Background Closed system transfer device (CSTD) mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drug or vapour concentrations outside the system. However, various CSTDs are not equally effective.
Purpose We evaluated the impact of current and new CSTD systems on exposure of healthcare personnel to chemotherapy agents and how the new CSTD would fit into our workflow.
Material and methods To ensure safety and compliance of a new CSTD system, our first step was a hands-on product demonstration to evaluate the new technology. The review included ease of use of the system and review of all system components.
The second step was to take surface wipe samples. We used CytoWipe kits from Exposure Control. We carried out two compounding trials (existing CSTD and new CSTD), each lasting 3 weeks. Sampling locations in pharmacy included:
Scale in the laminar flow cabinet (LAF)
Counter with prepared chemotherapy.
Floor in front of the LAF.
Pass through surface.
Baseline contamination was determined with initial cleaning with NaOH and HCl. During the trials, cleaning was performed per facility protocol (detergent, IPA and biocid B or C (KlerWipe) daily and 0.05 M NaOH weekly). Monitored drugs were cyclophosphamide and 5-fluorouracil. Exposure Control analysed cyclophosphamide using a GC-MSMS method and 5-fluorouracil using a HPLC system with UV detection.
Results We found that while both systems were easy to use, the new CSTD system provided enhanced safety by ensuring compliance without an option to bypass the system. The limited surface wipe sample analysis showed that cleaning and workflow were important factors in minimising exposure of healthcare personnel to chemotherapy agents. With the current CSTD system, cyclophosphamide contamination was found on surfaces 1, 2 and 4, and barely detectable on 5 and 6. No contamination with 5-fluorouracil was found. With the new CSTD, cyclophosphamide contamination was found only on surfaces 4 and 6 that had little or no correlation with compounding. No contamination with 5-fluorouracil was found.
Conclusion The study showed that the new CSTD system ensures compliance, fits into our workflow and can help minimise exposure of healthcare personnel to chemotherapy agents.
No conflict of interest
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