Oncology News

Clinical Update to ONS Safe Handling Guidelines Regarding Surface Safe®

The sec­ond edi­tion of the ONS guide­lines Safe Han­dling of Haz­ardous Drugs, pub­lished in Feb­ru­ary 2011, makes ref­er­ence to the use of Sur­face Safe® solu­tion, mar­keted by Hos­pira, Inc., for decon­t­a­m­i­nat­ing pri­mary engi­neer­ing con­trols (see pp. 28, 30, and 55 in the pub­li­ca­tion). Sub­se­quent to the pub­li­ca­tion of the ONS guide­lines, Hos­pira noti­fied its cus­tomers that it will no longer be mar­ket­ing this prod­uct. Cur­rently, no com­mer­cially avail­able alter­na­tive has been deter­mined. ONS will issue an alert once an appro­pri­ate alter­na­tive prod­uct has been identified.

Much sup­port for the use of chlo­rine bleach exists in the gen­eral decon­t­a­m­i­na­tion ref­er­ences and in spe­cific drug mate­r­ial safety data sheets from man­u­fac­tur­ers. Sodium thio­sul­fate is a known deac­ti­vat­ing agent for a num­ber of chemother­apy drugs and is also a spe­cific neu­tral­izer for chlo­rine bleach.

To approx­i­mate the same con­cen­tra­tion as is avail­able in Sur­face Safe (2% sodium hypochlorite),

  • Mix approx­i­mately half stan­dard Clorox® (5.25%; Clorox Ultra is more con­cen­trated) with half ster­ile water for irri­ga­tion (SWFI).
  • Add a small amount of liq­uid deter­gent (not too much or it will be hard to rinse).

For com­plete decon­t­a­m­i­na­tion of a bio­logic safety cab­i­net, includ­ing under the work tray, about 1 liter of the bleach and deter­gent mix­ture is needed. This mix­ture will accom­plish clean­ing (deter­gent), removal of drug residue (tow­elette with proper dis­posal), and deac­ti­va­tion of some haz­ardous drugs and most microbes (bleach). Chlo­rine bleach at 2% con­cen­tra­tion is an excel­lent disinfectant—better than alcohol—and a spo­ri­cide, which alco­hol is not.

Because chlo­rine bleach can dam­age stain­less steel sur­faces, fol­low with sodium thio­sul­fate solu­tion. The thio­sul­fate neu­tral­izes the bleach to avoid this dam­age. The sodium thio­sul­fate also deac­ti­vates some haz­ardous drugs (e.g., plat­inum com­pounds, mechlorethamine). To approx­i­mate the same con­cen­tra­tion as in Sur­face Safe (1.0%), mix sodium thio­sul­fate with SWFI. The thio­sul­fate may be avail­able in 10% or 25% solu­tion, which requires about 1:10 or 1:25 dilu­tion with SWFI. The neu­tral­iza­tion process cre­ates NaCl—salt—which must be rinsed thor­oughly with SWFI to remove.

Use gauze pads (4 x 4) for each step of the process, and dis­pose of them as chemother­apy waste.

  1. Bleach/​detergent solution
  2. Sodium thio­sul­fate solution
  3. SWFI rinse
  • Casteg­naro, M., De Meo, M.D., Laget, M., Mich­e­lon, J., Gar­ren, L., Sportouch, M.H., & Hansel, S. (1997). Chem­i­cal degra­da­tion of wastes of anti­neo­plas­tic agents. 2: Six anthra­cy­clines: Idaru­bicin, dox­oru­bicin, epiru­bicin, piraru­bicin, aclaru­bicin and daunoru­bicin. Inter­na­tional Archives of Occu­pa­tional and Envi­ron­men­tal Health, 70, 378–384. doi: 10.1007/s004200050232
  • Gon­za­lez, R., & Mas­soomi, F.F. (2010). Man­u­fac­tur­ers’ rec­om­men­da­tions for han­dling spilled haz­ardous drugs. Amer­i­can Jour­nal of Health-​​System Phar­macy, 67, 1985–1986. doi: 10.2146/ajhp100137
  • Hansel, S., Casteg­naro, M., Sportouch, M.H., De Meo, M., Mil­havet, J.C., Laget, M., & Dume­nil, G. (1997). Chem­i­cal degra­da­tion of wastes of anti­neo­plas­tic agents: Cyclophos­phamide, ifos­famide and mel­pha­lan. Inter­na­tional Archives of Occu­pa­tional and Envi­ron­men­tal Health, 69, 109–114. doi: 10.1007/s004200050124
  • Hos­pira, Inc. (n.d.). Sur­face Safe® pack­ets. Retrieved from http://​www​.hos​pira​.com/​P​r​o​d​u​c​t​s​/​s​u​r​f​a​c​esafe.aspx
  • Roberts, S., Khammo, N., McDon­nell, G., & Sewell, G.J. (2006). Stud­ies on the decon­t­a­m­i­na­tion of sur­faces exposed to cyto­toxic drugs in chemother­apy work­sta­tions. Jour­nal of Oncol­ogy Phar­macy Prac­tice, 12, 95–104. doi: 10.1177÷1078155206070439

