Hazardous drugs used in healthcare can harm workers through occupational exposure. Exposure risks depend on a drug's toxicity, route of exposure, physical/chemical properties, formulation, and workplace activities. Closed system drug transfer devices (CSTDs) can help minimize exposure by mechanically preventing drug transfer outside the system. National Institute for Occupational Safety and Health (NIOSH) recommends using CSTDs during handling and administering hazardous drugs as part of a safety program including training, exposure assessment, and emergency procedures. NIOSH is developing a test protocol to evaluate CSTD performance in containing hazardous drugs.

1. Occupational health and safety
Hazardous drug exposures in health care

2. 1 Occupational Exposure to Hazardous Drugs
Occupational exposure to hazardous drugs has been linked to a
range of health problems, and it doesn't take much to cause harm.
It can be something as simple as accidentally touching your nose
or mouth with a contaminated glove or hand after handling a drug.
Understanding the risks and how to effectively mitigate them can
help keep both clinical and non-clinical staff safe while providing
patients with the treatments they need.

3. Because of the complex nature of certain
conditions, clinically effective medications may
pose some serious risks to healthcare and
pharmaceutical staff. These drugs can effectively
kill cancer cells. The trade-off is that they also kill
healthy cells in the process, which is why patients
undergoing chemotherapy experience undesirable
side effects such as hair loss. For people who are
battling cancer, often, the benefits outweigh the
risks and side effects.
2 The Risks of Occupational Exposure to Hazardous Drugs

4. •For people who don't have
cancer, though, exposure offers no
benefit. There are a number of
measures healthcare leaders can
put in place, including the use of
CSTDs, that can help minimize
dangerous exposure to these
drugs. This makes pharmaceutical
care safer for everyone
involved, including patients and
caregivers.

5. Hazardous drugs used to treat
patient illnesses can harm
unprotected healthcare
workers in their workplaces
How Exposures Can Occur
3

6. •so in order to protect them it is
recommended that workplaces assess the
hazards specific to their workplace and
develop hazard control strategies to mitigate
those hazards. These may include use of
engineering controls, such as ventilated
hoods and enclosures , such as establishing
safe handling policies, and routine training
reviews for potentially exposed individuals;
and supplying personal protective
equipment (PPE), such as chemotherapy
gloves and gowns.

7. Steps you can take to protect workers. No
single approach can protect all workers in
healthcare workplaces against all hazardous
drugs. These steps, however, can lessen the
chance that hazardous drugs will do harm:
Minimizing Occupational Exposure to Hazardous
Drugs - Safety Protocols and Equipment
4

8. STEPS
Clearly label all hazardous drugs so workers will know to carefully handle
them.
Do not use automated counting machines for hazardous drugs. The
machines can produce powder and contaminate the work area.
Use liquid formulations when possible to avoid crushing tablets or
opening capsules.
avoid cutting, crushing, or otherwise manipulating pills or capsules. This
might produce powder that can contaminate a workplace .

9. When manipulating hazardous drugs, use effective engineering controls
and personal protective equipment.

10. conclusion
•Consider relevant factors when
determining appropriate hazard
control strategies. For example,
administering unopened, intact
tablets and capsules may have
lower risk of exposure than
preparing syringes or IV bags of
injectable drugs

12. The potential exposure of workers from handling a hazardous drug depends on
several factors unique to each work setting. Such factors include:
1-A drug’s toxicity .
2-Route of exposure .
3-A drug’s physical and chemical properties .
4-Drug formulation .
5-Workplace activity .
NIOSH (National Institute of Occupational Safety and Health )
Publications
5

13. Drug’s toxicity
•This refers to the type of harm a drug
can cause to a person’s health. For
example, cytotoxic drugs are used to
kill cancer cells, but they can also cause
cancer or other harm to healthcare
workers who work with or handle them
without adequate protection. Some
drugs may harm a person’s ability to
have healthy children.

14. Route of exposure
•How workers may be exposed to a drug is
an important factor to consider in
developing strategies for controlling
exposure. Workers can be exposed to
hazardous drugs through breathing vapors,
dusts, or aerosols, absorbing it through
skin contact swallowing it, or accidental
injection.

