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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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

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