Case Study: CSTD use in Veterinary Medicine  

Dogs get cancer at roughly the same rate as humans, with nearly half of dogs over the age of 10 developing cancer.1 Cancer is a common concern in small animals, and as our beloved companions, they deserve the highest standard of care. Recently, there has been a notable rise in the use of antineoplastic chemotherapy within small animal veterinary practice. This trend is primarily driven by a growing awareness among pet owners about tumor diseases, along with significant advancements in diagnostics and therapies for small animal oncology.  

While such therapies were initially carried out by large oncology centers, they are increasingly being offered by specialized small animal clinics.

Safety concerns  

Exposure Risks for Veterinarians and Pet Owners 

The use of cytostatic drugs poses an increased risk of exposure for veterinary staff and pet owners present during chemotherapy.  

Given that the substances involved possess mutagenic, teratogenic, and carcinogenic properties, and that it is difficult to define minimum quantities for these effects, it is crucial to minimize the risk of exposure for both veterinary personnel and pet owners. The risk of exposure on surfaces is further increased considering that most veterinary clinics do not employ primary engineering controls, such as safety cabinets or isolators. 

Research in human medicine indicates that there is no connection between the number of chemotherapy treatments administered at a facility and the degree of exposure risk.2 This means that even facilities performing a relatively small number of chemotherapy treatments must prioritize minimizing exposure risks and implementing suitable protective measures.  

The European College of Internal Medicine for Companion Animals has developed guidelines for the appropriate use of antineoplastic chemotherapeutic agents.3   

The compounding of intravenous infusion solutions for antitumor chemotherapy, along with the administration of chemotherapeutic agents, introduces distinct risks of contamination and exposure to cytostatic drugs. Veterinarians encounter significant exposure risks in these processes. 4 Key steps in the process include reconstituting the vial, accurately extracting the substance, and managing the infusion solution.  

Syringe unit with a closed syringe plunger prevents toxic aerosols from escaping.

Risks of Bacterial Contamination   

 Small animals need much less medication than humans, but the medications often come in standard-sized vials, resulting in significant waste. Traditional systems carry a high risk of microbial contamination, making multiple withdrawals unsafe, especially for immunosuppressed patients who are more vulnerable to sepsis. Additionally, many cytostatic drugs are costly, and disposing of unused substances is both expensive and harmful to the environment. 

Use of CSTDs for the Application of Cytostatic Drugs to Small Animals  

Utilizing a closed system transfer device (CSTD) mitigates both environmental and microbial contamination risks, protecting medical personnel and pet owners. 

Currently, only a limited selection of CSTDs are available on the market in small animal oncology.5 EQUASHIELD has undergone extensive testing in human oncology, clinically backed to be safe and easy to use. The use of CSTDs does not exempt the oncologist of the obligation to adhere to current legal regulations governing chemotherapy. Nonetheless, it is strongly advised for veterinarians to prioritize their own safety. 6 

Case Study: Oncology at the Kleintierzentrum Kinzigtal Small Animal Center 

This summary highlights the experiences of Kleintierzentrum Kinzigtal Small Animal Center, written by Dr. Jörg Schäffner, as they transitioned to EQUASHIELD CSTDs. For the complete article, please download here.

At the Kinzigtal Small Animal Center in Baden-WĂĽrttemberg, Germany, we regularly provide chemotherapy for various tumors, including lymphomas, mastocytomas, and epithelial tumors like prostate and anal sac carcinoma. Treatments often involve intravenous administration of cytostatic drugs such as vincristine, doxorubicin, and carboplatin, with a successful slow infusion method.  

Before the introduction of EQUASHIELD CSTDs, the conventional system left staff vulnerable to exposure. Before application, the calculated volume of a cytostatic drug was drawn from the sealed glass vial. Since multiple doses were often extracted from a single vial, this process introduced a risk of contamination for both the user and the surrounding environment. Another potential source of exposure and contamination arose when air was introduced to equalize the pressure between the vial and the syringe. Finally, there was the risk of needlestick injuries. 

Veterinarian administering cytotoxic drug chemotherapy to small animals

Introducing EQUASHIELD

Over the past year, we have effectively mitigated these risks by utilizing the closed EQUASHIELD system. Administering treatment to restless, unsedated animals requires a safe and user-friendly approach to effectively prevent contamination of medical staff, pet owners, and the surrounding environment. It is crucial for us to have a system that can accommodate the unpredictable movements of the patient, ensuring the safe and hazard-free administration of cytostatic medications. The self-locking vial adapter, which remains firmly connected to a vial once it has been opened, and the syringe unit  connected to the double-membrane closure system thus safely reduces both hazards. The sterilized air is introduced into the drug vial from the sealed chamber in the syringe unit to equalize pressure. 

As the syringe unit is locked to the Luer Lock Adaptor of the infusion system, there is no risk of disconnection and subsequent contamination even if the patient moves. The slow application is carried out in a stress-free and controlled manner. Even when the syringe unit plunger is pulled back, the pressure equalization system reduces the risk of environmental contamination from aerosols. After administering the cytostatic drug and flushing the infusion tubing, the entire system is safely removed and disposed of in designated waste containers. Using CSTDs minimizes the risk of bacterial contamination, allowing us to make multiple withdrawals from the vial while effectively addressing the issue of waste.

