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Despite the growing use of chemotherapy drugs in resource-constrained settings, training opportunities on safe handling practices are lacking. This study’s objectives were to develop and evaluate an e-learning training module on the safe handling of chemotherapy drugs to strengthen knowledge and practices in low- and middle-income countries (LMICs). The module’s curriculum was developed using the Six-Step Approach for Curriculum Development for Medical Education. Asynchronous, self-paced, e-learning lessons within the module were created and uploaded onto a free online platform, Pharm-Ed. The study ran online from January to April 2021. Participant recruitment was done using convenience sampling through various channels (social media, communities of practice). Training module effectiveness was evaluated using knowledge assessments (a pre-test and post-test study design) and participant satisfaction. We developed a comprehensive e-learning module on the safe handling of chemotherapy drugs comprising 11 asynchronous, self-paced, e-learning lessons. Eighty-two participants (68% pharmacists and 17% pharmacy students) from 17 countries completed at least one lesson, with a total of 259 lessons completed. Evaluation of the different lessons showed significant improvements in theoretical knowledge (p

Despite the growing use of chemotherapy drugs in resource-constrained settings, training opportunities on safe handling practices are lacking. This study's objectives were to develop and evaluate an e-learning training module on the safe handling of chemotherapy drugs to strengthen knowledge and practices in low- and middle-income countries (LMICs). The module's curriculum was developed using the Six-Step Approach for Curriculum Development for Medical Education. Asynchronous, self-paced, e-learning lessons within the module were created and uploaded onto a free online platform, Pharm-Ed. The study ran online from January to April 2021. Participant recruitment was done using convenience sampling through various channels (social media, communities of practice). Training module effectiveness was evaluated using knowledge assessments (a pre-test and post-test study design) and participant satisfaction. We developed a comprehensive e-learning module on the safe handling of chemotherapy drugs comprising 11 asynchronous, self-paced, e-learning lessons. Eighty-two participants (68% pharmacists and 17% pharmacy students) from 17 countries completed at least one lesson, with a total of 259 lessons completed. Evaluation of the different lessons showed significant improvements in theoretical knowledge (p 0.01) in all except one lesson and a high degree of participant satisfaction. As the use of anti-cancer drugs in LMICs will continue to increase, this e-learning module is an effective means to address the lack of training opportunities on the safe handling of chemotherapies for healthcare workers in these countries. The module could be integrated into a multi-modal approach aimed at reducing occupational exposure and increasing patient safety in cancer care centers.

PURPOSE Chemotherapies are considered high-risk drugs for patient and staff safety. Considering the rising burden of cancer and the increasing use of chemotherapy drugs in low- and middle-income countries (LMICs), promoting continuous improvements in the safety and quality of practices in these settings is essential. This paper describes the development and proof of concept of a toolkit to audit chemotherapy handling practices in the health care facilities of LMICs. METHODS A steering committee defined the audit method and the toolkit content. Several checklists were developed to facilitate the audit and data collection. Items included in checklists were derived from key reference works on safe handling. Different tools were validated using Delphi surveys and expert reviews. Audits of pilot sites were performed to test the toolkit's applicability and relevance. RESULTS The toolkit contains a 134-item global assessment tool for the different processes at each step of the medication pathway and three step-specific observation checklists to assess different health workers' practices during the prescription, preparation, and administration of chemotherapies. The toolkit also proposes using a surface-wipe sampling method to measure any cytotoxic contamination of the immediate environment. The toolkit was tested in three teaching hospitals in Africa. CONCLUSION The toolkit developed was successfully implemented in a variety of LMIC settings, providing a comprehensive evaluation of the quality and safety of the chemotherapy drug handling practices in participating health care facilities. This toolkit can help facilities in LMICs to implement a new approach to continuously improving the quality and safety of their practices and ultimately ensure patient and staff safety., A toolkit for implementing safe chemotherapy handling practices to ensure patient and staff safety in LMICs

