WASHINGTON, DC—Implementing closed-system transfer devices (CSTDs) minimized variability in infusion setup of hazardous drugs, which also limited occupational exposure while standardizing administration, a study presented at the Oncology Nursing Society (ONS) 38th Annual Congress has found.

The National Institute for Occupational Safety and Health, the American Society of Health-System Pharmacists, and ONS all recommend using CSTDs to decrease exposure to hazardous drugs during preparation and administration. “A CSTD is a device that mechanically prevents contamination of the care environment by hazardous drugs via the release of hazardous drug-containing droplets, aerosols, or vapors,” stated Amy Callahan, RN, MSN, CRNP, AOCNS®, of the National Institutes of Health (NIH), Bethesda, MD.

At the NIH Clinical Center, nurses administer an average of 1,100 hazardous drugs monthly, including both U.S. Food and Drug Administration-approved and investigational agents, placing them at high risk for exposure. To limit occupational exposure and standardize administration of hazardous drugs, an interdisciplinary team comprising nursing, pharmacy, and hospital epidemiology “evaluated four CSTD products for safety, infection-control properties, cost, and versatility,” Callahan noted. “The system had to accommodate the variety of administration techniques required by various investigational drugs.”

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Nursing and pharmacy assessed current administration processes for the hazardous drugs “and identified the spiking of IV bags on nursing units as a potential source of hazardous drug exposure,” she stated. “To minimize risk during spiking, pharmacy agreed to spike all hazardous drugs IV bags and prime selected hazardous drugs in the controlled environment of the biological safety cabinet.”

The team also found that use of a CSTD decreased nursing exposure during administration. The system selected for evaluation included a male Luer-locking device, pharmacy applied to all hazardous drugs, and a female Luer-locking device, applied by nursing to the vascular access device.

A 3-month pilot in high-volume areas was followed by hospital-wide implementation. Callahan noted that during the first year of use, which included the pilot, voluntary reporting of hazardous drugs spills increased from 13 to 37 spills. This is attributed to heightened reporting during implementation. Since hospital-wide implementation, there have been 10 spills, 80% <5mL in volume.”

Sixty percent of the spills were attributed to user error, which was addressed through education. After stakeholder satisfaction surveys that included nursing and pharmacy were completed, “a staff-led committee was created to review hazardous drugs spills, ongoing product concerns, educational needs, and future initiatives,” she concluded.