Some medicines – whether given as tablets or as a drip through the veins – are hazardous to the healthcare staff who handle them. Patients receive infusional hazardous medicines through the veins as treatment for serious diseases like cancer. When healthcare staff are exposed to these medicines, they can decrease their fertility and result in miscarriages, stillbirths, and cancers. Several recommended practices can reduce healthcare staff exposure to these hazardous medicines. These include protective clothing, gloves, and special cabinets where staff can prepare the hazardous medicines prior to giving them to patients. Together, these practices constitute ‘safe handling’. A closed-system drug-transfer device (CSTD) is a device system that mechanically prevents the escape of hazardous drug outside the system.

What is the aim of this review?

There is significant uncertainty as to whether using CSTD in addition to safe handling decreases the exposure and risk of staff contamination to hazardous medicines compared to safe handling alone. We sought to resolve this issue by searching for existing studies on the topic.

Key messages

Based on very low-quality evidence, there is currently no evidence for or against adding CSTD to safe handling of hazardous medicines. Further well designed studies are necessary.

What was studied in the review?

We included all types of studies that compared CSTD plus safe handling (‘CSTD group’) and safe handling alone (‘control group‘).

What are the main results of the review?

We included 23 studies (358 hospitals) in this review, none of which used the gold standard study design (randomised controlled trials) or explored a treatment’s value for money. In 21 studies, the people who used the CSTD and safe handling were pharmacists or pharmacy technicians. Nineteen studies provide information that could be included for this study.

There is no evidence of any benefit for using CSTD in the indirect measures of exposure such as the presence of the hazardous drug in the urine of the healthcare professionals. There is no evidence that the contamination of surfaces or the floor with most hazardous medicines was decreased by the use of CSTD. There is significant variability between the studies in terms of whether the use of CSTD resulted in cost savings, with some studies reporting increased costs and others reporting decreased costs after introducing CSTD. None of the studies report on health benefits such as reduction in skin rashes, infertility, miscarriage, development of any type of cancer, or adverse events.

The overall quality of evidence is very low for all the outcomes because all the studies had one or more significant limitation in their design. Therefore, the results may not be reliable.

How up-to-date is this review?

We searched for studies up until 26 October 2017.