It’s been said that hospitals are a great place to get sick – not for those who are already ill (although they, too, risk exposure to all sorts of germs and viruses during their stay), but for the healthy, especially for hospital workers who are exposed to hazardous substances all day long.
Of course, safety precautions are taken, but there are some procedures that by nature put workers’ health at risk, such as the administration of powerful and dangerous drugs, like those used in chemotherapy. Workers who prepare these drugs for injection risk exposure to dangerous substances that could make them sick – even a wayward drop that escapes from a needle as it is removed from a vial of antineoplastic drugs could be bad news. “It’s a major problem,” said Eric Shem-Tov, CEO of Israeli biotech company Equashield. “The only way to avoid this is with a sterile transfer system that ensures that the medicine remains uncontaminated, as do workers, and our product helps accomplish this.”
Contamination by antineoplastic drugs, a general term used for anti-cancer drugs, as well as other hazardous chemicals, is actually a common problem for hospital workers. A recent study at Toronto’s Ryerson University shows that many surfaces in hospital pharmacies, operating rooms, and treatment areas retain residue from antineoplastic drugs and other “handle with care” pharmaceuticals that could be dangerous to hospital workers. In addition, the study found residue on the skin of significant numbers of hospital workers – for example, antineoplastic drug residue was found on the skin of more than a quarter of nurses who came into contact with patients on chemotherapy regimens.
Chemotherapy drugs, produced under rigorous conditions of sterility, are transported in individual dose vials to hospital pharmacies, where they must be prepared to be injected, usually via a fluid injection bag attached to the patient. “On a ward, most patients are given their medications at specific times, like in the morning, so the pharmacist is usually very busy at certain times of day preparing the drugs, and the staff is busy distributing them,” said Shem-Tov. “The pressure often leads to mistakes, such as accidental needle jabs, leaks of fluid or vapor due to failure to fully secure the injection process, accidental spills, and other issues.”
Once released into the environment, anyone in the area is at risk of ingesting this residue – and even a small amount can be problematic. Those “infected” run the risk of problems ranging from skin irritation to long term complications, such as infertility, miscarriage, congenital malformations and abnormalities, leukemia and other types of cancer.
In recent years, various public and private agencies, like the National Institute for Occupational Safety and Health (NIOSH) in the U.S., have mandated that hospitals take steps to prevent these kinds of exposures, and there are several systems on the market to prevent accidental pollution of the medical environment. But most of them are cumbersome to use, requiring many steps that busy hospital personnel don’t always properly implement, said Shem-Tov.
That won’t happen with Equashield, Shem-Tov said – and the hundreds of hospitals in the U.S. and elsewhere that use the company’s medication transfer system agree. After much research, Shem-Tov said, the company determined that what was causing all the escaped fumes and droplets was – air. As the drug is pushed from the vial into the syringe, from which it will be transferred into the fluid bag, pressure disparity expels vapors, droplets and aerosols into the work environment. Equashield’s trick, said Shem-Tov, was “maintaining constant equal pressure inside the vial, thus preventing the escape of vapors and aerosols and providing full aerosol and vapor protection.”
An Equashield syringe has two chambers – one for liquid, and one for air, located at the end of the injection piston. As the piston moves, one chamber’s volume increases, while the other chamber’s volume decreases by precisely the same amount – a totally balanced exchange of air and liquid, ensuring that there is no excess pressure that will push out droplets or vapors. To keep things even safer, the system is completely enclosed, with no exposure of the syringe tip at any time during the transfer process. And, as the needle head is recessed back out of the Equashield mechanism, it moves through a mechanical “dryer” to ensure that there is no residue to escape.
The system, said Shem-Tov, “has been proven to prevent microbial ingress in media-filled vials after repeated inoculation with bacteria and up to 10 vial accesses and transfers, over 7 days of testing, under the most extreme conditions. Currently it is the only system to fully comply with NIOSH’s definition of a closed system by mechanically prohibiting the transfer of environmental contaminants into the system and the escape of hazardous drug or vapor concentrations outside the system.”
Equashield, established in 2004, has about 180 workers, and does all its manufacturing in Israel. “American hospitals that are committed to worker safety want to make sure they are getting high-quality products, so they prefer to buy our system over others that are made in countries where they would be less expensive to produce,” said Shem-Tov. The system was first deployed in 2010 at Cleveland Clinic, and is currently used in hundreds of hospitals and clinics in the U.S., and as word gets out about the product Shem-Tov expects more orders come in. “We are building a large new factory in northern Israel, because I anticipate needing much more production capacity in the next few years. I can promise the people who work for me lots of work for many years to come,” he added.
Last month, said Shem-Tov, the company came out with an updated version of the system, the Equashield II, “which is the only preassembled syringe on the market that requires no further setup, enabling quicker deployment times than other closed systems. By covering more routes of exposure than ever, our new product is a truly closed system, and as such, provides medical professionals with unprecedented safety.”