ORIGINAL RESEARCH article
Front. Public Health
Sec. Occupational Health and Safety
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1400571
This article is part of the Research TopicEnvironmental Impact of MedicinesView all articles
A twenty-eight-day evaluation of cytotoxic drug vapor containment in an aircleaning closed-system transfer device
Provisionally accepted
Daniel Mordechai Epstein*
Dekel Navarro- Nextar Chempharma Solutions, Ness-Ziona, Israel
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Objective: Several studies have demonstrated that hazardous drugs can evaporate even at ambient temperature during their preparation in healthcare facilities, potentially posing a health risk for clinicians. The National Institute for Occupational Safety and Health (NIOSH) has defined closed system transfer device (CSTD) performance as preventing the release of hazardous drugs in the form of vapor, aerosol, or droplets. Most CSTDs can be used to store drugs for up to 7 days after their preparation. However, as some drugs are stable for more than 7 days, the CSTD usage period represents a limiting factor leading to residual drug waste. We investigated whether the Chemfort ® CSTD with the Toxi-Guard ® system, an activated carbon matrix, minimizes the exposure to hazardous drug vapors or aerosols that may be released for 28 days after drug preparation.Methods: Cyclophosphamide, a cytotoxic drug with relatively high vapor pressure was chosen as the representative drug to demonstrate vapor escape prevention.Testing was performed using intact vial adaptors (with Toxi-Guard ® ) after incubation for 28 days, intact vial adaptors (with Toxi-Guard ® ) without incubation, a vial adaptor from which the carbon matrix was removed (positive control) and a vial adaptor containing only water (negative control). After each test, the components were rinsed or swabbed to test for cyclophosphamide contamination.No escaped cyclophosphamide was detected in the tests performed using Chemfort ® with intact Toxi-Guard ® . In the system tested without Toxi-Guard ® , 110.3 ng of escaped cyclophosphamide were detected.The intact Toxi-Guard ® , as part of the Chemfort ® Vial Adaptor, prevents release of hazardous cyclophosphamide from the vial into the environment for up to 28 days. This result supports potential extension of its usage period and potential drug waste prevention with associated cost savings.
Keywords: activated carbon, air cleaning technology, Closed System Transfer Device, drug vapors, Hazardous drugs
Received: 13 Mar 2024; Accepted: 28 Apr 2025.
Copyright: © 2025 Epstein and Navarro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Daniel Mordechai Epstein, Nextar Chempharma Solutions, Ness-Ziona, Israel
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.