Podcast: Closed-system drug-transfer devices for reducing exposure to infusional hazardous medicines in healthcare staff

The Cochrane Work Group has produced many reviews relevant to occupational health and some of these relate directly to the health of healthcare workers. In March 2018, they published a new review doing just that, examining the evidence on the handling of medicines that might be dangerous to staff. Kurinchi Selvan Gurusamy, from UCL Medical School in London England, tells us what they found.

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John: Hello, I'm John Hilton, editor in the Cochrane Editorial and Methods department. The Cochrane Work Group has produced many reviews relevant to occupational health and some of these relate directly to the health of healthcare workers. In March 2018, they published a new review doing just that, examining the evidence on the handling of medicines that might be dangerous to staff. Kurinchi Selvan Gurusamy, from UCL Medical School in London England, tells us what they found.

Kurinchi: Some of the medicines we use to treat serious diseases can be hazardous to the healthcare staff who handle them. For instance, some of the drugs we infuse through a patient’s veins to treat their cancer can decrease fertility and lead to miscarriages, stillbirths, or even cancer in the staff administering the drugs. There are recommended ways to reduce staff exposure to these hazardous medicines, including protective clothing, gloves, and special cabinets where they can prepare the medicines before giving them to patients. Together, these practices constitute the practice of 'safe handling'.
As well as safe handling, some national agencies recommend the use of something called a closed-system drug-transfer device that mechanically prevents the escape of hazardous drug. However, there is significant uncertainty as to whether adding such a device to safe handling decreases the exposure and risk of staff contamination compared to safe handling alone. We did this review to tackle this uncertainty, in the hope of estimating the benefits of using the devices in addition to safe handling practices.
We included 23 studies from more than 350 hospitals in the review. None of the studies used the gold standard study design for such comparisons, namely a randomised trial, or explored the value for money of closed-system drug-transfer devices. In 21 studies, the people who used these devices were pharmacists or pharmacy technicians, and we were able to fully include 19 studies. However, the overall quality of evidence is very low because all the studies had one or more significant limitation in their design, meaning that the results may not be reliable.
In summary, there was no evidence of any benefit for using closed system transfer devices when we examined measures of exposure such as the presence of the hazardous drug in the urine of the healthcare professionals. There was also no evidence that the contamination of surfaces or the floor with most hazardous medicines was decreased by using these devices. There was significant variability between the studies in terms of whether the devices resulted in cost savings: some studies reported that costs went up while others found that they went down after introducing the devices. None of the studies reported health benefits for staff such as reductions in skin rashes, infertility, miscarriage, development of cancer, or adverse events.
The take home message is that, based on very low-quality evidence, we are not able to conclude for or against adding closed-system drug-transfer devices to safe handling of hazardous medicines, and the ongoing uncertainty will not be resolved without further, well-designed studies.”

John: If you would like to learn more about the current evidence and watch for any updates to this review if these new studies are done, just go to the internet and search 'Cochrane closed-system drug-transfer devices' to be linked to it.

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