 

Veterinarian using EQUASHIELD CSTD

Veterinarian using EQUASHIELD CSTD

Concluding Thoughts

In our experience, the introduction of EQUASHIELD is a significant contribution to safe chemotherapy. Our consistent positive experiences with EQUASHIELD, characterized by intuitive and safe handling, along with significant time savings compared to other systems, validate the findings of a study from North America.7 EQUASHIELD reduces the risk of microbial contamination of opened cytostatic vials.7 For medical staff and pet owners, exposure risks have been effectively reduced.  Implementing EQUASHIELD has significantly improved occupational safety in our veterinary clinic.      

Handling Hazardous Drugs in Veterinary Medicine: Promoting Safety with Closed System Transfer Devices

In the United States, it is estimated that there are over 100,000 veterinary healthcare workers, including veterinarians, veterinary technicians, and support staff, who play a crucial role in the care and treatment of animals1. These professionals are often exposed to hazardous drugs, such as chemotherapy agents and immunosuppressive medications, which can pose significant occupational health risks. Long-term effects of such exposure can include skin and respiratory irritation, organ damage, and an increased risk of developing various cancers3 . Research on the demographic characteristics of veterinary healthcare workers indicates that most of these professionals are women and may be at a higher risk of reproductive toxicity due to hazardous drug exposure2. It is essential for veterinary healthcare workers to be aware of these risks and implement safety measures to minimize exposure and protect their health. Safety measures include using personal protective equipment (PPE) and closed system transfer devices (CSTDs) when preparing and administering hazardous drugs. 

Cancer in Pets is on the Rise 

According to the American Veterinary Medical Association (AVMA), cancer is a leading cause of death in pets, accounting for almost 50% of all disease-related pet deaths annually5. The growing number of cases has been attributed to several factors, including increased life expectancy due to advancements in veterinary care, improved diagnostics, and greater awareness among pet owners. Among household pets, dogs have the highest incidence of cancer, with one in four dogs developing cancer at some point in their lives5. Cats also experience cancer, albeit at lower rates compared to dogs. This upward trend in cancer cases among pets highlights the need for continued research, early detection, and advanced treatment options to improve outcomes and enhance the quality of life for affected animals.

In this blog post, we will discuss the different types of hazardous drugs used in veterinary settings, detail the potential risks involved in handling these drugs, and provide a step-by-step guide for veterinarians to follow when handling hazardous drugs, focusing on the use of closed system transfer devices (CSTDs).

Hazardous Drugs in Veterinary Medicine 

Hazardous drugs are medications that pose a potential risk to humans through exposure due to their inherent toxic properties. In veterinary medicine, hazardous drugs can include: 

  1. Chemotherapy agents used to treat various cancers in animals 
  1. Hormones and hormone antagonists 
  1. Immunosuppressive agents for managing autoimmune diseases and facilitating organ transplants 
  1. Antiviral medications 
  1. Certain antibiotics and antifungal agents 

Potential Risks and Precautions

Veterinary healthcare professionals often handle hazardous drugs to treat a variety of medical conditions in animals. These professionals must understand the potential risks associated with handling these drugs and take necessary precautions to ensure their safety, as well as the safety of the animals they treat. Handling hazardous drugs can pose risks to veterinary healthcare professionals, including skin irritation, respiratory issues, and reproductive toxicity. Often, vets are compounding hazardous drugs without engineering controls, such as biological safety cabinets or compounding aseptic containment isolators. These veterinary healthcare providers may be at a higher risk for exposure to hazardous drugs and vapors.

To minimize these risks, it is essential to follow proper handling procedures, including:

  1. Wearing appropriate personal protective equipment (PPE) such as gloves, gowns, and eye protection.
  2. Utilizing engineering controls like biological safety cabinets or compounding aseptic containment isolators when possible.
  3. Implementing safe work practices, such as avoiding hand-to-mouth contact and washing hands thoroughly after handling hazardous drugs.
  4. Regularly training staff on safe handling practices and staying updated on the latest guidelines and recommendations.

The Role of Closed System Transfer Devices in Veterinary Medicine

CSTDs, such as EQUASHIELD CSTDs, play a crucial role in mitigating the risk of exposure to hazardous drugs during the preparation and administration process. These devices create a sealed barrier between the drug and the environment, preventing the escape of hazardous drug or vapors.

Clinical studies4 have shown that by incorporating CSTDs into their practice, veterinarians can:

  1. Reduce the risk of exposure to hazardous drugs for themselves and their staff.
  2. Minimize the risk of contamination during drug preparation and administration.
  3. Improve the overall safety of handling hazardous drugs in veterinary settings.

A Step-by-Step Guide for Handling Hazardous Drugs

To ensure safety when handling hazardous drugs in veterinary medicine, follow these recommended steps:

  1. Storage: Store hazardous drugs separately from other medications, ideally in a designated area with proper ventilation and limited access.
  2. Preparation: Prepare drugs in a designated area, using engineering controls like biological safety cabinets. Institute safety measures such as using CSTDs and wearing appropriate PPE during preparation.
  3. Administration: Administer drugs following the recommended route and dosage, ensuring the use of proper PPE and equipment, including CSTDs.
  4. Disposal: Dispose of hazardous drug waste including used vials, syringes, and contaminated PPE, according to local, state, and federal regulations.

In conclusion, handling hazardous drugs in veterinary medicine requires diligence and adherence to proper safety protocols. By implementing safe handling practices, utilizing closed system transfer devices, like EQUASHIELD CSTDs, and staying informed about the latest guidelines and recommendations, veterinary healthcare professionals can enhance their safety and the safety of the animals they treat.