Adoption of Closed-System Drug Transfer Devices: Effectiveness in Reducing Occupational Exposure to Hazardous Drugs and the Change Management Process.

Abstract

Background: Closed-system drug transfer devices (CSTDs) are known to be effective in reducing hazardous drug contamination and, in turn, the risk of exposure for health care workers. In response, the Fraser Health Authority in British Columbia had plans to introduce CSTDs into practice.

Objectives: To confirm the effectiveness of CSTDs in reducing hazardous drug contamination and to understand health care workers' perspectives regarding the change management process for CSTD implementation.

Methods: Surface wipe samples were collected at 4 health care facilities within the health authority over 3 time points: T₀, 1 month before CSTDs were introduced; T₁, 1 month after CSTDs were introduced; and T₂, 5 months after implementation. Comparative analysis of drug contamination levels was conducted between 2 pairs of sampling times: T₀ vs T₁ and T₁ vs T₂. To understand the change management process, health care workers at the same departments (as those where wipe samples were collected) were surveyed.

Results: A total of 156 wipe samples were collected, consisting of 13 samples at each of the 4 sites at each of the 3 time points. There was a statistically significant reduction (p < 0.01) in the sum of the mass of drug contaminants from T₀ to T₁ (25.82 vs 4.01 ng/cm²) and from T₁ to T₂ (4.01 vs 0.068 ng/cm²). About 50 individuals responded to each question of the survey, and respondents had generally positive comments regarding the transition to CSTDs. Nevertheless, suggestions for improvement included offering various forms of training (e.g., online video, hands-on sessions) and ensuring ongoing communication.

Conclusions: CSTDs were confirmed to be effective in reducing surface contamination levels, and the change management process employed by the health authority appeared to be well received.