Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield)

Chemotherapy is hazardous to the people who prepare and administer it; surface contamination and detectable drug in the urine of pharmacy and nursing staff were documented from the 1990s. A closed-system transfer device mechanically prevents the transfer of contaminants into the system and the escape of drug or vapour out of it: a vial adaptor with an expansion chamber or filter equalises pressure as the syringe draws, and double-membrane connectors seal the syringe and infusion line ends so that the drug path is never open. BD's PhaSeal, from the Swedish company Carmel Pharma, was the first widely adopted design; ICU Medical's ChemoLock and ChemoClave, Equashield's fully enclosed syringe unit, Simplivia's Tevadaptor (sold as OnGuard by B. Braun in the United States) and Baxter's and Corvida's devices followed. United States Pharmacopeia chapter 800 requires a CSTD for administration of antineoplastic hazardous drugs and recommends one for compounding, and the devices are paired with compounding robots (Loccioni's APOTECAchemo, Omnicell's IV systems, Equashield Pro), biological safety cabinets and isolators inside the pharmacy.

The evidence is that CSTDs reduce surface contamination and staff exposure, though designs differ in how well they contain vapour, the NIOSH test protocol for certifying them has remained a draft, they add cost and plastic waste to every dose, and they do not eliminate exposure from spills, excreta or aerosolised drug during PIPAC and HIPEC.