Handling Hazardous Drugs

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.

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.

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.

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.