CSTDs Overview
Pharmacy Closed System Drug-Transfer Devices (CSTDs) are
specialized mechanical devices designed to prevent the escape
of hazardous drug vapors, aerosols, and liquids during drug
preparation, transfer, and administration. They are used in pharmacy
and healthcare settings to ensure the safe handling of hazardous
drugs, protecting healthcare workers, patients, and the environment
from exposure. CSTDs are a critical component of safety protocols
in pharmacy practice, ensuring a safer working environment and
minimizing risks associated with the handling of hazardous drugs.
National Institute for Occupational Safety and Health (NIOSH) definition:
Closed System Drug-Transfer Device (CSTD): a drug transfer device that
mechanically prohibits the transfer of environmental contaminants into
the system and the escape of hazardous drug or vapor concentrations
outside the system.
Closed System: a device that does not exchange unfiltered air or
contaminants with the adjacent environment.
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Key Features of CSTDs
1. Closed System Design: A completely sealed system
that prevents contamination by ensuring no venting or
leakage of drug or vapor into the environment during
drug manipulation.
2. Dual Protection: Prevents:
• The escape of hazardous drug particles, vapors,
or aerosols into the environment.
• Contaminants from entering the drug vial or
container, maintaining sterility.
3. Regulatory Standards: Required under USP <800>
guidelines for the preparation and administration of
hazardous drugs to minimize occupational exposure.
4. Mechanisms of Action: Includes features like:
• Mechanically Closed Systems: Physically
block the transfer of contaminants or escape of
hazardous materials.
• Air-cleaning Closed Systems: Use filters or
membranes to clean air exchanged during drug
manipulation.
5. Applications: Used for handling hazardous
medications such as chemotherapy drugs, biologics,
and other cytotoxic agents in sterile compounding,
administration, and waste management.
6. Integration with Existing Systems: Compatible
with syringes, vials, and IV bags, and often used in
conjunction with compounding aseptic containment
isolators (CACIs) or biological safety cabinets (BSCs).
7. Benefits:
• Reduces healthcare worker exposure to
hazardous drugs.
• Maintains medication integrity and sterility.
• Enhances compliance with occupational and
environmental safety regulations.
8. Components
• Vial Adapter
• Syringe Adapter
• IV Bag / Spike Adapter