This document has been superseded and the new version can be found https://stacks.cdc.gov/view/cdc/175049 : NIOSH researchers conducted a field survey at Veterinary Hospital D in October 2017. The purpose of the site visit was to identify and evaluate hazardous drug engineering controls as well as to sample for potential surface contamination at the hospital. NIOSH researchers also observed and interacted with the hospital's veterinarians and staff to obtain information about the hazardous drug work practices and daily activities along with the oncology treatment processes. A TSI VelociCalc(TM) Plus Model 9565-P thermal anemometer was used to measure air velocities at the face of the ductless fume hood, while a Wizard Stick handheld smoke generator was used to visualize air movement inside and around the periphery of the hood. Both the qualitative and quantitative tests showed that the chemical fume hood was operating appropriately. The fume hood's face velocity (0.67 m/s [98 fpm]) was within the range of operation of 0.41 to 0.51 m/s (80 to 100 fpm) that is considered adequate for most hoods. The fume hood's exhaust was recirculated back into the compounding area after high-efficiency filtration. This is in contradiction to current guidance for such exhaust to be routed directly to the outdoors. A TSI Accubalance Plus Air Capture Hood Model 8373 was used to measure the supply (0.16 m3/s or 336cfm) and exhaust (0.19 m3/s or 391 cfm) ventilation in the oncology department. The air changes per hour (ACH) of the oncology department was calculated from the exhaust rate to be 4, which is less than the required ACH (minimum 12 ACH) for unclassified containment segregated compounding area. The presence of potential surface contamination was evaluated with wipe samples. These were collected in areas where the staff handled chemotherapy drugs, such as the oncology department. Wipe samples were also collected in less obvious places (i.e., telephone, door handles) to determine if current workplace safety practices at the hospital were adequate to prevent inadvertent contamination of these surfaces. Sampling and analytical procedures varied by the hazardous drug for which they would be evaluated (i.e., the analyte). In some cases, a single sample could be evaluated for more than one analyte simultaneously. Methotrexate, chlorambucil, doxorubicin, vincristine, and mustargen were the drugs used during the NIOSH visit. Sample analyses results revealed that 2 of 2 wipe samples submitted for toceranib analysis came back positive (0.25 to 0.64 ng). Eight of 8 of the samples submitted for N-methyldiethanolamine (MDEA) analyses were also positive (1.7 to 68.2 ng) while simultaneously being non-detectable (ND) for lomustine and chlorambucil. (Note: MDEA was monitored as a potential stable marker for the highly unstable antineoplastic drug mustargen as explained in the text.) The ND determination means that contamination was either not present, or was present at levels below the detectable limit of the analytical method. Disposable gown cuff samples were analyzed for the drugs. The gown cuff samples came back positive for MDEA (5.2 to 37.2 ng) and toceranib (2.20 ng). None of the samples submitted for carboplatin and vinblastine were positive. Two out of 18 samples submitted were positive for cyclophosphamide (6.88 ng/sample) and doxorubicin (56.4 ng/sample) while simultaneously being ND for vincristine, methotrexate, and epirubicin. In some cases, NIOSH researchers collected wipe samples on certain surfaces that were highly anticipated to contain drug contamination (e.g., suspected drug droplet at end of a CSTD connection). This strategy was done to verify the analytical methods' ability to detect drug contamination under the sampling, handling, shipping variables specific to this evaluation. These "known" contaminated samples were for doxorubicin (56.4 ng/sample) and the mustargen vial (0.26 to 2.6 ng for toceranib and MDEA). Although many of the wipe sample analytical results were ND, there is no safe level of exposure when handling hazardous drugs. The cyclophosphamide, MDEA, and toceranib presence serves as two reminders: (1) that hazardous drug contamination can sometimes linger despite cleaning efforts and (2) the detected contamination on desk one might ordinarily think of as "safe", emphasizes the importance of proper work practices regarding the use of gloves and shoe covers, hand washing, and food/drink prohibitions within the hazardous drug handling environments. Therefore, it is important to continue to use engineering controls (e.g., biological safety cabinets), supplementary controls (e.g., closed system drug-transfer devices), protective work practices (e.g., surface cleaning after every oncology patient, regardless of whether I.V. chemotherapy was administered), and personal protective equipment (e.g., gloves and gowns rated for chemotherapy protection, respirators, shoe covers, eye protection) to reduce unintentional exposures to the staff or pet owners.