Volume 1, Issue 4 -

Purpose: Coring of a medication vial’s rubber stopper has been reported as a major cause of visible particle presence in injectable preparations. In this study, we investigated and quantified visible particle formation caused by coring associated with four potential causal factors. Methods: The factors studied were: nature of the rubber stopper; rubber stopper thickness, type of metal needle bevel used to pierce the stopper, and puncture technique. For each one of 16 different situations, 40 medication vial rubber stoppers were punctured, and the contents filtered. The filters were then examined under optical microscopy and particles present counted and measured. Results: The incidence of particle formation ranged from 0 % to 75 %, depending on the situation. Particle length was on average of 0.98±0.39 mm. The situation that gave the most particles (75 %; 30/40) was obtained when using a short bevelled needle, a 4 mm thick chlorobutyl vial stopper and with a puncture angle of 90°. Whilst a puncture technique reduced particle formation by more than 50 % for the most at risk situation, but without eliminating particle formation (residual formation of 22.5 %; 11/40), the use of a blunt bevelled needle totally eliminated the incidence of visible particle creation. The thickness of the rubber and the nature of the elastomer seemed to be linked to coring incidence, but in lesser proportions. Conclusion: Puncturing the stoppers using a technique with a 45° puncture angle reduced particle formation, but only the use of a blunt metal needle totally eliminated it.

Objective The main objective is to evaluate RFID tags detection rates using various exploratory scenarios in order to identify optimal conditions of use. The secondary objective is to evaluate RFID tags detection rates based on a real-life scenario involving a cardiorespiratory resuscitation drug tray used within our institution in order to identify optimal conditions of use. Background The traceability of goods has been a subject of interest for more than a century. Traceability makes it possible to locate goods at every step in the chain from production through to disposal. Just as with other Automatic Identification and Data Capture technologies, radio frequency identification (RFID) is used to increase the traceability of objects. Results Seven variables that could influence RFID tags detection rates were evaluated in eight exploratory scenarios. Optimal detection parameters allowing to a 100 % detection rate were identified: a 10-second reading time; a reading distance of 10 cm; parallel orientation of reader-antenna and at least two back and forth readings for a total of 6 sec were required for optimal reading. Detection rates decreased after 100 RFID tags and it were not affected by the shape of the RFID tags. Reader-antenna and RFID tag interferences resulted from aluminum paper or RFID tags that touched one another. RFID tag detection rates obtained per operator were similar. Regarding real-life scenarios, detection rates increased with reading times and a plateau effect was observed after 10 sec. Undetected elements varied and non-detection was almost always related to the proximity of two RFID tags rather than the nature of the items read. Conclusion To our knowledge, this is the first prospective descriptive study that compares RFID tag detection rates based on various exploratory scenarios in order to identify optimal conditions of use. Such results can be used to develop a software application supporting drug replenishing through RFID in the drug use process.

Objective: The aim of this paper is to review the surface contamination of three hazardous drugs within a teaching hospital and comment the different strategies put in place over the years in the context of these multicenter studies. Background: Many cross-sectional studies have been published about surface contamination with hazardous drugs in healthcare settings. Methods: This is a descriptive retrospective and longitudinal study. The study was conducted in a 500-bed mother-child university health center in Quebec, Canada. Results: A total of 72 samples (e. g. 36 in the pharmacy and 36 in outpatient care area) were obtained between 2010 and 2016 for a total of 216 analyses (three drugs/samples tested). The proportion of positive samples was 50 % (36/72) for cyclophosphamide, 32 % (23/72) for ifosfamide and 19 % (14/72) for methotrexate. The cyclophosphamide concentrations measured varied from undetectable to 400 pg/cm 2 . The ifosfamide concentrations measured varied from undetectable to 830 pg/cm 2 . The concentrations of methotrexate measured varied from undetectable to 660 pg/cm 2 . Conclusion: This study shows a longitudinal perspective of the surface contamination of hazardous drugs in a teaching mother-child hospital. Every hospital should review its annual scorecard of contamination with a longitudinal perspective to minimize drug contamination. It is possible to contain surface contamination with hazardous drugs with different strategies.

Introduction: The staff handling the cytotoxics are exposed to contamination as an occupational hazard. The unit of the Centre Hospitalier Universitaire (C.H.U) of Saint Pierre is ISO9001 certified. In a constant effort to improve the quality of our work, samples of the work surface were collected and allowed us, in a first step, to evaluate the contamination in a CRU in Reunion Island. As a result, corrective and preventive actions were implemented in the work routines. Material and method: 53 samples of the work surface, collected in December 2015 and in March and April 2016 in seven different spots, were treated in this observational study. The 5-FU was chosen as example and analysed and quantified by using liquid chromatography associated with a mass spectrometer with a detection limit of 2 ng/pf. Results: We observed a great difference in contamination; 29 samples were positive, the isolator container was the location with the highest level of contamination, including manipulator gloves under the isolator, work surface and the inside of the isolator bin. The contamination was reduced after a first clean-up with water only. The overwrapping bags and the manipulator gloves are only a little or not at all contaminated. Conclusions In order to reduce the exposure to cytotoxic residuals, corrective actions have been implemented: more frequent changes of manipulator gloves, the use of closed systems, and cleaning of the isolator with water. The efficiency of these modifications of work practices will be evaluated again in a few months.

Intrathecal analgesia has increased over the past two decades based on high level proof of efficacy in patients with cancer. Morphine and Ziconotide remains the reference. Polyanalgesic Consensus Conference IT treatment algorithm recommends as the second line therapy opioids/ziconotide combination. Sufentanil and ziconotide combination can be used. The implantable pumps development helped to improve the comfort of the patient. The refills were prepared under a laminar airflow hood under strictly aseptic conditions, by the hospital pharmacist. In order to secure the process, a new analytical method by simple liquid chromatography ultraviolet spectrometry method was developed for the simultaneous quantification of two analgesic drugs (sufentanil, ziconotide). The method was validated according to the recommendation of the US Food and Drug Administration (FDA). The method was linear between 0.1 to 4 μg/mL for ziconotide and 3.125 to 50 µg/mL for sufentanil. This routine quality control analysis secures the production process.