Document resource
Background and Importance Handling cytotoxic drugs exposes healthcare staff to significant occupational risks. While biological safety cabinets are the standard, situations such as equipment failure or urgent bedside preparation require safe alternatives. Closed system transfer devices (CSTDs) may provide additional protection, but their characteristics differ. A structured evaluation was needed to support the choice of the most appropriate device and to ensure safe, standardised practice.Aim and Objectives This study aimed to evaluate and compare four commercially available CSTDs. Specific objectives were to assess the devices’ safety and usability, and to develop standardised preparation protocols tailored to each cytotoxic drug.Material and Methods A comparative study using scientific literature and manufacturer data evaluated four CSTDs: Chemfort (Asept), Chemolock (ICU Medical), Qymono (Vygon), and PhaSeal (BD). Each device was assessed across seven criteria: Ergonomics, Safety, Compatibility (NIOSH hazardous drug list), Assembly process, Aseptic duration, Dead volume, and Cost. A global performance score was calculated as the average of all criteria.Standardised methotrexate preparation protocols were implemented in the gynaecology unit. A summary table was created in the cytotoxic reconstitution unit (URC), listing cytotoxic agents, their key characteristics, and the corresponding preparation protocol to support safe and consistent practice.Results The characteristics of the four CSTDs were consolidated into a comparative table and visualised using a radar chart.Based on this multicriteria analysis, Chemfort (Asept) was identified as the most suitable device, offering the best balance of safety, ergonomics, and compatibility with hospital workflows.Following this evaluation:A standardised syringe preparation protocol was implemented for methotrexate in the gynaecology/obstetrics department.A cytotoxic drug reference table was developed within the URC, listing each agent’s key properties and indicating the appropriate preparation protocol.These resources enhance safety, consistency, and usability in cytotoxic drug preparation, improving operational reliability for hospital staff.Conclusion and Relevance This study confirms that Chemfort is a suitable CSTD for safe cytotoxic drug preparation, with the best technical specifications aligned with the hospital’s operational requirements.Implementation will be accompanied by close monitoring of user satisfaction, preparation times, economic impact, and long-term sustainability.The outcomes of this follow-up will support wider deployment and contribute to continuous improvement in the safety, efficiency, and quality of cytotoxic drug preparationConflict of Interest No conflict of interest