Hazardous drugs (HDs) are chemicals that demonstrate one or more of the following characteristics: carcinogenicity, genotoxicity, teratogenicity, reproductive toxicity, or organ toxicity. In addition, newer drugs with a structural or toxicity profile that mimics an agent known to be hazardous by one of the aforementioned criteria also should be treated as such (National Institute for Occupational Safety and Health [NIOSH], 2016). Any HD-handling activity can result in exposure for healthcare workers (HCWs), as documented in a multitude of case reports and studies throughout the medical literature. Exposure to HDs has been associated with acute symptoms (e.g., nasal sores, hair loss, skin rash), adverse reproductive outcomes (e.g., infertility, miscarriage), genetic changes (e.g., chromosomal aberrations, sister-chromatid exchanges), and an increased occurrence of cancer (Centers for Disease Control and Prevention [CDC], 2019).
The Occupational Safety and Health Administration (OSHA) acknowledged the occupational risks of HDs and issued recommendations for their safe handling more than 30 years ago (OSHA, 1986). Updated guidelines from NIOSH and professional societies subsequently have been published (NIOSH, 2016; Polovich & Olsen, 2018; Power & Coyne, 2018). All guidelines address the need for HD-related policies and procedures, education and training, and safe-handling precautions in settings in which HDs are present. Safe-handling precautions include the use of engineering controls, safety equipment, safe work practices, and personal protective equipment (PPE). When used appropriately and consistently, recommended precautions reduce occupational HD exposure (NIOSH, 2004).
Occupational HD exposure can be minimized by a comprehensive HD safe-handling program based on a hierarchy of controls (Connor & McDiarmid, 2006). When a hazard cannot be eliminated, engineering controls are recommended to control exposure. For antineoplastic HDs, engineering controls must be used in a way consistent with expertise within consensus guidelines of United States Pharmacopeia (USP) chapters. Administrative controls are the next level of protection and include safe-handling policies and procedures, hazard communication, education, and medical surveillance of those who potentially are exposed. Finally, PPE that has been tested for use with HDs provides barrier protection for workers. PPE includes gowns, gloves, eye and face shields, and respirator protection, depending on the HD-handling activities. Both employers and employees must share the responsibility for HD safe handling.
Approved by the Oncology Nursing Society Board of Directors, July 2019. Approved by the Hematology/Oncology Pharmacy Association Board of Directors, August 2019.
This joint position statement has been endorsed by the American Nurses Association (ANA), Infusion Nurses Society (INS), and the Academy of Medical-Surgical Nurses (AMSN).
Centers for Disease Control and Prevention. (2019). Occupational exposure to antineoplastic agents and other hazardous drugs: Recent publications, guidelines, review articles and surveys. Retrieved from http://www.cdc.gov/niosh/topics/antineoplastic/pubs.html
Connor, T.H., & McDiarmid, M.A. (2006). Preventing occupational exposures to antineoplastic drugs in health care settings. CA: A Cancer Journal for Clinicians, 56, 354–365. https://doi.org/10.3322/canjclin.56.6.354
National Institute for Occupational Safety and Health. (2004). Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Retrieved from http://www.cdc.gov/niosh/docs/2004-165
National Institute for Occupational Safety and Health. (2016). NIOSH list of antineoplastic and other hazardous drugs in healthcare settings, 2016. Retrieved from https://www.cdc.gov/niosh/docs/2016-161/pdfs/2016-161.pdf
Occupational Safety and Health Administration. (1986). Guidelines for cytotoxic (antineoplastic) drugs. Retrieved from https://www.osha.gov/pls/oshaweb/ owadisp.show_document?p_table=DIRECTIVES&p_id=1702
Polovich, M., & Olsen, M. (2018). Safe handling of hazardous drugs (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.
Power, L.A., & Coyne, J.W. (2018). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacists, 75, 1996–2031. https://doi.org/10.2146/ajhp180564