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OR I G I N A L A R T I C L E
Engineering controls in veterinary oncology: A survey of148 ACVIM board-certified oncologists and environmentalsurveillance in 20 specialty hospitals
K. Alexander | N. Northrup | D. Clarke | H. Lindell | T. Laver
Department of Small Animal Medicine and
Surgery, College of Veterinary Medicine,
University of Georgia, Athens, Georgia
Correspondence
Dr N. Northrup, Department of Small Animal
Medicine and Surgery, College of Veterinary
Medicine, University of Georgia, 2200 College
Station Road, Athens, GA 30602.
Email: northrup@uga.edu
Funding information
The University of Georgia CaRES (Cancer
Research, Education, and Service) Fund
Engineering controls (EC, facility and equipment barriers between hazards and people) are used
to avoid exposure to chemotherapy drugs. In this study, American College of Veterinary Inter-
nal Medicine board-certified veterinary oncologists were surveyed about their use of contain-
ment primary EC (C-PEC) and supplemental EC (closed system transfer devices, CSTD). The
survey was completed by 148 (38%) of practicing diplomates. All used EC. Both C-PEC and
CSTD were used at 92% of hospitals; however, US Pharmacopoeial Convention Chapter <800>
(USP <800>) standards were met at only 19% of hospitals and oncologists did not know the
type of C-PEC at 18% of hospitals. Next, surface contamination and EC use were assessed with
environmental surveillance for carboplatin, cyclophosphamide, doxorubicin, and vincristine in
20 veterinary specialty hospitals using a commercially available kit. No contamination with car-
boplatin, doxorubicin, or vincristine was detected, however, there was contamination with
cyclophosphamide at 4 hospitals. Based on this study, most veterinary oncologists use C-PEC
and CSTD, but few meet USP <800> standards. Current measures appear effective for pre-
venting contamination with IV drugs, but additional measures are needed for oral drugs.
KEYWORDS
chemotherapy, safety, USP <800>
1 | INTRODUCTION
Veterinary medicine has been identified as an occupation of concern
for exposure to antineoplastic drugs, with documented levels of con-
tamination as much as 15 times greater than in hospitals treating
human cancer patients.1 No permissible exposure levels have been
defined, so the goal should be zero exposure.2–8 The National Insti-
tute for Occupational Safety and Health (NIOSH) and US Pharmaco-
poeial Convention (USP) provide guidelines on hazardous drugs
(HD) that inform the Food and Drug Administration (FDA), Centers
for Disease Control and Prevention, Occupational Safety and Health
Administration, and state regulatory agencies. NIOSH published rec-
ommendations for veterinary professionals handling HD in 20109 and
describes a hierarchy of controls for avoiding exposure to hazards.10
Most effective is not using the HD. When this is not possible, the
next most effective level is engineering controls (EC), facilities and
equipment that serve as barriers between people and hazards. There
are 3 categories of EC: primary, secondary, and supplemental.7,10 The
containment primary engineering control (C-PEC) recommended by
NIOSH for sterile HD preparation is a 100% vented biological safety
cabinet (BSC) or compounding aseptic containment isolator (CACI). In
addition, supplemental EC, specifically closed system transfer devices
(CSTD) are recommended inside C-PEC and during administration of
intravenous (IV) HD.3 On December 1, 2019, new USP standards,
General Chapter <800> HD—Handling in Healthcare Settings (USP
<800>), will take effect.11 These standards require a 100% vented
C-PEC and CSTD for preparation of sterile HD and CSTD for admin-
istration of IV HD.7 USP <800> applies to all healthcare professionals,
including veterinary professionals.7
Because safety recommendations have not been uniform
and have had limited enforcement, we were interested in HD han-
dling by veterinary oncologists. We focused on use of C-PEC andPresented in part at the Veterinary Cancer Society Annual Conference,
October 26-28, 2017, in Portland, Oregon.
Received: 30 November 2017 Revised: 10 January 2018 Accepted: 11 January 2018
DOI: 10.1111/vco.12390
Vet Comp Oncol. 2018;1–7. wileyonlinelibrary.com/journal/vco © 2018 John Wiley & Sons Ltd 1
CSTD because they are the most effective, readily accessible
controls.10,12–18 The objectives of this exploratory study were: (1) to
determine, via self-reporting, which C-PEC and CSTD are used by
American College of Veterinary Internal Medicine (ACVIM) board-
certified veterinary oncologists and (2) to assess surface contamina-
tion with commonly used antineoplastic agents and the use of C-PEC
and CSTD in a sample of veterinary oncology specialty hospitals.