IntroductionChemotherapies are handled using Good Manufacturing Practices, which ensure asepsis and high-quality production. Continuous education is compulsory and usually includes theoretical and practical exercises.ObjectivesThis work aimed to validate an innovative method of teaching good manufacturing practices based on an escape room mixing simulation and gaming.MethodPairs of learners were locked in a simulated clean room (Esclean Room) and had 1 hour to produce a chemotherapy and escape by finding solutions to 23 “Good Manufacturing Practices mysteries” linked to combination locks. To measure the experiment’s impact on teaching, questionnaires including the 23 mysteries (in different orders) were filled in before, just after and one month after escape from the Esclean Room. Pharmacy staff’ degrees of certainty were noted for each question. A satisfaction survey was completed.ResultsSeventy-two learners (29% senior pharmacists, 14% junior pharmacists, and 57% pharmacy technicians) escaped the Esclean Room and 56 answered every questionnaire. The educational intervention resulted in increases in correct answers and certainty. Correct answers rose from 57% in the first questionnaire to 80% in the third ( p ConclusionThis study built and tested a pedagogical escape room involving a high risk, professional, pharmacy process. The use of this pharmacy technology simulation had a positive impact on pharmacy staff theoretical knowledge.

Background Use of automated systems for the production of chemotherapy will increase in answer to hospitals’ needs to rationalise production. The aim of the study was to evaluate the performance of a PharmaHelp® automated system for compounding chemotherapy. Methods Viable and non viable particles in air and liquid were measured by particle counter. Surface chemical contamination was simulated with a quinine solution. Microbiological contamination and aseptic processes were studied using media-fill tests. Dose accuracy was evaluated using a gravimetric method, in simulation studies and with real products in daily practice. Productivity was calculated by batch of ten IV-bags. Results No particles or microbiological contamination were detected. Filling was accurate for all the volumes of non-viscous solution studied (97–103 %). Minimum volumes which could be prepared accurately were 2 mL and 5 mL for the non-viscous and viscous solutions, respectively. For 2–5 mL volumes, the robot was less accurate than average, and 0–2 % of bags were rejected (deviation>10 %). Average fill deviations were from 0–3 % for 2–5 mL volumes and Conclusions The automated system was able to produce chemotherapy effectively, delivering appropriate quality with productivity comparable to manual preparations. These results confirmed that such automated systems have the potential to guarantee optimal safety for patients and technicians.

PurposeChemotherapy preparation units face peaks in activity leading to high workloads and increased stress. The present study evaluated the impact of work overloads on the safety and accuracy of manual preparations.MethodSimulating overwork, operators were asked to produce increasing numbers of syringes (8, 16, and 24), with markers (phenylephrine or lidocaine), within 1 h, in an isolator, under aseptic conditions. Results were analyzed using qualitative and quantitative criteria. Concentration deviations of 30% from the expected concentration were considered as accurate, weakly accurate, inaccurate, and wrong concentrations, respectively.ResultsTwenty-one pharmacy technicians and pharmacists carried out 63 preparation sessions (n = 1007 syringes). A statistically significant decrease in the manufacturing time for one syringe was observed when workload increased (p 30%), 6 mislabeling, 2 wrong diluents, and 1 wrong drug. There was no statistically significant difference in the mean concentration accuracy of final preparations across the three workloads. The overall error rate increased with the number of preparations made in 1 h: 1.8% for 8 preparations, 2.7% for 16 preparations, and 5.4% for 24 preparations (p ConclusionAlthough pharmacy technicians and pharmacists were able to increase production speeds with no effect on mean concentration accuracy under stressful conditions, there were greater probability errors being made. These results should encourage actions to spread workloads out over the day to avoid peaks in activity.

Background Our chemotherapy production unit decided to rethink its organisational strategy and to revise its production processes through lean methodology to meet growing activity, in the context budget constraints that limit the increase in staff. Purpose To evaluate the impact of a lean management approach on the efficiency of a chemotherapy unit. Material and methods A five-step lean methodology approach was applied with a team of 12 technicians and five pharmacists supported by a lean expert, from January 2015 to July 2016: DEFINE: objectives, value stream mapping, process flows. MEASURE: steps, process duration, use of stock. ANALYSE: added-value steps, waste, waiting time and causes. IMPLEMENT: imagine and implement solutions. CONTROL: efficiency, performance, satisfaction. Results The team identified 73 items impacting the efficiency of the process during the ‘Measure’ phase. During the ‘Analyse’ step, 18 opportunities divided into four main themes were proposed to improve the organisation: Flow: smoothing the activity and reducing the early morning peak (–12% between 7 and 9 am), producing continuously according to demand of the day (‘Just in time’ eight maximum ongoing preparations), improving occupancy rates of isolators (+25% between 10 and 12 am, and +20% between 1 and 4 pm), revising the steps of double–control and using mistake–proofing resulted in a decrease in crossing time of manufacturing from 9 hour 45 min to 1 hour 45 min. bull; Space: reorganisation with a reduction of unnecessary movements. bull; Management: creation of a position of ‘coordinator of the day’, and daily meetings (‘Obeya’) to reassign tasks. bull; Stock and control: rationalisation of storage and orders. A net gain of 40% full-time equivalent was reached. The satisfaction survey showed a positive acceptance of the project and its conduct. Conclusion The application of a lean methodology allowed the optimisation of the management of our chemotherapy production unit and saved human resources. The main actions were to eliminate waiting time, to smooth daily activity, and to reorganise roles, spatial organisation and storage. The positive impact on the efficiency of our facility and the satisfaction of the team proved that lean methodology is a relevant tool in the hospital pharmacy. No conflict of interest

