Hazardous drugs need to be prepared by pharmacists, nurses or physicians using proper personal protective equipment and engineering controls. The risk of exposure to hazardous drugs through inhalation or direct skin contact is present during preparation and handling activities, including:
- Transferring hazardous drugs from one container to another, and reconstituting or manipulating them.
- Withdrawal of needles from drug vials.
- Expulsion of air from a drug-filled syringe.
- Drug handling practices, such as mixing, crushing, reconstituting, aerosolizing and blending of drugs;
- Needle or sharps handling and disposal;
- Priming of IV lines; and
- Labeling of containers containing drugs.
Antineoplastic drugs (cancer-treatment medications) are an example of one class of hazardous drugs. This class includes medications such as Vincristine, Dacarbazine, Mitomycin, Cytosine arabinoside, and Fluorouracil.
- Personal Protective Equipment: OSHA requires the employer to assess hazards and then select and ensure the use of appropriate personal protective equipment to protect employees from hazardous chemicals such as those found in some drugs. [29 CFR 1910.132]
- Eye and Face Protection: OSHA requires the use of appropriate chemical-barrier face and eye protection whenever splashes, sprays, or aerosols of hazardous drugs may be generated that could result in eye, nose, or mouth contamination. [29 CFR 1910.133]
Recognized Controls and Work Practices
- Containment Primary Engineering Controls (C-PEC) and Ventilated Cabinets: Use approved C-PECs when preparing hazardous medications. [Controlling Occupational Exposure to Hazardous Drugs (Section V, B, #2)]
- Compound sterile and non-sterile hazardous medications within a Containment Primary Engineering Control (C-PEC) located in a Containment Secondary Engineering Control (C-SEC) (USP 800).
- C-PECs for compounding sterile Hazardous Drugs include Class II and Class III (Biological Safety Cabinets (BSCs) and ISO Class 5 Compounding Aseptic Containment Isolators (CACIs) that meet or exceed the standards set in USP 797 (USP 797).
- Do not use Horizontal Laminar Airflow Workstations for the preparation of hazardous drugs, since they increase the likelihood of drug exposure. [Controlling Occupational Exposure to Hazardous Drugs (Section IV, A, #4)]
- Ensure that BSCs contain:
- Covered needle containers for needle disposal.
- Covered waste containers for excess fluids disposal.
- Expel air from syringes in a C-PEC, not at the time the healthcare worker gives the injection. [Controlling Occupational Exposure to Hazardous Drugs (Section V, F, #2)]).
- Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH), Publication No. 2004-165, (September 2004). This document provides healthcare workers and employers with measures for minimizing exposure to hazardous drugs.
- Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Worker/Employer Summary Sheet.
- Hazardous Drugs. OSHA Safety and Health Topics Page.
- Controlling Occupational Exposure to Hazardous Drugs. OSHA.
- Hazardous Drug Exposures in Health Care. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic.
- NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2016.
- Hazardous Drugs. Washington State Department of Labor and Industries.
- Worker Exposure to Hazardous Drugs. Subject of NIOSH Alert and Guidelines. The Joint Commission and OSHA Lend Support to National Effort to Curb Hazards.
- Antineoplastic Agents. Occupational Hazards in Hospitals. Centers for Disease Control and Prevention (CDC) Workplace Safety and Health Publication, (2004).
- McDiarmid M, Oliver M et al. (2010). Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. JOEM, 52(10): 1028-1034.
- Safe Handling of Hazardous Drugs. Duke Occupational & Environmental Safety Office, (Updated April 29, 2016).
- Safe Handling of Hazardous Drugs: Reviewing Standards for Worker Protection. Pharmacy Practice News, (2011).
- Oncology Nursing Society.