2 | MATERIALS AND METHODS
2.1 | Part 1. Survey of veterinary oncologistsregarding engineering controls
An online survey (Survey Monkey, Inc., San Mateo, California) was
sent to all ACVIM board-certified oncologists via the specialty listserv
on April 12, 2017. Two reminders were sent before the survey was
closed 1 month later. Prior to distribution, the survey was completed
and edited by 3 veterinary oncologists to ensure that it was well
organized, clearly written, and easily completed within 1 to 2 minutes
per hospital. This study was reviewed by the University of Georgia
Human Subjects Office (UGA-HSO) and assigned a determination of
Not Human Research.
Inclusion criteria were: (1) ACVIM board certification in veteri-
nary oncology and (2) current practice in clinical oncology. Partici-
pants were asked to provide information about the use of C-PEC and
CSTD (yes/no and type) and chemotherapy administration caseload
(Appendix S1, Supporting information). For oncologists practicing at
more than 1 hospital, questions were repeated for each hospital.
Responses were submitted anonymously and could not be linked to
oncologists or hospitals. Data were summarized with descriptive sta-
tistics using Microsoft Excel, version 15.33.
2.2 | Part 2. Environmental surveillance forcarboplatin, cyclophosphamide, doxorubicin andvincristine
Environmental surveillance for carboplatin, cyclophosphamide, doxo-
rubicin, and vincristine was conducted at 20 veterinary specialty hos-
pitals. This study was reviewed by the UGA-HSO and assigned a
determination of Not Human Research. Institutions were recruited
with ACVIM Specialty of Oncology listserv messages on November
22, 2016 and February 7, 2017. Inclusion criteria were: (1) an ACVIM
board-certified veterinary oncologist treating patients onsite, (2) che-
motherapy administered multiple times per week, (3) location in the
United States, (4) use of EC fitting 1 of 4 groups (below), and
(5) informed consent to participate. The goal was to recruit 5 hospitals
for each of 4 groups based on C-PEC and CSTD use. Group 1 hospi-
tals used C-PEC meeting USP <800> standards for volatile HD and
asepsis, and CSTD. Group 2 used C-PEC vented outside, but not
meeting USP <800> standards and CSTD. Group 3 used C-PEC not
vented outside and CSTD, and Group 4 used CSTD only. Institutions
were enrolled in order of response to recruitment emails until the
groups were filled.
2.3 | Institutional data
Institutional data were collected with a standardized form (Appendix
S2) and included: date of environmental surveillance, locations sam-
pled, C-PEC and CSTD utilized (yes/no and type), room(s) in hospital
where chemotherapy was prepared and administered, number of
days per week chemotherapy was administered, number of chemo-
therapy treatments per week, number of doses of carboplatin, cyclo-
phosphamide, doxorubicin and vincristine administered per week, and
whether these drugs were administered on the day of surveillance.
Identities of participating oncologists and institutions were kept con-
fidential. Data were summarized with descriptive statistics using
Microsoft Excel, version 15.33.
2.4 | Sampling for surface contamination
Surface contamination was analysed using a commercially available
kit (Maxxam ChemoAlert™ Surface Sampling Kit, Maxxam Analytics,
a Bureau Veritas Group Company, Pharmaceutical Industrial Hygiene
Laboratory, Lake Zurich, Illinois). Kits were divided into smaller kits
containing the supplies needed for each hospital. Instructions with
photographs were provided in each kit and electronically. Three stan-
dardized sites for sampling were selected based on expectation of
risk for contamination: (1) the drug preparation area, (2) the table or
floor where drugs were administered, and (3) the floor at the site of
patient discharge.17,19–22 Based on C-PEC use, the preparation area
was swabbed below the pass-through of a CACI (Figure 1A), below
the workspace of BSC/hood (Figure 1B), or on the surface of a table.
Surfaces were swabbed by one person at each institution. The
individual wore clean gloves for each site. A clean 4 cm × 25 cm tem-
plate was taped to the area being swabbed. If necessary to allow a
4 cm × 25 cm sampling area, the template could be bent around a
corner or its outer edges could be trimmed. A polyester cleanroom
swab (Texwipe STX721A, Kernersville, North Carolina) was soaked in
ChemoAlert (Maxxam Analytics, a Bureau Veritas Group Company,
Pharmaceutical Industrial Hygiene Laboratory, Lake Zurich, Ilinois)
wetting agent (100% methanol) and excess removed by flicking the
swab. The sampling area was wiped with one face of the swab in a
zigzag pattern making 5 passes across the long dimension (Figure 2A).
