Seth Eisenberg (Professional Practice Coordinator, Infusion Services, Seattle Cancer Care Alliance)

Hazardous Drugs

Risks associated with exposure to hazardous drugs (HDs) such as chemotherapy, have been well documented over the past two decades and include miscarriages and infertility, as well as an increased possibility of developing cancer. Nurses administering HDs are at a high risk for exposure as IV tubing is prone to dripping when disconnected. Spills are also a significant source of exposure since unlike compounding, administration takes place in an open, unprotected environment. Not surprisingly, HD contamination has been found in hospitals and clinics in Europe, North America, Canada, and Australia. And while personal protective equipment (PPE) is a necessary approach to safety, preventing HDs from escaping the IV tubing or container should be the primary objective.

CSTDs

In 1999, the first closed system drug-transfer device (CSTD) was described in the literature to help mitigate HD exposure during compounding. The original device, along with several others that followed, were then adapted with varying degrees of success for HD administration. The publication of USP General Chapter <800> in 2016 by the US Pharmacopeia, making CSTDs required for IV administration, has helped the CSTD acronym become more familiar to U.S. nurses.

The European Challenge

In Europe, the use of CSTDs for compounding is considerably less common than in the U.S, and most HDs in the UK are prepared without them. In France, only 12% of nurses reported using a CSTD for administration. Further complicating the problem is a misunderstanding of what a “closed system” represents. Almost half of the nurses in a recent UK survey indicated they used closed systems for HD administration—despite the fact that CSTDs are not readily available to them. The authors believed that the nurses mistakenly confused the term with needless connectors.

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