BACKGROUND: Chemotherapy preparation units have to face an increasing activity with constant staff. Safety is therefore compromised. PURPOSE: The purpose of our experiment was to measure the effect of a work overload on preparations, accuracy and occurrence of errors. MATERIALS AND METHODS: Our work was performed in a real working environment using simulated preparations and two tracer drugs (phenylephrine or lidocaine). Twenty-one operators participated in three preparation sessions and had to produce an increasing number of syringes (8, 16 and 24) within a same time period (1 hour). Syringes were assayed by a validated capillary electrophoresis method. Results were analysed according to qualitative (choice of wrong stock solution, diluents and labelling) and quantitative (dose deviation from the target concentration: accurate,30%) criteria. RESULTS: A statistically significant decrease in the preparation time per syringe was observed when workload increased (p30% deviation), six mislabelling, two wrong diluents and one wrong drug. The overall error rate increased with the number of preparations performed in 1 hour: 1.8% for eight preparations, 2.7% for 16% and 5.4% for 24 (p

Two capillary electrophoresis (CE) methods were developed for the analysis of 16 antineoplastic drugs contained in injectable pharmaceutical formulations. A capillary zone electrophoresis (CZE) method coupled to UV was developed with a background electrolyte (BGE) made of a 100 mM phosphate buffer at pH 2.5 containing 50% (v/v) of acetonitrile and dynamic coating of capillaries with Ceofix®. This method allowed the analysis of doxorubicin, epirubicin, idarubicin, daunorubicin, irinotecan, topotecan, vincristine, vindesine, vinblastine, and vinorelbine in less than 8 min. A micellar electrokinetic chromatography (MEKC) method coupled to UV was also developed for the determination of methotrexate, pemetrexed, etoposide, etoposide phosphate, fludarabine phosphate and 5-fluorouracil. A run time of 16 min was obtained with a BGE made of 50 mM borate buffer at pH 9.2 with 80 mM of sodium dodecyl sulfate (SDS) and 20% (v/v) of acetonitrile. For both methods, the applied voltage was 30 kV and the sample injection was performed in the hydrodynamic mode. All analyses were carried out in fused silica capillaries with an internal diameter of 50 µm and a total length of 64.5 cm. Both methods were validated and trueness values between 99.4% and 101.3% were obtained with repeatability and intermediate precision values of 0.5-1.8% for all drugs. These methods were found appropriate for controlling injectable pharmaceutical formulations containing antineoplastic drugs and successfully applied in quality control.

Resume L’allogreffe de cellules souches hematopoietiques (allo-CSH) reste le seul traitement curatif de nombreuses hemopathies malignes ainsi que de certaines pathologies benignes ou constitutionnelles. Le busulfan propose dans sa forme injectable est rapidement devenu l’un des piliers pharmacologiques du conditionnement myeloablatif ou non. C’est suite au declenchement courant 2010 d’un essai clinique multicentrique international de phase II que nous avons eprouve la robustesse et la fiabilite de notre organisation en un modele complexe de cooperation multifactorielle. Dans ce protocole de type « BuCy2 » d’une duree habituelle de quatre jours, le busulfan intraveineuse est administre a raison d’une seule dose quotidienne en lieu et place des 16 perfusions conventionnelles ; en revanche, la dose totale cible reste inchangee, aux adaptations posologiques pres. Le traitement est tres securise au moyen d’un suivi therapeutique conduit en temps reel via des mesures reiterees de concentrations plasmatiques et de calculs d’aires sous la courbe. Le processus est techniquement complexe et impose la cooperation etroite des equipes concernees. Une analyse SWOT/MOFF ( strength, weakness, opportunity and threat /menaces, opportunites, forces, faiblesses) a ete construite et a guide une demarche continue d’amelioration de la qualite du service rendu au triple profit de la chaine de soins, du patient et de l’environnement. Divers points critiques ont ete identifies, et corriges ; l’experience est fortement contributive de la securisation et de la fiabilite du circuit du medicament. La performance de l’allo-CSH s’en trouve amelioree. A un echelon superieur, il repond au cahier des charges et a la plupart des exigences d’un veritable systeme de management de la qualite.

