Exploring the occupational protection potential of an intravenous compounding robot across the cytotoxic drug workflow.

OBJECTIVE: To evaluate an intravenous compounding robot's occupational protection across the full workflow (compounding, packaging, administration) by measuring cytotoxic drug residues, and to assess its cleaning protocol and cross-contamination risk for subsequent non-cytotoxic drug compounding. METHODS: (1)Questionnaire survey: Cytotoxic drug handlers at various workflow stages were surveyed for occupational protection and awareness. (2) Experimental study: Cyclophosphamide and fluorouracil were selected for a 3-day robotic vs. manual compounding comparison. Surface wipes samples from 168 sites were quantified by HPLC-MS/MS. (3) Recommendations were derived by integrating the questionnaire and experimental results. RESULTS: The survey revealed that all respondents (100%) acknowledged that their work stage involved an occupational exposure risk and that protective measures were necessary, but only compounding staff strictly adhered to protection, 18.2% of packaging staff, 14.3% of transport workers lacked gloves, while only 45.5% of nurses always wear gloves each time. Experimental data showed that robotic compounding substantially reduced surface residues at compounding sites (gloves and gown sleeves) compared with manual compounding, with manual groups showing sporadic extreme values (e.g., fluorouracil on gloves: 834.340 ng/cm2). Residues were also detected on packaging and administration-particularly in the manual group (fluorouracil on bags: up to 734.704 ng/cm2)-indicating that exposure risks extend beyond the compounding stage. Internal robotic residues were low, though a single post-cleaning detection of 0.018 ng/cm2 suggests minor cleaning blind spots. No detectable cross-contamination was observed when non-cytotoxic drugs were subsequently compounded. CONCLUSIONS: This preliminary study suggests that the intravenous compounding robot shows potential for reducing occupational exposure across compounding, packaging, and administration, with the most pronounced effect observed during compounding. However, exposure risks persist in packaging and administration, particularly in manual operations, and inadequate protective awareness among staff calls for improved supervision and training. Additionally, initial findings indicate that internal contamination after cytotoxic compounding is low and can be further reduced by cleaning, supporting the tentative feasibility of using the same robot for subsequent non-cytotoxic compounding. Cross-contamination risk appears low and controllable, as yet, it has not been possible to translate residue value directly into actual cancer risks for staff, further validation is needed.