CSTDs are devices that are intended to “mechanically prohibit transfer of environmental contaminants into the system and the escape of hazardous drug or vapor concentrations outside the system.”19(p44) The review of the evidence for CSTDs did not find any published studies that evaluated health outcomes but rather found studies of surrogate markers such as presence of antineoplastic drugs in urine, surface contamination, and containment levels of drugs in controlled laboratory settings. Review authors concluded that the largely industry-sponsored body of evidence was of low quality and that there is a need for a third party to develop a neutral testing method to determine the efficacy of CSTDs. Another recent systematic review33 using the GRADE methodology34 concluded that the quality of the published literature on CSTDs was low and at high risk of bias.