Background and objectives Centralized chemotherapy preparation units have established systematic strategies to avoid errors. Our work aimed to evaluate the accuracy of manual preparations associated with different control methods. Method A simulation study in an operational setting used phenylephrine and lidocaine as markers. Each operator prepared syringes that were controlled using a different method during each of three sessions (no control, visual double-checking, and gravimetric control). Eight reconstitutions and dilutions were prepared in each session, with variable doses and volumes, using different concentrations of stock solutions. Results were analyzed according to qualitative (choice of stock solution) and quantitative criteria (accurate, 30% deviation). Results Eleven operators carried out 19 sessions. No final preparation (n = 438) contained a wrong drug. The protocol involving no control failed to detect 1 of 3 dose errors made and double-checking failed to detect 3 of 7 dose errors. The gravimetric control method detected all 5 out of 5 dose errors. The accuracy of the doses measured was equivalent across the control methods ( p = 0.63 Kruskal–Wallis). The final preparations ranged from 58% to 60% accurate, 25% to 27% weakly accurate, 14% to 17% inaccurate and 0.9% wrong. A high variability was observed between operators. Discussion Gravimetric control was the only method able to detect all dose errors, but it did not improve dose accuracy. A dose accuracy with

Introduction & objectifs L’unite de production des chimiotherapies a decide de repenser sa strategie organisationnelle et de revoir son processus de production par la methodologie lean pour repondre a une activite croissante, malgre des ressources stables. Les objectifs de ce projet sont d’augmenter la productivite et la qualite, tout en diminuant les delais et couts de production, puis d’ameliorer la qualite de vie au travail. Methodes Le projet a ete mene par l’equipe de production, sous la supervision d’un pharmacien accompagne d’un expert lean , de janvier 2015 a juillet 2016. L’application de la methodologie lean s’est faite selon une demarche classique en 5 etapes : – definir : objectifs, cartographie, familles de processus et flux ; – mesurer : etapes, duree du processus, trace des deplacements, utilisation du stock ; – analyser : valeurs ajoutees des etapes, gaspillages, temps d’attente et causes ; – implementer : imaginer et mettre en œuvre des solutions ; – controler : efficience, performance, satisfaction. Resultats Sur 73 elements impactant l’efficience du processus, l’equipe a propose 18 points d’amelioration classes en 4 themes dont les principaux sont : – flux : lissage de l’activite et du pic de production matinal (−12 % entre 7 et 9 h) en produisant en continu selon la demande du jour (« just in time », 8 preparations max. en cours), en revisant les etapes de double insu et en utilisant des detrompeurs. Un meilleur taux d’occupation des isolateurs (+24,8 % entre 10 et 12 h et +19,6 % entre 13 et 16 h) et une diminution du temps moyen de parcours d’une production de 9 h 45 a 1 h 43 ont pu etre mis en evidence ; – espace : reorganisation des locaux (diminution des deplacements) ; – management : creation d’un poste de « coordinateur du jour » et reunions quotidiennes pour reattribuer les tâches ; – stock et commande : rationalisation du stock et des commandes. Le nombre moyen de personnes dans l’unite est passe de 4,7 a 4,3 personnes (un gain de 40 % d’equivalent temps-plein). L’enquete de satisfaction montre une acceptation positive du projet et de sa conduite. Discussion & conclusions L’application du lean a permis d’optimiser le processus de production des chimiotherapies et de gagner en temps humain. Les principales actions ont ete d’eliminer les pics de production et lisser l’activite journaliere, de reorganiser les roles, les locaux et le stock. L’impact positif sur la duree du processus, la performance de production et la satisfaction de l’equipe de production demontrent que le lean est un outil a promouvoir en pharmacie hospitaliere.

