Key findings

It was not possible to reach robust conclusions on the effectiveness of closed-system transfer-devices (CSTDs) in reducing the risk of exposure to hazardous anti-cancer drug treatments.

CSTDs may be effective at preventing exposure when used as part of a wider set of safe-handling adherence protocols. There is continued uncertainty about the incremental benefits of CSTDs in limiting exposure over and above those achieved by other safe-handling practices, such as wearing double chemotherapy gloves and wearing eye and face protection.

The evidence reviewed consisted of one moderate quality systematic review (which included 23 non UK based observational studies of low quality).

There were no statistically significant differences in any of the outcomes examined by the systematic review: detection of exposure in urine, proportion of surfaces contaminated, and quantity of surfaces contaminated. The only significant reduction was in the quantity of surface contamination with Cylophosphamide in pharmacy areas in CSTD groups compared to control groups (based on two uncontrolled before-after studies; and five cross-sectional studies). However, the clinical importance of this reduction is unknown.

Four studies reporting a range of guidelines for the safe-handling of hazardous drugs recommended implementation of training, personal protective equipment (PPE), CSTDs, medical surveillance and other safety measures, largely based on expert consensus.

What were we asked to look at?

We were asked to review the evidence on the effectiveness of closed-system transfer-devices (CSTDs) in reducing the risk of exposure to hazardous anti-cancer drug treatments in healthcare professionals (all relevant staff groups including pharmacy, nursing and cleaning staff), patients and their visitors.

Why is this important?

Individuals who come into contact with anti-cancer drugs during their manufacture, transportation, distribution, administration and disposal, can be exposed to low dose cytotoxic effects from leaks, spills and aerosol dispersion of the drugs. Exposure to cytotoxic drugs can have short-, medium- and long-term adverse health effects. CSTDs are designed to mechanically prohibit the transfer of environmental contaminants into the system, and the escape of hazardous drug or vapor concentrations outside the device. Therefore, implementation of CSTDs may reduce the risk of exposure to cytotoxic drugs.

Referred by

NHS Forth Valley