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BD® HD Check System

Providing life-saving treatments can put your staff at risk

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BD® HD Check System

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Overview

Anyone who handles hazardous drugs (HDs) during transportation, preparation, administration or waste disposal may be at risk. A Canadian study of six hospitals found that frequently contacted surfaces at every stage of the hospital medication system had measurable levels of antineoplastic drug contamination.9


The revolutionary BD® HD Check System has a convenient handheld design that enables testing for select HDs at any location. It provides reliable, easy-to-read results in less than 10 minutes, so you can take immediate corrective action and prevent HD residue from spreading. 

See how >

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Potential Risks

Close to 8 million healthcare workers are potentially exposed to hazardous drugs in the U.S.1 And the risks to their health are real and significant.

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    Detrimental effect on DNA

    Pharmacists and nurses who handle antineoplastic drugs show a 2.5-fold increase in total chromosomal aberrations (CAs), with up to a 5-fold increase in certain CA types2,3

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    Increased rates of cancer

    This includes relative risk of leukemia increases for oncology nurses,4 a 2.8-times increase in non-melanoma skin cancer and a 3.7-times increase in non-Hodgkin’s lymphoma in pharmacy techs5

     

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    Damage to internal organs

    Three consecutive head nurses handling cytostatic agents over time had liver damage6

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    Reproductive issues

     

    Double the risk of miscarriage among staff handling antineoplastic drugs, along with an increase in risk of malformations in offspring7,8

Exposure can occur at any point in the journey of a hazardous drug at your facility

    Unsafe surfaces and practices can increase the risk of hazardous drug exposure

    Your facility may have already invested in safety measures such as engineering controls and personal protective equipment (PPE) to help protect your healthcare workers. But a NIOSH survey10 of 1,954 professionals revealed that up to 61% of them touched other work surfaces while wearing chemotherapy gloves:

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      61%

      through IV pump/bed controls10

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      26%

      through pens/pencils10

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      20%

      through doorknobs/cabinets10

    Explore other high-touch work surfaces that could be contaminated:

    Pharmacy or Preparation areas

    Pharmacy Areas

      Nursing Areas

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        BD's unique end-to-end program can help you implement sustainable monitoring
        References
        1. Hazardous drug exposures in healthcare. Centers for Disease Control and Prevention website. www.cdc.gov/niosh/topics/hazdrug/. Published September 27, 2018. Accessed December 2, 2019.
        2. Cavallo D, Ursini CL, Perniconi B, et al. Evaluation of genotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees. Mutat Res. 2005;587(1-2):45–51.
        3. McDiarmid MA, Oliver MS, Roth TS, Rogers B, Escalante C. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. J Occup Environ Med. 2010;52(10):1028– 34.
        4. Skov T, Maarup B, Olsen J, et al. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med. 1992;49(12):855–861.
        5. Hansen J, Olsen JH. Cancer morbidity among Danish female pharmacy technicians. Scand J Work Environ Health. 1994;20(1):22–26.
        6. Sotaniemi EA, Sutinen S, Arranto AJ, et al. Liver damage in nurses handling cytostatic agents. Acta Med Scand. 1983;214(3):181–189.
        7. Nurses’ Health and Workplace Exposures to Hazardous Substances. Study conducted by Environmental Working Group, Health Care Without Harm, American Nurses Association, Environmental Health Education Center at University of Maryland School of Nursing. Environmental Working Group website. http://www.ewg.org/research/nurseshealth/nurses-exposure Published December 11, 2007. Accessed January 24, 2017.
        8. Hemminki K, Kyronen P, Lindbohm ML. Spontaneous abortions and malformations in the offspring of nurses exposed to anesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J Epidemiol Community Health. 1985; 39(2): 141–147.
        9. Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374-83. doi: 10.1080/15459624.2013.789743.
        10. Connor TH, Zock MD, Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations. J Occup Environ Hyg. 2016;13(9):658-687. doi: 1080/15459624.2016.1165912.
        11. Gabay M, Johnson P, Fanikos J, et al. Report on 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination. Am J Health Syst Pharm. 2021;78(17):1568-1575. doi:10.1093/ajhp/zxab134
        12. Valero-García S, González-Haba E, Gorgas-Torner MQ, et al. Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH). Farm Hosp. 2021;45(2):96-107. doi:10.7399/fh.11655
        13. Domingo T, Fontán G, Enríquez M, et al. Guide for monitoring surfaces for hazardous drug contamination. 1st ed. Instituto Español de Investigación Enfermera; Consejo General de Enfermería; 2021.
        14. Valero García S, Centelles-Oria M, Palanques-Pastor T, Vila Clérigues N, López-Briz E, Poveda Andrés JL. Analysis of chemical contamination by hazardous drugs with BD HD Check® system in a tertiary hospital. J Oncol Pharm Pract. 2021;10781552211038518. doi: 10.1177/ 10781552211038518
        15. Kiffmeyer TK, Tuerk J, Hahn M, et al. Application and assessment of a regular environmental monitoring of the antineoplastic drug contamination level in pharmacies–the MEWIP project. Ann Occup Hyg. 2013;57(4):444–455. doi:10.1093/annhyg/mes081.
        16. Salch SA, Zamboni WC, Zamboni BA, Eckel SF. Patterns and characteristics associated with surface contamination of hazardous drugs in hospital pharmacies. Am J Health Syst Pharm. 2019;76(9):591-598. doi:10.1093/ajhp/zxz033
        17. United States Pharmacopeial Convention (USP). USP general chapter <800>. Hazardous drugs – handling in healthcare settings. Rockville, MD: United States Pharmacopeial Convention. DocID: GUID-5D76173F-5CB6-47B8-815E-7C275A916085_7_en-US
        18. Wipe Analysis. Pharmacy Purchasing & Products. https://www.pppmag.com/article/2525. Published March 2020. Accessed May 21, 2021.
        19. Massoomi F. HD Check-In An interview with HD safety expert Fred Massoomi, RPh, PharmD, FASHP. BD-7875. 2018.


