Comparison of closed system transfer devices for turnaround time and ease of use

Abstract

Objective/purpose: The primary purpose of this study was to compare three closed-system transfer devices with differing mechanical interfaces for their suitability for adoption into our daily practice. The secondary purpose was to use the results of this study to support the selection of one of the closed-system transfer devices, which would suit both the pharmacy and nursing staff at our institution, furthermore promoting the enculturation of international recommendations into our clinical practice. Study design/methods: The hazardous drug preparation process was observed and timed continuously from the moment the technician started compounding until the finished product was handed to the designated checker by raising hands. A self-administered, structured questionnaire was used for data collection looking at ease of use of each of the devices from the perspective of pharmacy technicians and nurses. The questionnaire contained an open-ended 10-point Likert-type scale of eight domains. Results/key findings: An improvement in the compounding efficiency of hazardous drugs using PhaSealTM (n¼46), ChemoLockTM (n¼45), and EquaShield II (n¼45), when compared respectively against the historical control (n¼86), was statistically significant (p<0.001). However, no statistically significant difference among the different closed-system transfer devices for preparation of hazardous drugs was observed in our study (p¼0.1). In terms of ease of use, there was no difference in preference for ChemoLockTM and EquashieldII among the pharmacy technicians with both scoring a mean score of 10 with regard to implementation. While PhaSealTM scored a mean score of 7.2. Among the nursing staff there was a slight preference for ChemoLockTM over EquashieldII with a mean score of 9.2 and 9, respectively with regard to the recommended product, while PhaSealTM scored a mean score of 7.4. Both nursing staff and pharmacy technicians had a preference ChemoLockTM, with a mean score of 10 and 9.6, respectively in terms of on how easy was each device/system to use and overall impression for pharmacy technicians. This was followed by EquashieldII with a mean score of 9.8 and 8.6, respectively and then PhaSealTM with a mean score of 7.2 and 6.6, respectively. Pharmacy technicians felt there were more steps, packaging and clutter when using PhaSeal in comparison to the other devices. With Equashield II, the estimation of clutter was higher than that of ChemoLockTM despite the number of packages being within a similar range. Conclusion/recommendations: Our study found that with experienced staff, compounding of hazardous drugs with closed-system transfer devices can be as efficient as or even more so than with the traditional needle and syringe method. With the lack of statistically significant difference among the different closed-system transfer devices studied, in addition to the cost, ease of use was one of the factors that decided the products applicability in our institution.