# A twenty-eight-day evaluation of cytotoxic drug vapor containment in drug-binding closed-system transfer device

## TL;DR

This study shows that a drug containment device can safely hold a hazardous drug for 28 days, reducing waste and saving costs.

## Contribution

The study demonstrates the 28-day effectiveness of a CSTD with an activated carbon matrix in containing hazardous drug vapors.

## Key findings

- No cyclophosphamide vapor was detected when using the Chemfort® CSTD with ToxiGuard® for 28 days.
- A system without ToxiGuard® released 110.3 ng of cyclophosphamide, confirming its importance in containment.
- The results suggest the potential for extending CSTD usage and reducing drug waste.

## Abstract

Several studies have demonstrated that hazardous drugs can evaporate even at ambient temperature during their preparation in healthcare facilities, potentially posing a health risk for clinicians. The National Institute for Occupational Safety and Health (NIOSH) has defined closed system transfer device (CSTD) performance as preventing the release of hazardous drugs in the form of vapor, aerosol, or droplets. Most CSTDs can be used to store drugs for up to 7 days after their preparation. However, as some drugs are stable for more than 7 days, the CSTD usage period represents a limiting factor leading to residual drug waste. We investigated whether the Chemfort® CSTD with the ToxiGuard® system, an activated carbon matrix, minimizes the exposure to hazardous drug vapors or aerosols that may be released for 28 days after drug preparation.

Cyclophosphamide, a cytotoxic drug with relatively high vapor pressure was chosen as the representative drug to demonstrate vapor escape prevention. Testing was performed using intact vial adaptors (with ToxiGuard®) after incubation for 28 days, intact vial adaptors (with ToxiGuard®) without incubation, a vial adaptor from which the carbon matrix was removed (positive control) and a vial adaptor containing only water (negative control). After each test, the components were rinsed or swabbed to test for cyclophosphamide contamination.

No escaped cyclophosphamide was detected in the tests performed using Chemfort® with intact ToxiGuard®. In the system tested without ToxiGuard®, 110.3 ng of escaped cyclophosphamide were detected.

The intact ToxiGuard®, as part of the Chemfort® vial adaptor, prevents release of hazardous cyclophosphamide from the vial into the environment for up to 28 days. This result supports potential extension of its usage period and potential drug waste prevention with associated cost savings.