The same area was then swabbed in the perpendicular direction with
the opposite face of the swab in a zigzag pattern making 25 passes
(Figure 2B). Swabs were sealed in pre-labelled amber vials and
shipped on ice. Sites were sampled from Monday to Thursday only to
allow overnight shipping.
2.5 | Analysis for commonly used chemotherapydrugs
Maxxam Analytics analysed the swabs for carboplatin, cyclophospha-
mide, doxorubicin, and vincristine. The intent was to include the
drugs used most commonly in veterinary oncology within what the
study budget allowed. Maxxam Analytics is accredited by the Ameri-
can Industrial Hygiene Laboratory Association to the ISO/IEC
17025:2005 standard. Samples were analysed with high performance
liquid chromatography with tandem mass spectrometry (LC/MS/MS)
using a mass spectrometer (API 4000 Triple Quadrupole MRM,
2 ALEXANDER ET AL.
FIGURE 1 Examples of sampling sites for environmental surveillance in the chemotherapy preparation area: (A) The template is below the pass-
through of a CACI. (B) The template is below the opening to the workspace of a Class II, Type A2 BSC
FIGURE 2 Environmental surveillance using the ChemoAlert™ Surface Sampling Kit: (A) The sampling area was swabbed in a zigzag pattern
making 5 passes across the long dimension. (B) Next, the sampling area was swabbed in a zigzag pattern making 25 passes across the shortdimension
ALEXANDER ET AL. 3
Applied Biosystems/MDS SCIEX, Foster City, California). The limit of
quantification for all drugs was 0.05 ng/cm2 (5 ng/swab). Maxxam
Analytics has verified all 4 drugs to be stable for at least 22 days
when collected as instructed and stored in refrigerated conditions.
Internal positive and negative quality controls were evaluated prior to
analysis of all samples. Additionally, we submitted positive and nega-
tive controls prior to environmental surveillance. The positive control
swab was soaked in wetting agent and then 1 drop each of carbopla-
tin, doxorubicin (diluted with 0.9% NaCl to decrease its red colour to
barely visible), and vincristine, as well as cyclophosphamide powder,
were applied. The negative control swab was soaked with wetting
agent. Controls were submitted under a fictitious hospital name. Each
oncologist was notified of the results for his/her hospital.
3 | RESULTS
3.1 | Survey of veterinary oncologists regardingengineering controls
At the time of the survey, according to the ACVIM, there were 410 dip-
lomates in the Specialty of Oncology, with 388 in clinical practice
(287 private practice and 101 academia). One hundred and forty-eight
(38%) diplomates completed the survey, including 110 (38%) in private
practice, 37 (37%) in academia, and 1 in both. Eighty percent of
respondents (n = 119) worked at 1 hospital, 15% at 2, 3% at 3, and 1%
at 4 hospitals. Consequently, information was received about 186 hos-
pitals. The median reported range of chemotherapy treatments per
week was 21 to 30 (range: 0-10/week to >100/week).
All diplomates reported using at least 1 EC at each hospital. Con-
tainment primary EC and CSTD used are reported in Tables 1 and 2,
respectively. Primary EC were used at 94% of hospitals, most com-
monly Class II, Type A2 BSC (23%) and Class II, Type B2 BSC (17%,
Table 1). C-PEC of unknown type were used at 18% of hospitals.
CSTD were used at all but 2 hospitals, most commonly PhaSeal™
(Becton, Dickinson and Company, Franklin Lakes, New Jersey) and
Equashield® (Equashield, LLC, Port Washington, New York), at 52%
and 35% of hospitals, respectively (Table 2). Both C-PEC and CSTD
were used at 92% of hospitals, however, these met USP standards at
only 19% of hospitals (Table 3).
