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Potential Work Risks From Hazardous Drugs, Ways to Control Exposures, Described in NIOSH Alert

March 29, 2004
NIOSH Update:

Contact: Fred Blosser (202) 401-3749

Healthcare employers and employees should be aware that antineoplastic drugs and other pharmaceutical agents may pose work-related health risks to employees, the National Institute for Occupational Safety and Health (NIOSH) cautions in a new NIOSH Alert. The Alert makes recommendations for reducing occupational risks in healthcare settings by controlling job-related exposures.

Pharmaceutical agents are classified in the scientific literature as “hazardous drugs” if studies in humans and animals indicate that they have the potential to cause cancer, to result in developmental or reproductive toxicity, or to harm organs in exposures at low doses, the NIOSH Alert notes. Studies have linked occupational exposures with risks for various adverse effects in healthcare employees, including studies that have found higher-than-expected prevalence of cancer, leukemia, and reproductive problems among some groups of employees.

Factors for occupational risk in healthcare settings include the potency or toxicity of a given hazardous drug, and the extent of occupational exposure, NIOSH notes. Exposures may occur from the presence of an agent in or on the air, work surfaces, clothing, equipment, patient excreta, or other surfaces in areas where the drugs are used. More than 5.5 million healthcare employees may be occupationally exposed to hazardous drugs in the U.S., including pharmacy and nursing personnel, physicians, operating room personnel, environmental services employees, veterinary care staff, and shipping and receiving personnel.

“In using antineoplastic drugs and other therapeutic agents in carefully planned regimens to slow or halt the effects of cancer and other serious illnesses, where the potential side effects of the drugs are outweighed by their benefit, physicians can give new hope to patients,” said NIOSH Director John Howard, M.D. “At the same time, it is important to use proper strategies and procedures in handling these agents. Our recommendations provide tools to help prevent potentially hazardous occupational exposures.”

Among the steps described in the Alert, NIOSH recommends that:

  • Employers of healthcare workers should have written policies for medical surveillance of their employees, and for all phases of handling hazardous drugs, including receipt and storage, preparation, administration, housekeeping, deactivation, and cleanup and disposal of unused drugs, spills, and patient wastes.
  • Employers should formally seek input from employees who handle drugs.
  • Guidance documents, material safety data sheets, and training should be provided to employees.
  • Proper controls should be provided and used to reduce potential exposures. For example, properly ventilated safety cabinets should be provided for drug preparation. Horizontal laminar flow workstations that move the air from the drug toward the employee should never be used.
  • Syringes and intravenous (IV) sets used for preparing and administering hazardous drugs should have Luer-lok TM fittings to reduce risk of needlesticks, consistent with recommendations by the Occupational Safety and Health Administration and other organizations. (The reference to specific products does not constitute a commercial endorsement by NIOSH.) Employers should consider closed-system drug-transfer devices and needle-less systems to protect nursing personnel during the administration of drugs.
  • Personal protective equipment should be provided and used, including chemotherapy gloves; low-lint, low-permeability disposable gowns and sleeve covers, and eye and face protection. Proper respiratory protection should be provided and used when controls such as safety cabinets are not adequate to protect against exposure through inhalation.

The NIOSH Alert also includes five case reports illustrating the range of occupational health effects, drawn from peer-reviewed journal articles; numerous technical references and resources; and a sample listing of some drugs which meet a definition of hazardous drug. NIOSH plans to update the list annually.

A pre-publication copy of “NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Healthcare Settings,” is posted on the NIOSH web page at . Printed copies will be available after final editing and formatting. Requests for printed copies when they become available can be made through the NIOSH toll-free information number, 1-800-35-NIOSH, or by contacting the NIOSH Publications Office through the NIOSH web page at