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What the CDC Says About Closed System Drug-transfer Devices

For many patients, hazardous drugs are nothing short of life-saving. In pharmacy and nursing, especially in oncology, hazardous drugs occupy a vital place in the fight against devastating medical conditions.

Yet, these hazardous drugs can pose a serious risk to the dedicated healthcare workers that routinely handle them. Occupational exposure to hazardous drugs can lead to long and short-term health complications without adequate precautions. This is why the Centers for Disease Control (CDC) and the National Institute for Occupational Safety and Health (NIOSH) conduct research and provide recommendations for reducing such health threats.

Modern advances help keep caregivers safe from harmful substances. Closed system drug-transfer devices (CSTDs), are one such advance that significantly reduces hazardous drug exposure risk. Where do CSTDs fit into the picture, and what does the CDC say about them?


What Are CSTDs?

CSTDs are defined by the National Institute of Safety and Health (NIOSH) as "A drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drug or vapor concentrations outside the system4.

CSTDs protect both patients and healthcare workers, and they ensure that nothing can get into or out of the device during use. This includes environmental contaminants and hazardous drug vapors, aerosols, and droplets.

Types of CSTDs

There are two types of CSTDs: physical barrier and air-cleaning. Physical barrier CSTDs utilize a mechanical barrier to keep contaminants at bay. Air-cleaning CSTDs, such as Simplivia's Chemfort, rely on air cleaning technology to do so. In clinical research, both types of CSTD have proven effective for containing hazardous drug vapors1.

Simplivia CDC NIOSH Closed System Drug-transfer Device

Why Is It Important to Guard Against Hazardous Drug Exposure?

It's estimated that at least 8 million healthcare workers experience hazardous drug exposure every year. This is concerning because multiple studies demonstrate the insidious effects of occupational exposure to hazardous drugs. For instance, researchers note higher incidences of teratogenicity, chromosomal abnormalities, and even cancer in those routinely exposed to these substances4.

CSTDs are an effective way to ensure the preparations and administration of hazardous drugs is as safe as possible. Not only this, but they can benefit workflow efficiency, making it easier for oncology nurses and pharmacists to do their jobs.

What the CDC Says About CSTDs

When it comes to engineering controls, CSTDs are an integral part of the CDC's recommendations for reducing occupational risk. According to the National Institute of Occupational Safety and Health (NIOSH), CSTDs should be used throughout the entire process of compounding and administrating hazardous drugs.

From preparation and compounding in the pharmacy to patient drug
administration, NIOSH recognizes how a CSTD helps minimize dangerous
exposures when working with hazardous drugs5.

Other organizations agree with NIOSH's recommendation. The USP <800>, which outlines standards for working with hazardous drugs to keep patients, workers, and the environment safe, also advocates CSTD use. It requires facilities to use CSTDs for antineoplastic drug administration whenever the dosage form allows2.

Furthermore, CSTDs are the only engineering control available for drug
administration. They play a pivotal role in keeping patients and staff safe during hazardous drug treatments.

Research has proven the effectiveness of CSTDs for reducing hazardous drug contamination in the environment. NIOSH recommends that facilities utilize CSTDs for optimum safety. When used alongside other appropriate engineering controls like proper PPE, staff training, and ventilated cabinets, CSTDs are a powerful tool to ensure a safe working environment3.

Simplivia CDC NIOSH Hazardous Drugs

Should CSTDs Always Be Used?

As we have seen, NIOSH and the USP <800> prescribe CSTDs when working with hazardous drugs. They significantly improve safety during hazardous drug administration and benefit drug compounding.

If hazardous drug contamination occurs during drug compounding in the
pharmacy, it is easy for these toxic chemicals to escape into patient care areas and other parts of the facility. This can happen when the residue contaminates the outside surfaces, such as IV bags and tubing2.

Studies show that when pharmacists use CSTDs for drug compounding, the pharmacy sees far lower contamination levels. Not only this, but when using a CSTD to compound IV bags, the pharmacist also avoids the need for IV tubing, freeing up space within the biologic safety cabinet (BSC)2.

When it comes to handling any hazardous drug, the CDC recognizes that CSTDs go a long way toward ensuring the safety of nurses, pharmacists, and patients through every step of the process.

What Should a Facility Look for in a CSTD?

There are many CSTDs on the market. When considering which to implement, facilities should consider several factors. Is the CSTD compatible with other medical devices to be used alongside it? Also, have rigorous testing protocols proved the CSTD's integrity? Does the CSTD have a needle-free connector2, thus reducing the risk of accidental needle sticks?

Simplivia manufactures the Chemfort CSTD. This CSTD carries the benefits of a scientifically proven track record, safe needle-free system, and ease of use with standard vials. It contains the patented air-cleaning technology Toxi-Guard, which has been scientifically proven to ensure the highest level of safety for healthcare professionals and patients alike.

Toxi-Guard features an activated charcoal membrane that works together with a hydrophobic and oleophobic membrane to ensure the vial maintains sterility. Chemfort connects to all standard vials. An audible click confirms the safe connection.

The Chemfort septa can be pierced up to ten times while preventing drug leakage. Simplivia's CSTDs help ensure a safe and efficient working environment and reduce drug waste.

To learn more about Simplivia and how our products are helping medical
professionals maintain a safe everyday work environment, visit

1. Clark, C. Understanding Closed System Transfer Devices.
2. Eisenberg, S. Safe Handling Q&A: Closed System Transfer Devices. Oncology Nursing Society and Hematology/Oncology Pharmacy Association.
3. NIOSH [2020]. Managing Hazardous Drug Exposures: Information for
Healthcare Settings. By Hodson L, Ovesen J, Couch J, Hirst D, Lawson C, Lentz TJ,
MacKenzie B, and Mead K. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for
Occupational Safety and Health, DHHS (NIOSH) Publication 2020–XXX.
4. Page, R. Understanding Closed-System Transfer Devices: Why They Are
Important and How to Select an Appropriate System. Specialty Pharmacy Times.
5. The National Institute for Occupational Safety and Health. Hazardous Drug
Exposures in Healthcare: Closed System Transfer Device Research.


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