3.2 | Environmental surveillance for commonly usedcancer chemotherapy drugs
Twenty hospitals (5 in each group) were recruited. However, a site
recruited into Group 4 (CSTD only) actually used a Class II, Type A2
BSC and a CSTD. Consequently, the number of hospitals in each
group was: Group 1 (n = 5), Group 2 (n = 5), Group 3 (n = 6), and
Group 4 (n = 4). Information about participating hospitals is pre-
sented in Table 4. Participants reported administering a median of
25 chemotherapy treatments each week (range: 5-147). The median
number of treatments each week with carboplatin, IV cyclophospha-
mide, oral cyclophosphamide, doxorubicin, and vincristine were
4 (range: 2-35), 0 (range: 0-7), 4 (range: 0-45), 6 (range: 1-40), and
7 (range: 1-20), respectively. On the day of environmental
TABLE 1 Containment primary engineering controls used by ACVIM
board-certified veterinary oncologists reported in an online survey
Primary engineering control No. of hospitals
Containment aseptic compounding isolator 6
Class III biosafety cabinet (BSC) 8
Class II, B2 BSC 31
Class II, B1 BSC 12
Class II, A2 BSC 42
Class II, A1 BSC 4
Class II, A BSC 11
Class II BSC 7
Fume hood 19
Laminar flow hood 1
Unknown type 33
None 12
One hundred and forty-eight diplomates responded with informationabout 186 hospitals.
TABLE 2 Supplemental engineering controls (CSTD) used by ACVIM
board-certified veterinary oncologists reported in an online survey
Supplemental engineering control No. of hospitals
ChemoClavea 7
ChemoClavea and Spirosa 1
ChemoClavea and Mila CHEMO Safety Systemb 1
ChemoClavea and PhaSealc 1
ChemoLocka 2
Equashieldd 62
Equashieldd and PhaSealc 3
Mila CHEMO Safety Systemb 8
Onguarde with Tevadaptorf 6
PhaSealc 92
SmartSitec with Texiumc and Alarisc 1
None 2
One hundred and forty-eight diplomates responded with informationabout 186 hospitals.a ICU Medical, San Clemente, California.b MILA International, Inc., Florence, Kentucky.c Becton, Dickinson and Company, Franklin Lakes, New Jersey.d Equashield, LLC, Port Washington, New York.e B. Braun Medical Inc., Bethlehem, Pennsylvania.f TEVA Medical LTD, Shoham, Israel.
TABLE 3 Summary of primary and supplemental engineering
controls (C-PEC and CSTD) used by ACVIM board-certifiedveterinary oncologists reported in an online survey
Primary and supplemental engineeringcontrols
Percentage ofhospitals
USP <800> compliant C-PEC + CSTD 19
Non-compliant USP <800> C-PEC + CSTD 54
Unknown if USP <800> compliant C-PEC +CSTD
20
CSTD only 6
C-PEC only 1
One hundred and forty-eight diplomates responded with informationabout 186 hospitals.
4 ALEXANDER ET AL.
surveillance, carboplatin, cyclophosphamide (oral only), doxorubicin,
and vincristine had been administered at 5, 7, 7, and 9 hospitals,
respectively. Due to time constraints, samples were commonly col-
lected on days when oncologists did not plan to treat patients. Sites
of administration tested were a table (n = 8) or the floor (n = 11).
Due to renovation on the day of sampling, the administration area of
one hospital in Group 4 could not be tested.
The negative control tested negative for all 4 drugs. On the posi-
tive control swab, there were 99,000 ng of carboplatin, 168,000 ng of
cyclophosphamide monohydrate, 1,140 ng of doxorubicin hydrochlo-
ride, and 12,700 ng of vincristine sulphate. No contamination with car-
boplatin, doxorubicin, or vincristine was detected in the 20 hospitals
tested. Cyclophosphamide monohydrate (5.6, 8.1, 13.6, and
16.4 ng/swab) was detected in 1 hospital from each group at the site
of administration (n = 3) or preparation (n = 1). Preparation and admin-
istration of chemotherapy occurred in separate rooms at the hospital
with preparation site contamination and in a single room at the other
3 hospitals. Cyclophosphamide was given orally at all 4 hospitals and
was administered on the day of surveillance at one hospital. At one
contaminated hospital, a cyclophosphamide capsule broke open during
a difficult administration in the weeks prior to surveillance.
4 | DISCUSSION
Despite published safety recommendations and research supporting
use of EC, recent studies detected surface contamination in veteri-
nary hospitals.1,17,19–22 In addition to areas where drugs were
handled,17,19–22 contamination was identified at distant sites, like the
cafeteria.19 The objective of this study was to better understand EC
use and environmental contamination in specialty practices with
ACVIM board-certified veterinary oncologists. Arguably, this should
be the group of veterinarians in the United States with the greatest
knowledge of chemotherapy safety standards. We found that veteri-
nary oncologists are taking precautions to prevent exposure to anti-
neoplastic drugs. All 148 diplomates reported use of EC, however,
<20% of hospitals used EC meeting USP <800> standards. Regardless
of which EC were used and whether they met USP <800> standards,
no contamination with IV chemotherapy drugs was detected in the
20 hospitals tested. Safety measures appear effective for IV drugs. Of
concern was contamination with oral cyclophosphamide in 4/20 hos-
pitals, suggesting inadequate containment of oral drugs.
