Importance of Closed System Dispensing of Hazardous Medications

Hazardous drugs (HDs) are medications that have the potential to cause serious adverse health effects, such as cancer, reproductive toxicity, organ damage, or genetic mutations, in healthcare workers who are exposed to them. HDs include many antineoplastic agents, as well as some antiviral, hormonal, immunosuppressive, and bioengineered drugs¹.

Healthcare workers who handle HDs are at risk of exposure through various routes, such as inhalation, ingestion, skin contact, or needlestick injuries. Exposure can occur during any stage of the drug handling process, from compounding and dispensing, to administration and disposal. Studies have shown that HD exposure can lead to biological evidence of absorption, such as DNA damage, chromosomal aberrations, or urinary excretion of drug metabolites¹. Moreover, HD exposure can cause acute symptoms, such as skin rashes, nausea, headache, or allergic reactions, as well as chronic effects, such as infertility, miscarriage, birth defects, or cancer².

To protect healthcare workers from HD exposure, several guidelines and standards have been developed by various organizations, such as the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), the American Society of Health-System Pharmacists (ASHP), and the United States Pharmacopeia (USP). These guidelines and standards recommend the use of a combination of engineering controls, work practices, and personal protective equipment (PPE) to minimize the risk of HD exposure¹²³.

One of the most important engineering controls for HD handling is the use of contactless systems, such as closed system drug-transfer devices (CSTDs) or compounding aseptic containment isolators (CACIs). Contactless systems are designed to prevent the escape of HD vapors, aerosols, or droplets into the environment, as well as to prevent the contamination of the drug, the equipment, or the worker. Contactless systems can reduce the potential for HD exposure by up to 90% compared to conventional systems⁴.

CSTDs are devices that mechanically prohibit the transfer of environmental contaminants into the system and the escape of HD or vapor concentrations outside the system. CSTDs can be used for both drug compounding and administration, and can be attached to syringes, vials, bags, or infusion pumps. CSTDs can prevent HD spills, leaks, or aerosolization, as well as reduce the need for venting or wiping of vials or syringes⁴.

CACIs are ventilated cabinets that provide a barrier between the worker and the HD, as well as a HEPA-filtered unidirectional airflow that prevents the contamination of the critical area where the drug is compounded. CACIs can also be equipped with gloves or half-suits that allow the worker to manipulate the drug without direct contact. CACIs can prevent HD exposure during compounding, as well as maintain the sterility and quality of the drug product¹.

Contactless systems are essential for ensuring the safety and health of healthcare workers who handle HDs, as well as the quality and efficacy of the drug products. Contactless systems can significantly reduce the risk of HD exposure and its associated adverse effects, as well as comply with the current guidelines and standards for HD handling. Contactless systems are not only a best practice, but also a necessity, for HD handling in healthcare settings.

(1) Controlling Occupational Exposure to Hazardous Drugs. https://www.osha.gov/hazardous-drugs/controlling-occex.

(2) Toolkit for Safe Handling of Hazardous Drugs for Nurses in Oncology. https://www.ons.org/sites/default/files/2018-06/ONS_Safe_Handling_Toolkit_0.pdf.

(3) Risk Management for Hazardous Drugs | NIOSH | CDC. https://www.cdc.gov/niosh/topics/hazdrug/riskmanagement.html.

(4) Understanding Closed-System Transfer Devices: Why They Are Important .... https://www.pharmacytimes.com/view/understanding-closed-system-transfer-devices-why-they-are-important-and-how-to-select-an-appropriate-system.