Background
Occupational exposure to antineoplastic drugs remain a concern for healthcare workers involved in drug preparation, administration and environmental cleaning. Surface contamination in pharmacy and clinical areas is a recognized indicator of potential occupational exposure. Many antineoplastic agents are carcinogenic or reproductive toxicants; however, exposure assessment is challenged by the absence of occupational exposure limits, variability in contamination levels, non-standard analytical methods, and limited operational guidance for routine surveillance.

The Hazardous Drug Exposure Prevention Program (HAzDEPP) addresses this gap by piloting a collaborative, multi-site surveillance and exposure reduction framework in British Columbia, Canada. The program uses standardized surface wipe sampling conducted by pharmacy and nursing staff, benchmarking against ‘hygienic guidance values’, collection of contextual environmental data and a ‘Knowledge Attitude and Practice’ (KAP) survey on antineoplastic drug handling.  

Objectives
To implement and evaluate a standardized, staff-led surface contamination surveillance program for antineoplastic drug across multiple healthcare sites, and to assess the feasibility of a collaborative surveillance and feedback model that engages front-line staff through appreciative inquiry model to support ongoing exposure prevention.

Methods
Participating sites undergo surface wipe sampling every six months over two year study period. Pharmacy and Nursing staff conduct sampling using standardized kits and protocols on N pre-defined high-risk (primary) surfaces with N optional discretionary surfaces selected by staff.

Samples are analyzed for eleven commonly used antineoplastic drugs. Site-specific results are reported back after each round, followed by technical meetings to discuss findings, temporal and inter-site variability, implementation experiences and areas of concern. The anonymous KAP survey assesses staff knowledge, perceptions, and self-reported practices on hazardous drug handling at baseline and end-of-study.

Interim Results
Antineoplastic drug residues were detected on surfaces in both pharmacy and nursing areas across cancer sites in all rounds to date. Considerable variability was observed across sites and sampling periods, with differences between rounds attributed primarily to operational rather than temporal factors.

Contamination patterns varied by surface type and drug. Primary surface contamination remained stable across two rounds (16% of surfaces >LOD in round one; 15% in round two) while contaminated discretionary surfaces increased from 4% to 14%, indicating a broader and less predictable distribution of contamination. Nursing areas showed more frequent detections above LOD than pharmacy areas, particularly on patient administration, care and waste disposal surfaces.

KAP survey results showed higher knowledge but lower practice scores among Nursing staff, while Pharmacy staff showed lower knowledge but higher practice scores. This suggests differences in role-based workflows with pharmacy roles being more standardized and process-oriented. It aligns with surface sampling findings, where pharmacy areas showed more consistently lower contamination levels.

Technical meeting feedback highlighted recurring challenges in cleaning practices, drug transport from pharmacy to nursing units, and interpretation of low-level contamination data, guiding ongoing refinement of surveillance and prevention strategies.

Interim Conclusion
With strong engagement and operational success, HazDEPP has expanded from eight to sixteen cancer care sites. Ongoing sampling and structured feedback from frontline staff will further inform targeted prevention strategies and strengthen occupational exposure prevention in healthcare settings.