Adherence to NIOSH and USP standards is important to protect
veterinary professionals, patients, owners and the environment. Com-
pliance will be required if USP <800> is enforced in December 2019.
Based on our survey results, this will necessitate changes in EC for
the majority of veterinary oncology hospitals. While cost and other
factors likely play a role, lack of knowledge of EC type in 18% of hos-
pitals and limited adoption of more stringent controls support the
need for readily accessible, clear, evidence-based resources describ-
ing standards for handling HD, the importance of these standards,
and practical step-by-step instructions for implementation in veteri-
nary hospitals. USP <800> and publications about implementation of
its standards could potentially address this issue.
Thirty-eight percent of practicing oncologists responded to the
survey, with similar response rates for oncologists in private practice
and academia. This is considered a “good” response rate.23–25 We
used techniques reported to increase response and reduce sampling
error that could limit inferences to the general population of veteri-
nary oncologists.24,26–29 This included inviting all ACVIM board-
certified oncologists to participate, sending reminders, disclosing
investigators’ identities and university affiliation, having a concise
TABLE 4 Type of hospital, engineering controls (EC) used, site(s) of
chemotherapy preparation and administration, and chemotherapycaseload of 20 veterinary specialty hospitals participating inenvironmental surveillance for hazardous antineoplastic drugs
No. of hospitals
Group 1a Group 2b Group 3c Group 4d
Type of hospital
Academic 3 0 0 0
Private practice 2 5 6 4
Type of C-PEC
CACI 2 0 0 0
Class II, B2 BSC 3 0 0 0
Class II, A2 BSC 0 3 5 0
Fume hood 0 2 1 0
Type of CSTD
PhaSeal 2 3 4 3
Equashield 3 2 2 0
Tevadaptor 0 0 0 1
Separate rooms for preparation and administration
Yes 4 2 3 1
No 1 3 3 3
Number of chemotherapy treatments per week
0-10 1 0 1 1
11-20 1 1 2 1
21-30 2 1 1 2
31-40 1 1 0 0
41-50 0 0 1 0
51-60 0 1 1 0
>100 0 1 0 0
Number of days per week that chemotherapy is administered
1 0 0 0 1
2 0 0 0 1
3 0 0 1 0
4 2 2 0 1
5 3 2 3 0
6 0 1 1 1
7 0 0 1 0
Abbreviations: C-PEC, containment primary engineering control; CACI,compounding aseptic containment isolator; BSC, biological safety cabinet;CSTD, closed system transfer device.a Group 1 hospitals used a C-PEC meeting USP <800> standards for vola-tile HD and asepsis, and a CSTD.
b Group 2 hospitals used a C-PEC vented outside, but not meeting USP<800> standards and a CSTD.
c Group 3 hospitals used a C-PEC not vented outside and a CSTD.d Group 4 hospitals used a CSTD only.
ALEXANDER ET AL. 5
survey, and clearly stating that respondents and hospitals would be
kept anonymous. We could not restrict survey responses to one per
hospital and believed that asking oncologists to coordinate with
others in their practice would negatively impact response rate. There-
fore, all veterinary oncologists were recruited. A limitation of this
approach is that multiple oncologists from the same hospital may
have completed the survey. Another potential limitation is self-
selection bias; individual interest in the survey topic, knowledge of
EC at their facility, or self-assessment of performance in safe handling
of HD may have influenced likelihood of participation, resulting in
over- or underestimation of EC use. Caseload information may have
been obtained from a hospital database or by estimation, which could
have been affected by recall bias. The majority of respondents
reported 11 to 40 chemotherapy treatments per week, with a wide
range of 0-10 to >100. In agreement with this finding, the 20 hospi-
tals performing environmental surveillance reported a median of
25 chemotherapy treatments per week (range: 5-147).