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Comments

  1. May 17, 2011 at 11:15 am
    Kim Ross says:

    What kind of liq­uid deter­gent (laun­dry, dish, etc)??

  2. May 17, 2011 at 1:02 pm
    Marty Polovich says:

    Dish deter­gent is fine–any liq­uid deter­gent that you have on hand.

  3. August 10, 2011 at 5:58 pm
    Erin Fox says:

    There is a national short­age of sodium thio­sul­fate. The sole sup­plier of prod­uct can­not esti­mate when prod­uct will be avail­able.
    http://​www​.ashp​.org/​D​r​u​g​S​h​o​r​t​a​g​e​s​/​C​u​r​r​e​n​t​/​B​u​l​l​e​t​i​n​.​a​spx?id=766

  4. October 4, 2011 at 12:30 pm
    Nichole says:

    In 400ml (200 bleach, 200 SWFI) how much deter­gent would you add? Thanks.

  5. October 18, 2011 at 11:37 am
    ONS says:

    The amount of deter­gent depends on what deter­gent you are using. For dish-​​type deter­gent, a small “squirt” is suf­fi­cient for a half-​​liter or so. If using a hospital-​​type deter­gent, the label should indi­cate the cor­rect amount based on the volume.

  6. December 9, 2011 at 1:46 pm
    SHANA says:

    How often can you use this mix­ture to clean a germ free chemo hood? Would I be able to use it every­day at the end of my shift to clean my chemo hood?

  7. December 9, 2011 at 1:51 pm
    SHANA says:

    Also my direc­tor would like to know if its some­thing you must use every­day to clean a chemo hood or could you just use 70% alco­hol and only use that mix when spills cant be removed with just the alcohol

  8. December 15, 2011 at 6:55 pm
    Brian Davis says:

    If an alter­na­tive were avail­able, would the ONS com­mu­nity sup­port it? I want to bet­ter under­stand the demand.

  9. January 5, 2012 at 8:51 am
    ONS says:

    Hi Shana! Thanks for your ques­tions! It’s impor­tant to dis­tin­guish between “dis­in­fect­ing,” and “decon­t­a­m­i­nat­ing” a bio­log­i­cal safety cab­i­net (BSC). Dis­in­fect­ing is impor­tant for pro­tec­tion of the ster­ile prod­uct from pos­si­ble bac­te­r­ial con­t­a­m­i­na­tion dur­ing drug prepa­ra­tion. Decon­t­a­m­i­nat­ing is meant to remove haz­ardous drug residue from surfaces–protection of the employ­ees and environment.

    In order to reduce bac­te­r­ial con­t­a­m­i­na­tion of the sur­faces where ster­ile prod­ucts are mixed, the USP 797 Stan­dard requires wip­ing down the BSC sur­face with alco­hol before begin­ning prepa­ra­tion, and peri­od­i­cally dur­ing the day. Alco­hol should not be used for chemother­apy spills. Alco­hol is a dis­in­fec­tant. While it is use­ful for dis­in­fec­tion, it is a sol­vent, and may end up spread­ing chemother­apy residue across the sur­face of the BSC.

    The bleach/​detergent solu­tion is indi­cated for “decontamination”–meaning removal/​deactivation of haz­ardous drug residue. This should be done at the end of drug prepa­ra­tion for the day. In large vol­ume phar­ma­cies, it should be done more fre­quently. Since bleach is also a good dis­in­fec­tant, it serves that pur­pose, too.

  10. April 30, 2012 at 1:27 am
    Amjad K. says:

    Hello,
    Does any­one there know of a “video” show­ing the proper tech­nique of inject­ing anti­dote in case of chemoth­er­pay extravasation?

What do you think?

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