Closed-system transfer devices for the handling of hazardous drugs

The purpose of this review is to assess the clinical and cost-effectiveness of CSTDs for the handling of hazardous drugs, and to identify guidelines regarding the use of CSTDs for the handling of hazardous drugs. [...] Critical Appraisal of Individual Studies Included non-randomized studies were critically appraised using the Downs and Black checklist,4 economic studies were assessed using the Drummond checklist,5 and guidelines were assessed with the AGREE II instrument.6 Summary scores were not calculated for the included studies; rather, a review of the strengths and limitations of each included study were de [...] Urine samples were taken over 24 hours towards the end of the work week from the volunteers, and high-performance liquid chromatography-mass spectrometry was used to identify the presence of cyclophosphamide and ifosfamide (limit of detection 0.1 ng/mL). [...] In addition, the number of urine samples taken per person was low for one study (2 to 3 samples).8 None of the non-randomized studies reported baseline characteristics of the included pharmacists or hospital employees.3,7,8 None of the non-randomized studies employed a control group.3,7,8 One non-randomized study attempted to use previous studies as a control, which would not control for variables [...] In the before-after non-randomized study by Miyake et al., the mean amount of cyclophosphamide that was compounded during the 24-hour period that urine samples were taken from the four pharmacists was 3525 mg before the implementation of PhaSeal and 3945 mg after the implementation of PhaSeal.7 The mean amount of cyclophosphamide detected in the urine samples was 47.4 ng/24 h before PhaSeal, and 3