Handling Hazardous Drugs

Certain drugs, such as chemotherapy drugs used in oncology, can put medical staff at risk of skin irritation, reproductive issues, cytotoxicity, and cancer if not handled properly1,3. According to the Centers for Disease Control and Prevention (CDC), around 8 million healthcare workers in the United States alone are at risk of such exposure1.

Tips to Help Your Facility Implement Closed System Drug-Transfer Devices (CSTDs) in Practice

In addition to pharmacy workers and nurses, environmental services staff, doctors, veterinarians, laboratory researchers, and operating room professionals are also vulnerable to drug exposure in the workplace1. Hazardous drugs can leak into the environment during any phase of drug preparation, administration, and disposal.


In the last few decades, closed system drug-transfer devices (CSTDs) have emerged as effective medical devices for keeping healthcare workers safe when handling hazardous drugs.


How can healthcare organizations implement CSTDs effectively in their daily practice? Here are five ways your facility can introduce these essential protective devices into the workplace when handling hazardous drugs.

    1. Understand CSTD Differences and Key Features

    There are a range of CSTDs on the market today that are based on one of two technologies – physical barrier and air cleaning.

    • Physical barrier CSTDs rely on a physical barrier or expansion balloon to contain the drug and its vapors in order to prevent the escape of drug aerosols or vapors from the device.
    • Air cleaning CSTDs rely on air cleaning technology to prevent leakage of hazardous drug vapors.

    Both types of CSTDs can be used to reduce the risk of occupational exposure to hazardous drugs. When determining which type of CSTD to implement, facilities should establish the most important features of the device based on their needs.

    Ease of use can vary between devices, as can the interface between the syringe and vial. Facilities need to consider compatibility for bedside drug administration and pharmacy compounding since nurses and pharmacists alike will use CSTDs.

    Administrators responsible for purchasing decisions must also determine whether the device is compatible with the hazardous drugs used in the facility. Reviewing the literature on different CSTDs will help the organization establish which product will perform best for them5.

    CSTDs can represent an up-front investment, but healthcare facilities can see cost-savings in the long run. Closed system drug-transfer devices can extend the beyond-use date of many costly drugs6. This saves money while enabling more life-saving treatment for patients. In addition, CSTD use can reduce waste and increase efficiency in medical settings.

      2. Educate Staff on Hazardous Drugs and the Importance of CSTDs

      Not only is it necessary to establish purchasing needs for CSTDs — it is also important to educate staff on how vital CSTDs are to ensuring a safe workplace. This will help to ease the transition to CSTD use. Healthcare professionals need to know about the risks associated with hazardous drugs, and how using CSTDs can lower these risks. For example, facilities could design staff training to:

      • Highlight the findings of peer-reviewed studies evaluating the effects of hazardous drug exposure.
      • Address ways to curb exposure risk with CSTDs.

      Provide the evidence-based “why” behind any procedure and device in order to facilitate staff acceptance of CSTDs. When armed with this knowledge, medical staff within a healthcare organization will be better able to implement CSTDs.

        3. Get Staff Input Before Selecting a CSTD

        Decision-makers should gather input from staff who work with hazardous drugs before choosing a CSTD. In addition, it may be helpful to provide some sample CSTDs so healthcare workers can try out the devices and see which work best for them5.

        Pharmacists and nurses will have unique perspectives and concerns when it comes to CSTDs. Nurses worry about needle sticks since they use CSTDs at the bedside. Pharmacists may be more concerned about how much manipulation the device requires during compounding2.

        Understanding what each professional requires in order to do their jobs safely helps organizations select the best CSTD for the facility. By listening to the needs of medical professionals, organizations can empower them to play a key role in the decision-making process.

          4. Provide Staff Training for CSTD Use

          All potential CSTD users should receive thorough training. Pharmacists and nurses will use the device differently, so training should be specifically tailored to each role. Healthcare facilities could provide training through demonstrations, videos, written materials, and hands-on training. Regular skills checks can help maintain a high level of proficiency among staff who use the devices5.

            5. Maintain Clear Communication About Hazardous Drugs

            Establishing a good relationship with the selected CSTD vendor is also important. This allows for clear channels of communication if any concerns arise. When healthcare facilities and vendors exchange information freely, positive change is facilitated over time.

            Also, organizations should promote a culture where staff can freely voice concerns and comments. This ensures issues are resolved and improves workflow. Frequently, frontline healthcare professionals are the first to observe where improvements are necessary. Whether this applies to policies, protocols or equipment, it’s important to let staff voices be heard.

            At Simplivia, we’re dedicated to providing innovative solutions that keep healthcare workers safe when handling hazardous drugs. Our Tevadaptor® and Chemfort™ CSTDs have been scientifically proven to protect healthcare workers from exposure while ensuring drug sterility. With research, planning, and staff support strategies outlined above, healthcare organizations can implement Simplivia CSTDs successfully to provide safety and confidence for healthcare staff.


            Simplivia’s Tevadaptor® and Chemfort™ CSTDs are designed for ease of use at all stages from preparation to administration. They offer enhanced safety for pharmacists and nurses alike. Simplivia CSTDs are designed to work with any standard luer lock syringe, and their self-retracting needle mechanism ensures protection against needle sticks4.


            Ultimately, closed system drug-transfer devices are an effective means of keeping medical staff protected, and patients safe. At every step of hazardous drug preparation and administration, CSTDs prevent prevents airborne contaminants from entering the drug vial as well as the escape of hazardous drug vapors, aerosols or droplets to the environment. CSTDs represent an effective solution to occupational hazardous drug exposure.


            Visit Simplivia.com to learn more about our CSTDs and how we provide safety and confidence for healthcare professionals.

            1. Centers for Disease Control. Hazardous Drug Exposures in Healthcare. https://www.cdc.gov/niosh/topics/hazdrug/default.html#:~:text=About%208%20million%20U.S.%20healthcare,and%20shipping%20and%20receiving%20personne
            2. Page, M. Selection of Closed-System Transfer Devices: Tips for Engaging Nursing and Pharmacy Stakeholders in Purchasing Decisions. Pharmacy Times. https://www.pharmacytimes.com/view/selection-of-closed-system-transfer-devices-tips-for-engaging-nursing-and-pharmacy-stakeholders-in-purchasing-decisions
            3. Page, M. Understanding Closed-System Transfer Devices: Why They Are Important and How to Select an Appropriate System. Pharmacy Times. https://www.pharmacytimes.com/view/understanding-closed-system-transfer-devices-why-they-are-important-and-how-to-select-an-appropriate-system
            5. Spiro Stevens, J., Trace, C., Martinez, L. Tips for Successfully Implementing CSTDs. Pharmacy Purchasing and Products. https://www.pppmag.com/article/2702
            6. Wilkinson, A., Allwood, M., Casperson, V., et al. Extension of the practical shelf life of hazardous drugs using the Tevadaptor® closed system transfer device (CSTD) as a container system for preservative-free single-use vials for up to 28 days. BSTL. https://www.simplivia.com/files/pdf/Peer_Reviewed/ECOP_2014_Extension_of_practical_shelf_life_of_hazardous_drugs.pdf