Document Type : Research Paper

Authors

1 Department of Civil Engineering, Payame Noor University, Tehran, Iran.

2 Department of Civil Engineering, Payame Noor University, Shiraz, Iran.

10.22126/arww.2024.9925.1317

Abstract

Due to the increasing incidence of cancer, the consumption of anti-cancer or neoplastic drugs has increased significantly. These compounds are not removed during wastewater treatment with sufficient efficiency, they could be found in the groundwater. Oxidation is an efficient method for removing neoplastic drugs such as cyclophosphamide. The previous researchers could make use of a wide range of oxidants because of compiling the health protocols for the lowest risk of drug hazards. The purpose of this research is to remove cyclophosphamide residue in vomit contents, urine, or feces of patients through toilet sewage that merges with household sewage or municipal sewage. In this study, all experiments were done by the oxidation method of cyclophosphamide 10 mg/L with sodium hypochlorite and considering of effectiveness of pH changes and reaction time. It was shown that cyclophosphamide degradation has increased with increased concentration of sodium hypochlorite and reaction time at pH=9.8. The destructive 94.8% of cyclophosphamide was optimized by the concentration of 0.02 % sodium hypochlorite, pH=9.8, and a reaction time of 5 min. Also, the comparative results of drug removal in hospital wastewater with optimal concentration, pH, and time showed increasing of 4% reduction in cyclophosphamide drug removal (98.02%) compared to the test sample. The result of the research can be effective in removing cyclophosphamide by installing a dosing pump in the flush tank or toilet siphon of the oncology department.

