Exposure Monitoring

Background

HazDEPP is a two-year research initiative focused on reducing healthcare workers’ risk from incidental exposure to antineoplastic drugs. It introduces a new surface wipe-sampling surveillance strategy aimed at continual reduction of drug exposure, enhancing workplace education, and promoting best practices.

Healthcare workers face chronic exposure risks from hazardous drugs contaminating surfaces in pharmacies and clinical settings. Many of these drugs are carcinogenic or reproductive toxins with poor warning properties, making hazard recognition challenging. Existing guidelines (e.g., USP <800>) lack clear operational details, while the absence of Occupational Exposure Limits (OELs), standardized analytical methods, and reliable exposure data further complicate effective risk management

HazDEPP, funded jointly by WorkSafeBC and the BC Nurses’ Union, evaluates a proposed surveillance strategy designed to offer clear operational guidelines, optimized sampling procedures, and “Hygienic Guidance Values” (HGVs) that promote measurable exposure reduction. Currently implemented at eight cancer care centers across two health authorities and BC Cancer, the project aims to develop a sustainable surveillance system and plans to expand to additional healthcare settings in early 2025.

Data Collection & Management 

Each site undergoes four sampling rounds, focusing on up to ten sentinel surfaces for pharmacy and nursing areas separately and up to five discretionary surfaces. In addition, clinic staff document operational data such as volumes of drug preparation and administration, clinic workload and variations or any other suggestions or comments. These additional insights enhance the interpretation of contamination data. 

Post-sampling, a Knowledge, Attitude, and Practice (KAP) survey is conducted with healthcare staff to understand their practices and understanding of hazardous drug handling and safety protocols. 

All analyzed results are shared with respective sites, followed by technical meetings to discuss outcomes, challenges, and next steps. Subsequently, forums involving stakeholders, funders, unions, and health authorities contextualize the findings within national and international benchmarks and facilitate sharing of best practices. 

Collected data ultimately contributes to a centralized hazardous drug exposure database to facilitate ongoing research and policy development. 

Sampling Procedure

Healthcare staff conduct surface sampling using standardized kits prepared by UBC. Each kit includes: 

Sampling typically takes under 2 hours per site every 6 months.

For more information, please watch the sampling video here: https://ohr.ubc.ca/hazzdepp/surface-wipe-method/ 

Analytical Methodology

Collected samples are analyzed at UBC labs using High-Performance Liquid Chromatography-Mass Spectrometry (HPLC-MS/MS), designed specifically for sensitive and accurate detection of 11 antineoplastic drugs (e.g., cyclophosphamide, methotrexate, paclitaxel). Analytical procedures include sample extraction, addition of internal standards, and rigorous quality control checks to ensure reliability. The list of 11 antineoplastic drugs are as follows:

Rationale, Significance, and Deliverables 

Environmental contamination by hazardous drugs (HDs) remains widespread and persistent. Current regulatory frameworks reliant on compliance monitoring are limited by the absence of Occupational Exposure Limits (OELs) and standardized analytical methods for HDs. Recognizing the necessity for a quantitative approach to manage and control these hazards, HazDEPP aims to pilot and evaluate a novel surveillance method that provides quantitative exposure data without requiring OELs, is evidence-based, and incorporates educational components, transparency, and timely feedback. 

Key deliverables include: 

• Two years of routine surface wipe sampling at multiple cancer care centers across various health regions. 

• A validated hazardous drug surveillance program suitable for adoption across BC health regions. 

• A centralized database and reporting tools for ongoing surveillance and exposure monitoring. 

• An expanded network of healthcare professionals and stakeholders supporting continuous improvement and the implementation of best practices in hazardous drug exposure reduction. 

Project Impact

HazDEPP aims to improve workplace safety through informed, data-driven strategies that reduce hazardous drug exposure, support healthcare worker safety, and contribute significantly to occupational health practices in healthcare settings.