15. Drug’s physical and chemical properties
•The physical and chemical properties of drugs that
influence their hazard include vapor pressure, physical
state (solid, liquid, or gas) and molecular weight of the
drug . For example, when a drug has a high molecular
weight, like a monoclonal antibody, and its typical
dosing regimen is via injection, the drug would
generally be absorbed through intact skin very poorly
Of course, there may still be a risk of exposure to such
drugs from accidental needle sticks or inhalation of
dusts or droplets.

16. Drug formulation
•This refers to the form the drug takes for
administration such as a powder, liquid,
capsule, or prefilled syringe. Like a drug’s
physical and chemical properties, the
formulation of the drug is an important
indicator of the types of precautions needed to
avoid exposure. Different risk management
strategies are needed for powders than pre-filled
syringes.

17. Workplace activity
•This involves how workers use and
handle the drug in the workplace such as
administering the drug, compounding it,
shipping it, or receiving it. Different
activities have very different potential for
healthcare worker exposure.

18. Possible Solutions
•Institutions should have formal written
programs to manage hazards. Such programs
should include training, exposure assessment,
emergency procedures for spills, policies for
managing staff with reproductive concerns, and
most importantly, ways to ensure that the
institution is adhering to critical national
standards.

19. CSTD bag or infusion adapter attached to an IV bag.
NIOSH defines a Closed System Drug-Transfer Device (CSTD) as
“a drug transfer device that mechanically prohibits the transfer of
environmental contaminants into the system and the escape of the
hazardous drug or vapor concentrations outside the system”
[NIOSH 2004]. Currently, CSTDs generally follow one of two
design concepts, using either a physical barrier or an air-cleaning
technology to prevent the escape of hazardous drugs into the work
environment. When appropriately designed and used, CSTDs offer
enhanced protection against potentially hazardous exposures to
healthcare workers during the compounding and administration of
hazardous drugs.
Introduction
How CSTDs(Closed system drug-transfer devices)
Help Keep You Safe
6

20. •NIOSH recommends healthcare workers use a CSTD throughout the
hazardous drug- handling chain, from pharmaceutical compounding to
patient dose administration [NIOSH 2004]. While all CSTDs may not be
equally protective, research shows that CSTD use can reduce hazardous
drug contamination [Vyas 2013]. CSTDs should not be the only means
of worker protection. They should be used as part of a hazardous drug
safety program and used in conjunction with other engineering controls
[NIOSH 2004].

21. CSTD Performance Standards
•As CSTD designs and available models changed,
NIOSH and its industry partners realized the need for an
independent testing method for CSTD performance.
•While CSTD performance standards are available that
apply to sterile practice and patient protection, no CSTD
performance standards are available for drug
containment [Douglass et al. 2012]. To address this gap,
NIOSH researchers are developing a test protocol that
evaluates a CSTD’s containment of hazardous drugs.

22. NIOSH Research on CSTD Test protocol
•The following is information on NIOSH CSTD
research activities and includes links to early draft
protocols, other associated documents, and public
comments. Also provided is an update on the
research status of the most -recent NIOSH draft
CSTD test protocol. This is a unified test protocol
for both air-cleaning and barrier type CSTDs. Check
back for more on this continuing NIOSH research
project and other relevant CSTD information.

23. The Importance of CSTDs in Protecting Health
Care Professionals
•CSTDs help protect health care professionals from
hazardous drugs, including pharmacists preparing
medications and nurses administering medication. It
has been estimated that 8 million health care
professionals are exposed to hazardous drugs each
year, increasing the risk of chromosomal abnormalities,
teratogenicity, and cancer. More than 100 studies
substantiate the increased risk, and more than 50
studies have documented harm to health care

24. workers as a result of exposure.2-4

25. Conclusions
•CSTDs have an important role in
protecting health care professionals from
the risks of long -term low-level exposure
to hazardous drugs both during preparation
in the pharmacy and during administration
at the bedside by nurse.

26. Prepared By
- Abobaker Nasser Sheikh .
- Ahmad Radwan Ahmad .
- Ahmed Ashraf Mostafa .
- Ahmad Sami Al Hammady .
- Ahmed Sameh Eladl .
- Ahmed Amir Elkasir .
- Ahmed ashraf abdullah.
- Ahmed Ibrahim Abdalla

27. With sincere regards and appreciation to
Dr / Hala Samir

28. Thank you