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Siteman Cancer Center Adopts New Safety Measure

Gwen Ericson

Oct. 9, 2006 – Washington University School of Medicine in St. Louis has begun using a unique device that completely seals drug vials, IV hookups and syringes, preventing escape of hazardous medical compounds during the mixing and administration of chemotherapy drugs.

The Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital is the first medical institution in St. Louis to adopt such a device, referred to as a closed-system drug transfer device (CSTD). The device will be used within the Siteman Cancer Center pharmacy and in Siteman outpatient treatment areas whenever chemotherapy drugs are prepared or administered.

"This is a novel device," says Byron Peters, RPh, director of pharmacy at the Siteman Cancer Center. "It is the first and only closed-system device proven to reduce vapors and fluids coming from vials and syringes. With standard needles and syringes and non-closed devices used previously there was potential for spray or leakage."

Peters and colleagues at the Siteman Cancer Center, the Department of Veterans Affairs Medical Center in St. Louis and Saint Louis University conducted a study of the device, published in the Sept. 15 issue of the American Journal of Health-System Pharmacy. Using the CSTD eliminated, or significantly reduced, traces of the chemotherapeutic agents studied from surfaces where they were reconstituted from dried powders and in areas where nurses gave intravenous injections or used IV bags containing the chemotherapy agents used in the study.

Even though chemotherapy agents benefit cancer patients, some are known carcinogens. In September 2004, the National Institute for Occupational Safety and Health (NIOSH) issued an alert stating that health-care workers who handle hazardous drugs or work in areas where they are used may be exposed to these agents in the air or on work surfaces, clothing or medical equipment. The warning included a suggestion for the use of appropriate protective equipment.

The use of the CSTD at the Siteman Cancer Center will protect nursing and pharmacy staff and potentially visitors from the possibility of incidental exposure to trace amounts of toxic chemotherapy drugs generated during mixing and administration of these drugs,

Typically, during preparation of chemotherapeutic agents, a pharmacist, technician, or nurse injects a liquid into a membrane-covered vial that is filled with powdered drug. Air displaced by the liquid can spray out through the tiny opening created by the syringe needle, dispersing the drug into the air. In addition, drugs can leak out or vaporize during the injection process.

The device, manufactured and distributed by Carmel Pharma Inc. and named PhaSeal®, fully surrounds drug vials, IV hookups and syringe needles, locking in place to create a tight seal. A balloon attached to the device provides a contained area for air displaced from vials to go during the process of drug preparation.

Peters noted that the somewhat costly devices are not covered by insurance, and the cost will be absorbed by the Siteman Cancer Center. He expects the device will become more widely used in mixing and chemotherapy treatment rooms in the future as oncology offices become more aware of the benefits of the closed-system transfer device.

Harrison BR, Peters BG, Bing MR. Comparison of surface contamination with cyclophosphamide and fluorouracil using a closed-system drug transfer device versus standard preparation techniques. American Journal of Health-System Pharmacy 2006 Sep 15;63(18):1736-44.

Funding from Carmel Pharma Inc. supported the research cited.