Simplivia Blog

As an innovative company, we keep our eye on the big picture. We focus on new perspectives and leading approaches to healthcare that deliver safety and inspire confidence.

Common Questions Nurses Have About CSTD Use

For nurses and other healthcare professionals, the risk of exposure to hazardous drugs is genuine. About 8 million healthcare workers in the US alone are routinely exposed to cytotoxic drugs in the workplace. This exposure carries many potential health risks that can range from skin rashes to cancer2.

Fortunately, there are ways to mitigate this danger. For example, closed system drug-transfer devices (CSTDs) are a key measure that helps protect nurses and other healthcare professionals at risk of hazardous drug exposure. Consider these common questions asked by nurses regarding CSTD use:

Simplivia provides drug delivery solutions to keep healthcare professionals safe

What are CSTDs?

CSTDs (closed system drug-transfer devices) are drug handling devices that make working with hazardous drugs safer. The US National Institute for Occupational Safety and Health (NIOSH) defines CSTDs as “a drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of the hazardous drug or vapor concentrations outside the system”3.

CSTDs protect nurses by preventing leaks of hazardous drug vapors, aerosols or droplets that put them at risk during patient treatment. In addition, they ensure that the drug in use remains sterile. To ensure their safety, pharmacists use them while drug compounding and nurses use them during drug administration.

Why Should Nurses Use CSTDs?

It is well-established that hazardous drug exposure can put nurses and others in the healthcare workplace at risk of adverse health effects. Many studies demonstrate the risk for acute and chronic health issues in people exposed to hazardous drugs. These issues can include reproductive difficulties, skin irritation and even cancer2.

CSTDs are uniquely designed to prevent drug exposure during patient treatment through every step of the process. This is why CSTDs are such a key aspect of hazardous drug safety protocols6.

Chemfort Closed Administration CSTD Hazardous Drugs

When Should Nurses Use CSTDs?

Both pharmacists and nurses should use CSTDs during hazardous drug preparation and administration. USP <800> provides in-depth guidance on standards for handling hazardous drugs in order to protect healthcare workers and patients4. USP <800> recommends that pharmacists use CSTDs when compounding antineoplastic drugs. It also requires nurses to use them when administering these drugs8.

Hazardous drugs include antineoplastics, antibiotics, monoclonal antibodies and some bioengineered medications5. CSTDs are commonly used in oncology, given the hazardous nature of the antineoplastics used as chemotherapy agents.

What Are the Different Types of CSTDs?

In general, there are two main types of closed system drug-transfer devices:

  • Physical barrier CSTDs, which rely on a mechanical barrier to prevent drug leakage or contamination
  • Air-cleaning CSTDs, which use an air-filtering technology to provide a closed system3.

Simplivia's Chemfort™ is an air-cleaning CSTD. It uses Simplivia's patented Toxi-Guard® double-membrane air-cleaning technology to provide an efficient and safe drug transfer system.

The double membranes work together to prevent external contaminants from entering the device. While Toxi-Guard®’s carbon matrix membrane adsorbs vapors and aerosols, the second membrane blocks particles and contaminants from entering the CSTD and keeps liquids in, creating a seamless, sterile system7.

Chemfort CSTD Hazardous Drugs

How Do CSTDs Protect Nurses, Pharmacists, and Patients?

As we have seen, healthcare workers routinely face dangerous hazardous drug exposure. Using a needle and syringe system to administer hazardous drugs comes with the potential for nurses to suffer accidental needle sticks. There is also a greater chance of the drug leaking into the environment, whether through liquid leaks, spills, vapors, or aerosolization.

CSTDs protect nurses, pharmacists, and patients because they provide a closed system. When nothing can get in or out of the device, healthcare professionals are less likely to come into contact with the drugs they use to treat patients. Patients are likewise protected from harmful microorganisms or other environmental contaminants that, without this closed system, could end up in their drug during the course of treatment.

Besides protecting nurses, pharmacists and patients, increased safety becomes a trickle-down effect when facilities use CSTDs for hazardous drug treatments. With CSTD use, hazardous drug exposure is reduced for all personnel involved in transporting, storing, or disposing of these drugs, such as couriers and technicians6.

What Drugs Are Compatible With CSTDs?

With several CSTDs on the market today, it's essential to review the literature for each model to make this determination. Unfortunately, not all CSTDs available will be compatible with every known drug. Without consulting the manufacturer and facility protocols to verify drug compatibility, it is impossible to tell whether the device is safe to use.

When it comes to Simplivia CSTDs, one study concluded that Chemfort™ is compatible with all known hazardous drugs. In addition, the study demonstrated that the Chemfort™ system retained its integrity after withstanding some of the most aggressive solvents available. There was no evidence of structural damage or breakdown after seven days1.

When implementing strategies to improve nurses' safety in the workplace, CSTDs are an important piece of the puzzle. In addition, their use is recommended by the most up-to-date guidelines on safe drug handling practices.

Simplivia's Chemfort™ CSTD protects healthcare professionals and patients. Our CSTDs are proven safe, effective, and easy to use in clinical settings. To learn more about our products and how they are bringing peace of mind to the workplace, please visit

Simplivia Common Questions Nurses CSTDs
1. Chemfort: Compatibility with all known hazardous drugs. Simplivia.
2. Hazardous Drug Exposures in Healthcare. Centers for Disease Control and Prevention: The National Institute for Occupational Safety and Health.
3. Hazardous Drug Exposures in Healthcare: Closed System Drug-Transfer Device (CSTD) Research. Centers for Disease Control and Prevention. The National Institute of Occupational Safety and Health.
4. Hazardous Drugs — Handling in Healthcare Settings. USP General Chapter 800.
5. NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010.
6. Page, M. Ten Questions and Answers on CSTDs With Fred Massoomi, PharmD, FASHP. Pharmacy Times. November 2016, volume 5, issue 6.
7. Simplivia website.
8. Spiro Stevens, J., Martinez, L., Trace, C. Considerations for CSTD Use. Pharmacy Purchasing and Products.


Recent Posts