Allogeneic hematopoietic stem-cell transplant (allo-SCT) remains the only cure for many hematological malignancies and some benign and congenital diseases. Busulfan, proposed in its injectable form, has quickly become a mainstay of pharmacological and myeloablative (or non-myeloablative) conditioning. This is following the outbreak in 2010 of a multicenter international clinical phase II trial, we tested the robustness and reliability of our organization in a complex model of organization and multifactorial partnership. In this type "BuCy2" protocol based on a classical treatment duration of 4 consecutive days, the administration of IV busulfan is given in one single daily infusion instead of the conventional 16 infusions, while keeping the same total dose. Under these conditions, the treatment is totally secured using a therapeutic drug monitoring of busulfan, applied in real-time. The process is technically complex and requires the very close cooperation of the teams involved. A strength, weakness, opportunity and threat (SWOT) analysis has been constructed; it fully supports continuous quality improvement to the triple benefit of the nursing chain, the patients and their environment. Several critical points were identified and corrected. The experiment strongly contributes to the safety and security of the medication circuit at the hospital and, improves the performance of allo-SCT. It also contributes to the protection of all actors in the health field and their working environment via a well-functioning quality management system.

Background Chemotherapy preparation units have to face increasing activity with constant staff. Safety is therefore threatened. Purpose The purpose of our experiment was to measure the effect of work overload on preparation accuracy and error. Material and methods A simulation study using tracers (lidocaine and phenylephrine) was conducted in an operational context. 12 operators had to produce 1, 2 or 3 sets of 8 preparations in a fixed time of 1 h. For each series of 8 preparations, 4 syringes at different dosages and volumes, starting from 2 concentrations of stock solutions, were compounded for each tracer. Results were analysed according to qualitative (visual observation, choice of stock solution, diluents and label) and quantitative (validated CE methods; accurate: 30%) criteria. Results A gradual reduction in preparation time, inversely correlated with workload, was obtained (4 min 11 s, 3 min 07 s and 2 min 35 s for sessions with 8, 16 and 24 syringes, respectivelyp No difference in the accuracy of the doses was observed between the 3 levels of workload (p = 0.23, Cox model regression). The distribution of quantitative analysis for the production of 8, 16 and 24 syringes was as follows: accurate: 57%, 51% and 49%; weakly accurate: 26%, 25% and 32%; inaccurate: 16%, 23% and 17%; and error: 1%, 1% and 2%. The observed error rate (qualitative and quantitative analysis) for the preparation of 8, 16 and 24 syringes was 1.1%, 2.1% and 4.5%, respectively. The difference in errors rates between the 3 levels was not statistically significant (mixed effects logistic regression, p = 0.15), possibly due to a lack of power. Conclusion Our pilot study showed that operators are able to increase their working speed without impacting on dose accuracy. However, a large proportion of inaccurate preparations were observed and inclusion of robust control methods in the process is recommended. Acceleration of the manual production rate appears to be possibly associated with a greater probability of making a mistake, but this trend has to be confirmed in a larger sample size study. No conflict of interest.

Introduction et objectifs La plateforme d’enseignement Pharm-Ed® ( http://www.pharm-ed.net/ ) propose des dispositifs de formation en ligne gratuits pour les praticiens en pharmacie hospitaliere des pays en developpement francophones. Pour faire face a une augmentation des besoins de prise en charge des cancers dans ces pays (allongement de l’esperance de vie, Kaposi dans le contexte du SIDA), une lecon e-learning a ete developpee (ArticulateStoryline®) sur les risques lies a la manipulation des medicaments cytotoxiques. L’objectif de ce travail est d’en evaluer la pertinence. Methodes Cinquante praticiens de pays en developpement, de Suisse et de France ont ete invites a evaluer la lecon. Selon les criteres de Kirkpatrick, la satisfaction, l’apprentissage et l’intention de transfert de l’apprenant ont ete evalues pour estimer l’impact de l’enseignement [1] . Un questionnaire de satisfaction, a remplir en ligne apres le suivi de la lecon, a permis d’evaluer le contenu et le contenant de l’outil. Une question sur la mise en pratique de notions apprises dans la lecon a permis d’evaluer l’intention de transfert dans le comportement des participants. Un pre-test et un post-test ont permis de mesurer l’evolution des connaissances des participants. Resultats Vingt-deux praticiens ont participe a l’evaluation. Concernant le contenu, l’ensemble des participants (100 %) est satisfait des notions et themes abordes, ce qui est confirme par l’avis quasi-unanime (95 %) sur la definition claire des objectifs d’apprentissage. Concernant le contenant, la navigation est fluide et intuitive pour 91 % des participants, avec une structure facile a suivre (86 %) ; 86 % des participants ont apprecie de pouvoir suivre les differents elements du cours a leur rythme ; 91 % estiment la lecon utile dans la pratique et 41 % ont reformule des notions abordees dans la lecon. La moyenne au pre-test etait de 7,6 ± 1,6 sur 11, celle au post-test etait de 8,8 ± 0,9. Le gain relatif calcule par rapport au score initial des apprenants a ete de 35 %. Discussion et conclusions Les resultats du questionnaire de satisfaction soulignent la pertinence de l’outil pedagogique. L’amelioration du score au post-test et les reponses sur les possibilites de mise en pratique des notions abordees dans la lecon montrent un effet d’apprentissage et l’intention de transfert des participants. Ces resultats refletent un impact positif de la formation et nous encouragent a continuer de developper des dispositifs e-learning pour l’enseignement de la pharmacie hospitaliere pour les praticiens des pays en developpement.

