A trial of closed-system transfer devices that measures staff exposure properly, not only surface wipes

The evidence. The Cochrane review (2018) found 24 observational cluster studies in 359 hospitals and no randomised trials; all were at serious risk of bias, mostly in pharmacy staff, and mostly of one device. Very low certainty evidence was insufficient to show a difference in staff urine tests or surface contamination, and the authors wrote that "no firm conclusions can be drawn". They suggested multicentre randomised trials, or interrupted time series, measuring exposure to the drugs actually used and short-term health outcomes.

The standards. ASCO's safe handling standards (2019) rated the literature as low quality, noted that no standard test of device performance existed, and reported that USP chapter 800 requires the devices for nursing administration and recommends them for compounding. The devices add cost to every dose; adoption has not been measured by any source read.