Comparison of closed-system transfer devices to compound cytotoxic medicines in a hospital pharmacy compounding unit

Abstract

Background: The use of a closed system transfer device (CSTD) is recommended when compounding hazardous cytotoxic medicines for operator and environmental protection. The hospital pharmacy compounding unit has used the CSTD PhaSeal since 2014. Recent evidence suggests an alternative CSTD, Equashield, may be a suitable alternative. Aim: To determine if Equashield provides any advantages financially, in compounding time, rubber bung contamination, cytotoxic medicine surface contamination, staff satisfaction, and work health and safety benefits when compared to PhaSeal. Method: CSTD PhaSeal was compared to Equashield by performing a financial cost comparison, time in motion study to compare compounding time, evaluation of product contamination rates and cytotoxic surface contamination levels, work health and safety (WH&S) review and staff satisfaction survey. This project was exempt due to the local policy requirements that constitute research by the Children's Health Queensland Research Ethics Committee (Reference no: EX/23/QCHQ/97690). The justification for this ethics exemption was as follows: the study conformed with the Ethical considerations in quality assurance and evaluation activities and met local requirements for a quality assurance activity and did not involve any assessment of staff. Informed consent was obtained from all staff via verbal explanation of the project and their voluntary participation. Staff consented via completion of the voluntary survey. Results: The cost to compound using Equashield instead of PhaSeal was increased by AUD $4684 over a 6-month period, with a compounding time saving benefit of approximately 1 min per product. Product contamination by rubber stopper core was 16 per 100,000 products using Equashield. Surface cytotoxic contamination levels remained undetectable before and after the comparison. Staff preferred Equashield and a WH&S product review determined Equashield required less torque and force during use and may reduce repetitive strain injury. Conclusion: Equashield performed better in time to compound, rate of product contamination, staff satisfaction and WH&S assessment. The cost of Equashield was greater; however, Equashield demonstrated benefits over Phaseal in other areas of comparison, which could potentially offset the cost increase. The pharmacy demonstrated Equashield may be a suitable alternative to PhaSeal.