Closed System Transfer Devices (CSTDs) for Chemotherapy: More Than an Added Layer of Protection

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While many use some protective measures, recent figures suggest that only 41% have adopted CSTDs.
While many use some protective measures, recent figures suggest that only 41% have adopted CSTDs.

Chemotherapy drugs containing antineoplastic agents have been associated with several health risks ranging from skin irritation to more severe risks like pregnancy complications and birth defects, and have even been linked to some forms of cancer.

These risks must be taken seriously, which is why the United States Pharmacopeia (USP) has issued, and continues to develop, its recommendations for safe handling of hazardous drugs in USP <797>, on pharmaceutical compounding and sterile preparations, and in USP <800>, specifically on the handling of hazardous drugs. These recommendations are also in line with earlier recommendations from the Center for Disease Control's National Institute for Occupational Safety and Health (NIOSH).

While many hospitals and pharmacies that handle chemotherapy drugs use some protective measures such as using Personal Protective Equipment (PPE) and engineering controls like clean rooms and biological safety cabinets, recent industry figures suggest that only 41% of facilities have adopted the use of closed system transfer devices (CSTDs).1

Oncology professionals, therefore, face a danger as vapors, aerosols, and droplets of hazardous chemotherapy drugs can easily escape standard syringes and contaminate the workplace. And, due to the adhesive properties in chemotherapy drugs, these contaminants can actually leave the designated workspace.

Traces of chemotherapy drugs have been found on unlikely places like doorknobs, keyboards, and other surfaces. This means that not only are the oncology professionals put at risk, but also other hospital staff, and even patients and their families.

This is a particular problem in pediatric and veterinary oncology. The smaller syringes used in pediatric oncology (ie, 1-mL syringe) are extremely thin. The plungers in these systems are not stiff. In fact, since the plungers are so thin, they have to be made with a more malleable material. However, because these plungers bend easily, they are also significantly more susceptible to come in contact with the contaminated inner walls of the barrel and risk contamination by drug residue left on the syringe barrel.

RELATED: Using a Closed System Transfer Device Protects Against Accidental Chemo Exposure

Studies have shown that implementing the use of CSTDs reduces the presence of surface contamination in oncology settings. However, some CSTDs have been more successful at closing more routes of exposure. For example, standard syringes used in many CSTDs risk significant quantities of drug contamination on the syringe plunger. Among the many reasons for this is that the inner walls of the barrel become contaminated and the drug infiltrates onto the syringe plunger.               

By closing off this major route of exposure, the right CSTD can decrease surface contamination in health care facilities. This reduces the risk of hazardous drug exposure to medical oncologists and oncology nurses as well as administrative staff, patients, and families.

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