        BD-5894 (09/22)

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        Publications recommend a proactive approach to help detect HD contamination

        Routinely testing high-touch work surfaces for HD contamination is the proactive solution to help detect HDs, manage their associated risk and evaluate the effectiveness of your investments. The body of supporting evidence is growing worldwide—through consensus conferences, peer-reviewed journal articles and best practice guidelines.

        Explore most recent peer-reviewed studies contributing to the movement in more detail below:

        Routine monitoring can reduce contamination15 and even help to prevent it16

        A surface wipe sample study N=1,269 demonstrated a 56% decrease in contamination levels when monitoring occurred at regular intervals.15

        During the study, approximately 75% of the monitoring group introduced cleaning protocol changes as a result of monitoring.15

        67% of participating pharmacies stated that they had changed or would change their work procedures as a consequence of these findings.15

        — The MEWIP Project15

        A higher rate of contamination was identified at first wipe event compared to subsequent wipe events, suggesting that monitoring is beneficial in recognizing and correcting practices that lead to hazardous drug surface exposures, preventing future contamination from occurring.16

        — Salch et al16

        The BD® HD Check System

        The BD® HD Check System can detect surface contamination for select HDs in less than 10 minutes and can be integrated easily into your daily routine:

        • Easy-to-read results
        • Convenient handheld design
        • Track contamination levels over time

         

        The BD® HD Check System currently tests for three commonly used HDs: cyclophosphamide, methotrexate and doxorubicin

        HD experts recommend the BD® HD Check System to rapidly test for contamination11

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        Qualitative testing is recommended when rapid results are needed in order to determine the presence or absence of an HD.
         

        Currently, there is only 1 commercially available qualitative system (BD® HD Check, BD, Franklin Lakes, NJ), which offers 3 HDs that can be tested.

        —

        2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination11

        The 2020 National Consensus Conference peer-reviewed report was published in the American Journal of Health-System Pharmacy (AJHP) and became one of their top 25 articles in 2021.11

        Explore 5 of the consensus statements, so you can act on these expert recommendations11:

        1. Create an effective surface contamination monitoring plan in order to serve as a process validation tool and support a nonpunitive, fair and just institutional culture
        2. Establish a surface contamination monitoring policy for every healthcare setting where HDs are handled
        3. Develop a comprehensive, setting-specific wipe sampling plan for ongoing HD surface contamination monitoring
        4. Determine which surfaces are high risk areas, which HDs are to be detected, what tests need to be performed and at what frequency
        5. Employ both qualitative and quantitative tests for ongoing surface contamination monitoring

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        Practice guidelines recommend assessing what, where & when to test for HDs12,13

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        To be efficient, any surface contamination monitoring plan should include an assessment of the contamination risk present in the different sections of the HPD’s compounding area.


        This is essential to determine where to sample and establish a suitable monitoring frequency.

        —

        2021 practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH)12

        The 2021 guidelines from the Spanish Society of Hospital Pharmacists (SEFH)12 and the Spanish Nursing Council (SNC)13 offer structured solutions, with safe practices to monitor surfaces for HDs throughout your facility.
         

        Here are some their practice recommendations:

        Frequency of testing: Both recommend conducting a custom assessment to determine which areas carry high, medium or low contamination risk.12 The SEFH recommends typical sampling frequencies as monthly, quarterly or half-yearly.12 The SNC recommends establishing a sampling frequency based on the risk level assigned to areas during the assessment: weekly for high risk, monthly for medium risk and quarterly for low risk areas.13


        Drugs to test for: Both the SEFH and SNC recommend testing for marker drugs, specifically naming cyclophosphamide, methotrexate and doxorubicin as the most commonly monitored HDs.12,13 They recommend monitoring at least cyclophosphamide as a marker for control of surface contamination in the pharmacy and administration areas.12,13

        Read their safe practices and key recommendations here and here >

        USP <800> recommends routine surface sampling to help environmental quality17

        But approximately one in four U.S. hospitals practice environmental wipe sampling.18 Safety experts are sharing the benefits of routine monitoring with the BD® HD Check System.

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        Negative results today do not mean that tomorrow will be safe. [...] I find the BD® HD Check System fast, easy and reliable to use.
         