Keywords

Ahmed Khan, B. et al. (2019) ‘Healthcare waste management in Asian developing countries’, Waste Management & Research: The Journal of International Solid Waste and Public Cleansing Association, 37(9), pp. 863–875. doi: https://doi.org/10.1177/0734242X19857470 
Anastasi, M. et al. (2015) ‘Efficacy of two cleaning solutions for the decontamination of 10 antineoplastic agents in the biosafety cabinets of a hospital pharmacy’, The Annals of Occupational Hygiene, 59(7), pp. 895-908. doi: https://doi.org/10.1093/annhyg/mev031  
Arul, P. (2016) ‘A study to assess the effectiveness of structured teaching program for nurses administering intravenous chemotherapy, in PSG Hospital, Coimbatore, India. MA Dissertation. The Tamil Nadu Dr. M G R Medical UniversityBoddu, V. M. et al. (2016) 'Gray water recycle: effect of pretreatment technologies on low-pressure reverse osmosis treatment', Journal of Environmental Chemical Engineering, 4, pp. 4435-4443. doi: https://doi.org/10.1016/j.jece.2016.09.031
Asefa. S., Dinegde, N., and Demie, T. (2021) ‘Knowledge and practices on the safe handling of cytotoxic drugs among Oncology Nurses Working at Tertiary Teaching Hospitals in Addis Ababa, Ethiopia’, Dove Press Journal: Drug, Healthcare and Patient Safety, 13, pp. 71- 80. doi: https://doi.org/10.2147/DHPS.S289025
Capoor, M., and Bhowmik, K. (2017) ‘Cytotoxic drug disposal, cytotoxic safety, cytotoxic waste management, India’, Indian Journal of Medical and Paediatric Oncology, 38(2), pp. 190-197. doi: https://doi.org/10.4103/ijmpo.ijmpo_174_16
Carmignani, S., and Raymand, J. 1997 ‘Safe handling of cytotoxic drugs in the physician's office: A procedure manual Model’, Oncology Nursing Forum, 24, PP. 41-48. PMID: 9010864    
Cox, J., Speed, V., and O’Neal, S. (2015) ‘Development and evaluation of a novel product to remove surface contamination of hazardous drugs’, Journal Oncology Pharmacy Practice, 23(2), pp. 1-13. doi: https://doi.org/10.1177/1078155215621151
Dugheri, S. et al. (2018) ‘A new approach to assessing occupational exposure to antineoplastic drugs in hospital environments’, University of Florence, Italy, Arh Hig Rada Toksikol, 69, pp.226-237. doi: https://doi.org/10.2478/aiht-2018-69-3125
Federici, M. et al. (2019) ‘Efficacy of four cleaning solutions for the decontamination of selected cytotoxic drugs on the different surfaces of an automated compounding system’, Journal of Occupational Environmental Hygiene, 16(1), pp. 6-15.  doi: https://doi.org/10.1080/15459624.2018.1526384
Gohma, H., Inoue, Y., and Asano, M. (2014) ‘Testing the degradation effects of three reagents on various antineoplastic compounds’, Journal of Oncology Pharmacy Practice, 21(4), pp. 268-273. doi: https://doi.org/10.1177/1078155214530175
Hansel, S. et al. (1997) ‘Chemical degradation of wastes of antineoplastic agents; Cyclophosphamide, Ifosfamide, and Melphalan’, Archives of Occupational Environmental Health, 69(2), pp.109-14. doi: https://doi.org/10.1007/s004200050124      
Hon, C. et al. (2013) ‘Examining factors that influence the effectiveness of cleaning antineoplastic drugs from drug preparation surfaces’, Journal of Oncology Pharmacy Practice, 20(3), pp. 210–216. doi: https://doi.org/10.1177/1078155213497070      
Jureczko, M., and Kalka, J. (2020) ‘Cytostatic pharmaceuticals as water contaminants’, European Journal of Pharmacology, doi: https://doi.org/10.1016/j.ejphar.2019.172816
Kumar Tripathi, A. et al. (2020) ‘Environmental remediation of antineoplastic drugs: Present Status, Challenges, and Future Directions’, Processes,  8(7), pp. 747, doi: https://doi.org/10.3390/pr8070747
Minh Mai Le, L., and Jolivot, P. (2013) ‘Effectiveness of cleaning of workplace cytotoxic surface’, International Archives of Occupational and Environmental Health, 86(3), 333-341. doi: https://doi.org/10.1007/s00420-012-0769-1
Mohseni, A. et al. (2001) ‘Evaluation of collection, transfer, and disposal of hospital solids waste government and private hospitals in Mazandaran Province in 2001’,  Journal of Mazandaran University Medical Science, 11 (32), pp. 45-52. Available at: https://www.sid.ir/paper/45370/en (Accessed: 20 February 2022).
Ohe, T., Watanabe, T., and Wakabayashi, K. (2004) ’Mutagens in Surface Waters’, Mutation Research, 567 (2–3), pp. 109-149. doi: https://doi.org/10.1016/j.mrrev.2004.08.003
Rowney, N., Johnson, A., Williams, R. (2009) ‘Cytotoxic drugs in drinking water: a prediction and risk assessment exercise for the Thames catchment in the United Kingdom’, Environmental Toxicology and Chemistry, 28(12), pp. 2733-2743. doi: https://doi.org/10.1897/09-067.1 
Saab, Y., Nakad, Z., and Rahme, R. (2021) ‘Chemotherapeutic drugs in Lebanese surface waters: Estimation of population exposure and identification of high-risk drugs’, Sustainable Environment Research, 31, pp. 1-10. doi: https://doi.org/10.1186/s42834-021-00105-8      
Sewell, G.J. (2016) ‘Detergents and disinfectants currently used in hospital pharmacies', Abilities for removing and degrading cytotoxic drugs. Kingston University and Plymouth Hospitals Trust, UK, 15 November 2010. Available at: https://www.gerpac.eu/en (Accessed: 8 October 2021).
Simon, S. et al. (2020) ‘Efficiency of four solutions in removing 23 conventional antineoplastic drugs from contaminated surfaces’, PLOS ONE, 15(6), e0235131. doi: https://doi.org/10.1371/journal.pone.0235131         
Soubieux, A., Palamini, M., and Tanguay, C. (2019) ‘Evaluation of decontamination strategies for cyclophosphamide’, Journal Oncology Pharmacy Practice, 26(2), pp. 413-422. doi: https://doi.org/10.1177/1078155219865931     
Stasny, M. et al. (2019) ‘Removal of anthracycline cytostatics from the aquatic environment: Comparison of nanocrystalline titanium dioxide and decontamination agents’, PLOS One, 14(10), e0223117. doi: https://doi.org/10.1371/journal.pone.0223117  
Turci, R. et al. (2003) ‘Biological and environmental monitoring of hospital personnel exposed to antineoplastic agents’, Journal of Chromatography B, 789 (2), pp. 169–209. doi: https://doi.org/10.1016/s1570-0232(03)00100-4