ObjectivesThe objectives of this study were to review economic data on the use of closed system drug transfer devices (CSTDs) for preparing and administering hazardous drugs, and to evaluate the quality of data reporting as defined by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).MethodsAll references from a recent Cochrane review about CSTDs were evaluated for inclusion. A literature review was also conducted. Articles containing economic data about the use of CSTDs were retained for analysis. Two researchers independently graded the articles according to the 24-item CHEERS checklist.ResultsOf the 138 articles identified initially, 12 were retained for analysis. Nine of these studies did not report acquisition costs or did not detail acquisition costs. Six studies reported economic benefits associated with the used of CSTDs, all related to extending the beyond-use date. The mean number of CHEERS criteria fulfilled by the included articles was 9.2 (SD 2.4).ConclusionsCSTDs are costly to acquire. However, few studies have examined the economic impact of these devices, and the existing studies are incomplete. As a result, hospitals planning to implement these devices will be unable to make a sound economic evaluation. Robust economic evaluation of CSTDs is needed.

Purpose The main objective was to determine the efficacy of various types of cleaning equipment and products after deliberate contamination with cyclophosphamide. The secondary objective was to test various cleaning scenarios using these equipment and products. Methods The study had two phases: testing of cleaning equipment (wipe : woven microfibers – Hygen®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicronSolo®, two layers of non-woven microfibres and an inner layer of highly absorbent viscose fibres – MicroMix®, simili-tissu (low filament production) – Tork® and, mop : woven microfibers – Hygen®, microfibre and viscose – MicroOne®) and products (disinfectant : quaternary ammonium – DR100®, chlorine 0.1% – Zochlor® – Brutab® – PCS® NPH, sodium hypochlorite 2%, cleaner : detergent – Nu- Action 3®, cleaner and disinfectant: sodium hypochlorite 0.6% + detergent – Aliflex® and water) in phase 1 and testing of various cleaning procedures in phase 2. Specific areas of a room with a laminar flow hood (class II/type B2) were contaminated with 10 mcg of cyclophosphamide. Different types of surfaces were cleaned with various scenarios and the remaining cyclophosphamide was measured by the Institut national de santé publique du Québec. All tests were performed in triplicate. Results A total of 189 samples were obtained: 42 negative controls and positive controls, 54 during phase 1 and 93 during phase 2. All products were more than 96.5% effective. The 0.1% chlorines were the most effective products. Cleaning procedures with two or three products had average cleaning efficacies of 99.94–99.99%. Efficacy increased with the number of successive cleanings. When two products were used, the average cleaning efficacy varied between 99.78% and 99.98%, depending on the surface. Conclusion All cleaning products tested reduced cyclophosphamide contamination by more than 96.58%. Cleaning efficacy increased with successive cleaning. No scenario was effective in removing 100% of traces. Additional studies with larger samples should be conducted to confirm these results.

ObjectivesThe main objective was to identify all studies that present data regarding microbial contamination of vials used for preparation with closed-system drug transfer devices (CSTDs). Our secondary objective was to compare the reported contamination of vials punctured with a CSTD versus no CSTD and to evaluate the quality of data reporting as defined by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.MethodsA literature review was conducted on 31 December 2018 on PubMed, EMBASE and Cumulative Index to Nursing and Allied Health Literature. A manual search of the archives of relevant pharmaceutical conferences was made. All studies that presented data about microbial contamination of vials punctured with a CSTD or about beyond-use date extension were included. Two researchers independently graded the articles according to the STROBE criteria.ResultsOf the 280 articles identified initially, 12 were retained for analysis. Studies evaluated microbial contamination according to different incubation times and different culture media. Nine studies did not use any comparator group. Five studies found no contamination of vials punctured with CSTDs. For the others, the contamination was between 0.3% and 27%. Three studies compared the contamination of vials punctured with a CSTD and with a conventional system and did not show a significant difference between the groups. Seven studies declared a conflict of interest. The mean number of STROBE criteria fulfilled was 12.2±4.1 out of 34 (7 not applicable) for studies, and the mean number was 5±0 out of 12 for abstracts.ConclusionsVials punctured in ISO5 conditions with a CSTD presented a low frequency of microbial contamination. No study showed a significant difference between vials punctured with a CSTD and with a conventional method. Centre-specific sterility testing is needed to reflect the variability of handling procedures and equipment.

RÉSUMÉContexte : Il existe de nombreuses stratégies visant à réduire les risques d’exposition professionnelle aux médicaments dangereux qui pèsent sur les travailleurs du domaine de la santé, dont les systèmes utilisés pour la préparation et l’administration des médicaments.Objectif : L’objectif principal était de comparer le coût des fournitures utilisées pour la préparation et l’administration d’une dose d’antinéoplasique par voie intraveineuse (IV) dans un établissement de santé canadien pour adultes entre un système classique et un autre intégrant un système clos de transfert de médicament (SCTM).Méthode : Il s’agit d’une analyse de minimisation de coûts. La perspective adoptée est celle d’un établissement de santé universitaire type. L’évaluation ne porte que sur le coût des fournitures utilisées pour la préparation et l’administration d’une dose d’antinéoplasique IV. Il n’est pas nécessaire de procéder à l’actualisation des coûts. Nous avons déterminé 12 scénarios comportant certaines des 11 étapes possibles de la préparation et de l’administration d’une dose IV d’antinéoplasique.Résultats : Le coût des fournitures utilisées pour la préparation et l’administration d’une dose d’antinéoplasique varie entre 9,89 $ et 22,37 $ la dose pour le système classique et entre 12,34 $ et 64,19 $ la dose pour les systèmes intégrant un SCTM. Le surcoût moyen annuel des systems intégrant un SCTM est de 1,63 à 3,15 fois supérieur par rapport au système classique et il représente une dépense annuelle additionnelle allant de 363 566 $ à 1 238 072 $ par année pour un établissement de santé type pour adultes.Conclusion : Cette analyse de minimisation de coûts présente des données originales entourant la préparation et l’administration IV d’antinéoplasiques. Compte tenu des coûts importants associés à la préparation et l’administration des antinéoplasiques, les décideurs devraient mener des analyses complètes des coûts et des conséquences afin d’assurer une prise de décision éclairée.ABSTRACTBackground: Many strategies aim to reduce the risk of work-related exposure to hazardous drugs for health care workers; these strategies include the use of specific systems to prepare and administer these drugs.Objective: To compare the cost of supplies used for preparing and administering one IV dose of antineoplastic in an adult health care facility in Canada between the traditional approach and one using a closed-system drug transfer device (CSTD).Method: This study was a cost reduction analysis conducted from the perspective of a typical university health care facility. The assessment focused only on the cost of supplies used to prepare and administer oneIV dose of antineoplastic. It was not necessary to account for discounting. We developed 12 scenarios involving some of the 11 possible steps in preparing and administering one IV dose of antineoplastic.Results:The cost of supplies used to prepare and administer one IV dose of antineoplastic ranged between $9.89 and $22.37 per dose with the classical system, and between $12.34 and $64.19 per dose for systemsinvolving a CSTD. The annual average extra cost of systems involving a CSTD was 1.63 to 3.15 higher than the cost with the classical system and represents extra spending of between $363 566 and $1 238 072 each year for a typical adult health care institution.Conclusion: This cost reduction analysis presents original data relating to the preparation and administration of IV antineoplastics. Given the significant costs associated with preparing and administering antineoplastic drugs, decision-makers should perform a thorough analysis of costs and consequences to allow informed decisions to be made.

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