Assessing Etoposide and Cyclophosphamide Contamination and Current Cleaning Practices in Patient Bathrooms

Clin J Oncol Nurs. 2025 Mar 14;29(2):E52-E59. doi: 10.1188/25.CJON.E52-E59.

Abstract

Background: Antineoplastic drug (AD) exposure presents severe risks to healthcare workers. Previous studies have demonstrated that patient bathrooms are highly contaminated and have led to concern for excreta as a source of environmental contamination with ADs.

Objectives: This study assessed AD contamination and current cleaning practices to remove AD surface contamination in patient bathrooms.

Methods: Three surfaces in the bathrooms of patients who had received etoposide and/or cyclophosphamide were sampled and analyzed for contamination at three time points. Liquid chromatography-tandem mass spectrometry was used for analysis. Interviews and observations of daily and discharge cleaning were conducted to understand cleaning practices.

Findings: A significant reduction in etoposide contamination on toilets and floors was observed following discharge cleaning; however, no significant reduction was observed on walls for either AD or on floors for cyclophosphamide.

Keywords: antineoplastic drugs; excreta; occupational exposure; surface contamination.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents* / analysis
  • Cyclophosphamide* / analysis
  • Equipment Contamination* / prevention & control
  • Etoposide* / analysis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Toilet Facilities* / standards

Substances

  • Cyclophosphamide
  • Etoposide
  • Antineoplastic Agents