        It takes about 10 minutes to set up the device initially. After that, it takes less than 10 minutes to process a sample. This is a significant improvement over traditional wipe sampling kits that may take up to two weeks or longer to give a result, during which time HD residue may be spread to other locations.

         

        —

        Fred Massoomi, RPh, PharmD, FASHP19

        Facilities are already seeing results of tracking HD surface contamination14

        Performing surface monitoring at select locations in their tertiary hospital, Silvia Valero García and colleagues found that the BD® HD Check System offered multiple advantages, the primary being speed and immediacy in obtaining results.

         

        This allowed them to take immediate corrective measures when contamination was detected, and to quickly assess the effectiveness of containment and control measures.

        —

        The first known published study to use a qualitative technique to detect HDs on surfaces14

         

        Silvia Valero García and colleagues evaluated the suitability of using the BD® HD Check System to routinely monitor surfaces at select locations in their tertiary hospital. Their in-use study was published in the Journal of Oncology Pharmacy Practice (JOPP).

        Read more here about how the benefits of routine qualitative testing of surfaces for HDs can help your facility recognize and correct practices that lead to HD surface contamination.14

        BD's unique end-to-end program can help you implement sustainable monitoring

        You can set up, customize and sustain HD surface monitoring in your facility, step by step

          References
          1. Hazardous drug exposures in healthcare. Centers for Disease Control and Prevention website. www.cdc.gov/niosh/topics/hazdrug/. Published September 27, 2018. Accessed December 2, 2019.
          2. Cavallo D, Ursini CL, Perniconi B, et al. Evaluation of genotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees. Mutat Res. 2005;587(1-2):45–51.
          3. McDiarmid MA, Oliver MS, Roth TS, Rogers B, Escalante C. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. J Occup Environ Med. 2010;52(10):1028– 34.
          4. Skov T, Maarup B, Olsen J, et al. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med. 1992;49(12):855–861.
          5. Hansen J, Olsen JH. Cancer morbidity among Danish female pharmacy technicians. Scand J Work Environ Health. 1994;20(1):22–26.
          6. Sotaniemi EA, Sutinen S, Arranto AJ, et al. Liver damage in nurses handling cytostatic agents. Acta Med Scand. 1983;214(3):181–189.
          7. Nurses’ Health and Workplace Exposures to Hazardous Substances. Study conducted by Environmental Working Group, Health Care Without Harm, American Nurses Association, Environmental Health Education Center at University of Maryland School of Nursing. Environmental Working Group website. http://www.ewg.org/research/nurseshealth/nurses-exposure Published December 11, 2007. Accessed January 24, 2017.
          8. Hemminki K, Kyronen P, Lindbohm ML. Spontaneous abortions and malformations in the offspring of nurses exposed to anesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J Epidemiol Community Health. 1985; 39(2): 141–147.
          9. Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374-83. doi: 10.1080/15459624.2013.789743.
          10. Connor TH, Zock MD, Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations. J Occup Environ Hyg. 2016;13(9):658-687. doi: 1080/15459624.2016.1165912.
          11. Gabay M, Johnson P, Fanikos J, et al. Report on 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination. Am J Health Syst Pharm. 2021;78(17):1568-1575. doi:10.1093/ajhp/zxab134
          12. Valero-García S, González-Haba E, Gorgas-Torner MQ, et al. Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH). Farm Hosp. 2021;45(2):96-107. doi:10.7399/fh.11655
          13. Domingo T, Fontán G, Enríquez M, et al. Guide for monitoring surfaces for hazardous drug contamination. 1st ed. Instituto Español de Investigación Enfermera; Consejo General de Enfermería; 2021.
          14. Valero García S, Centelles-Oria M, Palanques-Pastor T, Vila Clérigues N, López-Briz E, Poveda Andrés JL. Analysis of chemical contamination by hazardous drugs with BD HD Check® system in a tertiary hospital. J Oncol Pharm Pract. 2021;10781552211038518. doi: 10.1177/ 10781552211038518
          15. Kiffmeyer TK, Tuerk J, Hahn M, et al. Application and assessment of a regular environmental monitoring of the antineoplastic drug contamination level in pharmacies–the MEWIP project. Ann Occup Hyg. 2013;57(4):444–455. doi:10.1093/annhyg/mes081.
          16. Salch SA, Zamboni WC, Zamboni BA, Eckel SF. Patterns and characteristics associated with surface contamination of hazardous drugs in hospital pharmacies. Am J Health Syst Pharm. 2019;76(9):591-598. doi:10.1093/ajhp/zxz033
          17. United States Pharmacopeial Convention (USP). USP general chapter <800>. Hazardous drugs – handling in healthcare settings. Rockville, MD: United States Pharmacopeial Convention. DocID: GUID-5D76173F-5CB6-47B8-815E-7C275A916085_7_en-US
          18. Wipe Analysis. Pharmacy Purchasing & Products. https://www.pppmag.com/article/2525. Published March 2020. Accessed May 21, 2021.
          19. Massoomi F. HD Check-In An interview with HD safety expert Fred Massoomi, RPh, PharmD, FASHP. BD-7875. 2018.


          BD-5894 (09/22)

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