In summary, occupational exposure to hazardous drugs is a serious concern for healthcare professionals.  Exposure is minimized though the proper use of personal protective equipment (PPE), proper compounding techniques and drug administration procedures. Fluorescent studies demonstrate that compounding hazardous drugs using traditional vial to syringe technique is one of the riskiest points of occupational exposure due to vial over-pressurization which can lead to spraying and leakage. The best practises to treat hazardous drugs have been summarized in two key practise guidelines: NIOSH  alert (http://www.cdc.gov/niosh/) and ASHP Guidelines to minimize occupational exposure (http://www.ashp.org/).

Both the NIOSH and ASHP documents recommend that you consider using a closed system drug transfer (CSTD) to minimize occupational exposure.  A CSTD is defined within the NIOSH alert as " drug transfer device that mechanically prohibits the transfer of environmental contaminants into the system and the escape of hazardous drug or vapour concentrations outside the system." While vented, filtered devices may reduce the release of drug aerosols, their design allows the device to be transferred from one vial to another, which creates the opportunity for environmental and product contamination. The CSTD available on the market: Phaseal (http://www.carmelpharma.com/phaseal.html); Texium with Smart Site(http://www.carefusion.com/products-and-services/products-services-categories/infusion/closed-system-solution-texium-and-smartsite.aspx); OnGuard with Tevadaptor (http://www.bbraunusa.com/); Genie with Spiros(http://www.icumed.com/).  To be considered CSTD, under the NIOSH definition and the ASHP guidelines, these devises must demonstrate containment of spills and leakage as well as aerosols and vapors. In addition, they should demonstrate their effectiveness in independent studies. These guidelines also state that the CSTD's should be used within a negative pressure ventilated environment (http://www.isotechdesign.com/en/products-pharmacies-rx/chemo-compounding.php) which is in compliance with the USP 797 sterile preparation guidelines (http://www.usp.org/products/797Guidebook/) while following appropriate PPE and work practises.

In conclusion CSTD provide important protection to both hospital staff and patients and should be given serious consideration in any facility where hazardous drugs are compounded. A comprehensive safe handling hazardous program requires a continuous review of all transfer devices; environment; published clinical data and practice standards.

This article was written by Firouzan " Fred" Massoomi, PharmD, FASHP and published in the Pharmacy Purchasing & Products, Vol.6 No.3 (http://www.pppmag.com).