Safe Handling of Hazardous Drugs

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Introduction

The issue of healthcare worker (HCW) exposure to hazardous drugs (HDs) first emerged in 1979. Guidelines for the safe handling of HDs have been available for more than 20 years. Although the recommended guidelines have not changed significantly during that time, the information related to the potential for occupational exposure has changed. Evidence of contamination in healthcare work environments with HDs has been reported in the occupational health literature since the early 1990s. This information regarding potential health risks, considered with the fact that nearly six million HCWs handle HDs (U.S. Bureau of Labor Statistics, 2009), emphasizes the need to focus on HD safe handling. Much of the evidence we present from the literature is old, but it still has value. We have not solved the problem of occupational HD exposure.

This manual is based on the recommendations of the Oncology Nursing Society (ONS), the Occupational Safety and Health Administration (OSHA), and the American Society of Health-System Pharmacists (ASHP, formerly the American Society of Hospital Pharmacists). Its intent is to help to translate the recommendations into practice for nurses who handle HDs in the care of patients. More importantly, nurses are encouraged to critically examine their work practices in order to identify activities that might result in HD exposure and to change practices that might put themselves and their colleagues at risk.

In preparing the update to these guidelines, the authors searched the PubMed system of the National Library of Medicine using the following key words: antineoplastic agents, hazardous drugs, and occupational exposure. Articles were limited to those published in the English language in peer-reviewed journals from 2000 forward. Older publications considered classic references are also included.

Further searches of the medical literature were conducted (based on initial findings, group feedback, and authors’ experience) to identify additional and relevant materials. In addition to searching peer-reviewed publications, the authors searched Web sites of known domestic or international medical organizations or professional societies involved in producing relevant materials (e.g., reports, white papers, official announcements) related to hazardous drug topics. The authors sought to identify literature that would point to recommended evidence-based standards of practice or specific quality measures that had been developed by healthcare organizations or specialty societies. Web sites of the following organizations were searched:

• www.ons.org
• www.ashp.org
• www.cdc.gov/niosh/
• www.OSHA.gov

Findings derived from these searches were used to generate additional searches for guidelines published in the United States and abroad.