The second part of this study assessed environmental contamina-
tion in 4 groups of hospitals classified based on EC use. The intent
was for this to be an exploratory study, with results guiding future
studies. Environmental surveillance is easy to perform. Commercial
pharmaceutical hygiene laboratories offer test kits with all necessary
supplies and instructions. Maxxam Analytics was used because of
expertise in analysing hospital and pharmaceutical samples, verified
sample integrity with the sampling and submission methods, sensitiv-
ity of the analytical technique, the option to split kits between hospi-
tals, and cost. We tested for carboplatin, cyclophosphamide,
doxorubicin, and vincristine in the areas of chemotherapy prepara-
tion, administration, and patient discharge. A more complete evalua-
tion would have included all drugs used at each facility and more
sites, but was not possible due to budget constraints. To maximize
the chance of detecting contamination, we tested for commonly used
chemotherapeutics at sites associated with risk.
Contamination with IV HD was not detected in any of the hospi-
tals, suggesting that veterinary oncology specialty practices are suc-
cessfully applying safety measures to avoid exposure. Lack of
contamination also suggests that the levels of primary and/or supple-
mental EC used by all 4 groups may be effective for containing IV
antineoplastic drugs. Despite this, we cannot recommend use of
CSTD without C-PEC. Since we tested only a limited number of hos-
pitals in 3 locations at one time, it is possible that contamination was
missed. Current standards call for use of CSTD and either a CACI or
a 100% vented BSC7 and previous studies have found that contami-
nation was decreased, but still present, with use of CSTD
alone.12–14,16
In contrast to IV HD, the rate of contamination with oral cyclo-
phosphamide (20% of hospitals) was concerning. There did not
appear to be an association with type of EC since one hospital from
each group was affected. Contaminated hospitals used both FDA-
approved cyclophosphamide and compounded cyclophosphamide,
demonstrating that exposure is possible with either formulation.
Cyclophosphamide was administered via multiple techniques that did
not involve opening capsules, breaking tablets, or compounding a
solution. At one hospital, contamination was suspected to be due to
a capsule breaking during a difficult administration and potential
inadequate clean-up of the spill. Another hospital had contamination
on its CACI even though cyclophosphamide was not prepared in the
CACI. The source was thought to be a chemotherapy waste container
stored below the pass-through. Potential sources of contamination
were not identified at the other hospitals.
Exposure to oral HD can occur through contact with contami-
nated packaging, compounding, counting and repackaging medica-
tions, opening capsules, splitting tablets, handling or accidental
breaking of capsules or tablets during administration, disposal of con-
taminated waste, and contact with objects touched with contami-
nated Personal Protective Equipment (PPE).7,20,30 In veterinary
medicine, risk of exposure during administration may be increased
with patients unwilling to consume the drug or resistant to oral
administration. A containment system for oral HD that can be deliv-
ered with the medication or a means of administration that is easy
and eliminates exposure to oral HD is needed.
This study is limited by the small number of hospitals evaluated.
It is possible that the population does not represent all veterinary
oncology specialty hospitals. An additional limitation was that envi-
ronmental surveillance was performed on only one day and contami-
nation could vary over time with changes in personnel, procedures,
caseload, and cleaning. Ideally, one person would have performed all
environmental surveillance, but this was not possible due to the geo-
graphic distribution of participating hospitals. To minimize variability,
a detailed description with photographs demonstrating the sampling
technique was provided and investigators were available by phone to
answer questions. Finally, participants could have altered safety or
cleaning procedures to reduce the likelihood of contamination. This
seems unlikely since participants would only benefit from an accurate
assessment of contamination associated with their procedures, and
participants knew they would be kept anonymous.
Based on the results of this study, the majority of veterinary
oncologists are aware of occupational safety issues and utilize EC
when handling HD. A wide variety of EC are used and many hospitals
will need to make changes to meet the new USP <800> standards.
Current measures appear effective for preventing environmental con-
tamination with IV antineoplastic drugs, but contamination with oral
drugs is common. Additional safety measures are needed to reduce
exposure to oral HD.
ACKNOWLEDGEMENTS
This study was funded by the University of Georgia CaRES (Cancer
Research, Education, and Service) Fund. We would like to thank all
participating veterinary oncologists and hospitals.
ORCID
N. Northrup http://orcid.org/0000-0001-8793-3433
T. Laver http://orcid.org/0000-0001-7943-7202
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How to cite this article: Alexander K, Northrup N, Clarke D,
Lindell H, Laver T. Engineering controls in veterinary oncol-
ogy: A survey of 148 ACVIM board-certified oncologists and
environmental surveillance in 20 specialty hospitals. Vet Comp
Oncol. 2018;1–7. https://doi.org/10.1111/vco.12390
ALEXANDER ET AL. 7
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