Background The increased use of chemotherapy drugs forces hospitals to rationalise their production. Automated systems are one of the possible solutions. Purpose To evaluate the performance of the PharmaHelp (Fresenius) automated system for accuracy (trueness and repeatability) and productivity comparing different working conditions. Material and methods Accuracy was studied by automated filling of 10 different volumes of IV bags from 0.5 to 250 mL. Working conditions studied were the filling position, size of syringes (20/60 mL), working day and manufacturing methods (dose banding/individualised doses). Gravimetric and chemical analyses (phenylephrine as tracer) were used for the measure of accuracy. Productivity was evaluated by the production time for batches of 10 IV bags of different filling volumes. Results were discussed according to accuracy limits of ±3%, ±5%, ±10% (IC95). Results The filling was true for all studied volumes (97–103%). The minimum volumes allowing accurate preparation were 100, 3 and 1 mL in the limits of 3%, 5% and 10%, respectively. The repeatability was not influenced by the filling position (Student’s t-test, p = 0.36, n = 180) or the working day (Student’s t-test, p = 0.14 day 1/2, p = 0.46 day 1/3, p = 0.09 day 2/3, n = 540). Accuracy was the same for the 2 manufacturing methods (Student’s t-test, p = 0.12, n = 360 (individualised doses), n = 180 (dose-banding)) and the 2 sizes of syringes (Student’s t-test, p = 0.46, n = 270). The production time depended on the injected volume and the size of the syringe. The production of 10 bags took 45 ± 112 min on average, 30% for the manual steps (pre-processing: 24%, post-processing: 6%) and 70% for the automated step. Conclusion The automated system produced IV bags from liquid active components. The filling was accurate from a volume of 3 mL for

Purpose To evaluate the chemical contamination of surfaces by cytotoxic agents during preparation of injectable chemotherapies in hospital pharmacies. Methods 526 wipe samples collected in 24 Swiss hospital pharmacies were analysed using a validated liquid chromatography–mass spectrometry/mass spectrometry method able to quantify 10 cytotoxic agents: cytarabine, gemcitabine, cyclophosphamide, ifosfamide, methotrexate, etoposide phosphate, irinotecan, doxorubicin, epirubicin and vincristine. Information on chemotherapies produced, equipment and production processes used were collected from all the hospital pharmacies on a voluntary basis in order to investigate their association with contamination rates. Results In two pharmacies, no trace of the 10 cytotoxic agents was detected. Chemical contamination was found in the other 22 hospital pharmacies, with combined total contamination of the 10 cytotoxic agents ranging from 8 ng to more than 41 000 ng per sample. Most contaminated samples came from inside biosafety cabinets, but some came from other clean room areas and logistics rooms. Statistically significant associations were observed between contamination rates and sampling locations, the number of chemotherapies prepared per year and types of cleaning solutions used. Conclusions This study demonstrated that most of the hospital pharmacies tested had some contamination of surfaces by different cytotoxic agents. Even if highest levels of contamination were mainly detected inside biosafety cabinets, technicians were also exposed to cytotoxic agents detected in logistical and storage areas. Protective measures should therefore be maintained or even reinforced in these areas in order to limit technicians' risks of exposure when handling cytotoxic products.