souverain, S., Nussbaumer, S., Mattiuzzo, M., & Bonnabry, P. (2014). Determination of
the external contamination and cross-contamination by cytotoxic drugs on the surfacesof vials available on the Swiss market. Journal of Oncology Pharmacy Practice, 20(2),100–111. https://doi.org/10.1177/1078155213482683
Fransman, W., Kager, H., Meijster, T., Heederik, D., Kromhout, H., Portengen, L., & Blaauboer,

The author takes full responsibility for this content. This article was funded, in part,by ICU Medical. The article has been reviewed by independent peer reviewers toensure that it is objective and free from bias. Mention of specific products andopinions related to those products do not indicate or imply endorsement by the
Oncology Nursing Society.

B.J. (2014). Leukemia from dermal exposure to cyclophosphamide among nurses in the
Netherlands: Quantitative assessment of the risk. Annals of Occupational Hygiene, 58(3),271–282. https://doi.org/10.1093/annhyg/met077
Friese, C.R., McArdle, C., Zhao, T., Sun, D., Spasojevic, I., Polovich, M., & McCullagh, M.C. (2015).
Antineoplastic drug exposure in an ambulatory setting: A pilot study. Cancer Nursing, 38(2),111–117. https://doi.org/10.1097/ncc.0000000000000143
Gabay, M., Johnson, P., Fanikos, J., Amerine, L., Kienle, P., Olsen, M., . . . Moody, M.L. (2021).

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Journal club programs can help to increase your ability to evaluate theliterature and translate those research findings to clinical practice, education, administration, and research. Use the following questions to start thediscussion at your next journal club meeting.
ɔ Based on the description of sequential hazardous drug (HD) wipe
testing in this article, if similar testing was performed in your clinicaloncology environment, what do you think the results would be?
ɔ Targeting areas/surfaces in your clinical oncology environment, wherewould sequential HD wipe testing potentially reveal HD contamination?
ɔ In your healthcare facility, how would you advocate for regular sequential HD wipe testing of surfaces/areas in your clinical environment?
ɔ What can you do to encourage your clinical colleagues to prevent HD
contamination in the clinical oncology environment?
Visit http://bit.ly/1vUqbVj for details on creating and participating in a journal club. Photocopying of this article for discussion purposes is permitted.

nation with cyclophosphamide, ifosfamide, and methotrexate in 66 Canadian hospitals:

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