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Use of a closed-system drug transfer device reduces contamination with doxorubicin during bolus injection

28 May 2020
13 min read
Volume 29 · Issue 10

Abstract

Background:

Administration of doxorubicin via bolus injection may result in environmental contamination and a risk of nurses becoming exposed. Small spills are frequently observed by nurses when syringes are connected to, and disconnected from, infusion lines.

Aims:

The effect of a closed-system drug transfer device (CSTD) on the release of doxorubicin was studied during administration via bolus injections.

Methods:

10 administrations with the currently used technique and 10 administrations using the CSTD were compared by analysis of doxorubicin contamination on gauze pads, tissues and gloves.

Findings:

Using the current technique, contamination was found during nine administrations, which was mainly on the gauze pads and, to a lesser extent, on the tissues and gloves, indicating release of doxorubicin during administration. With use of the CSTD, contamination was found only on one pair of gloves.

Conclusion:

Use of a CSTD significantly decreased the number of spills and level of contamination compared with the currently used technique and, consequently, the use of such devices offers a safer working environment for nurses.

It has been known for many years that cytotoxic drugs may cause adverse health effects in healthcare workers involved in the preparation and administration of these substances (National Institute for Occupational Safety and Health, 2004). Extensive safety precautions are therefore taken to prevent healthcare workers from being exposed to these substances (International Society of Oncology Pharmacy Practitioners Standards Committee, 2007; Mathias et al, 2019). They include administrative measures such as guidelines, protocols, education and training, and technical measures such as clean-room facilities, biological safety cabinets, isolators and closed-system drug transfer devices (CSTDs). In addition to these measures, personal protective equipment (PPE) is used to optimise workers' safety.

Despite all these precautions and measures, there is still a potential risk for staff to be exposed to cytotoxic drugs. Studies continue to show exposure of healthcare workers by analysis of cytotoxic drugs or their metabolites in urine (Connor et al, 2010; Ndaw et al, 2010; Sugiura et al, 2011a; Sugiura et al, 2011b; Ramphal et al, 2014; Hon et al, 2015; Kibby, 2017; Ndaw et al, 2018), and genetic damage is observed in peripheral blood lymphocytes (McDiarmid et al, 2010; Roussel et al, 2019). In addition, surface wipe sampling shows environmental contamination with cytotoxic drugs in many pharmacies, and inpatient and outpatient departments, where the drugs are prepared and administered to patients (Kibby, 2017).

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