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Institutions should have formal written programs to manage hazards.  Such programs should include training, exposure assessment, emergency procedures for spills, policies for managing staff with reproductive concerns, and most importantly, ways to ensure that the institution is adhering to critical national standards.

Since 2008, the Oncology Nursing Society and the American Society of Clinical Oncology have developed a joint program with best practices and implementation guidance now available without charge.

Although OSHA has no explicit standard, USP 800 focuses explicitly on protecting workers from exposures to hazardous drugs. It, and USP 797, represent professionally expected requirements in healthcare that incorporate national consensus standards on infrastructure maintenance (ASTM).

In addition to infrastructure management, employers should address reproductive concerns of employees. Examples that three health care organizations provided to OSHA contain essential elements of a program. Although none of the organizations had a formal written program, they all had processes in place to assure consistency across situations. Importantly, all were deeply familiar with the complexities of work and knew the ONS guidelines and USP 797 (in force at the time) in detail. All three carefully addressed employee concerns for health and safety and were able to consistently implement pay retention, a topic addressed in several formal documents.

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