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NIOSH looks at Precautionary Practices of Respiratory Care Practitioners who Administer Aerosolized Medications

November 18, 2015
NIOSH Update:

Press Office Contact: Nura Sadeghpour (202) 245-0673

A recent article from the National Institute for Occupational Safety and Health (NIOSH) found that safe handling of aerosolized medications is not always universally practiced in healthcare settings, placing workers, co-workers and even family members at risk. This article was published in the October issue of the Respiratory Care and is available online.

Results are derived from the 2011 Health and Safety Practices Survey of Healthcare Workers, the largest federally-sponsored survey of healthcare workers in the U.S. which addresses safety and health practices relative to chemical agents routinely used or present in healthcare settings. This paper describes current exposure control practices and barriers to using personal protective equipment (PPE) during administration of selected aerosolized medications among respiratory care practitioners including respiratory therapists (RTs), nurses, and other healthcare practitioners.

Respiratory care practitioners administer aerosolized drugs, such as pentamidine and various antibiotics, to treat respiratory infections. At the time of the survey, pentamidine was classified by NIOSH as a hazardous drug with rigorous safe handling guidelines. The antibiotics included in this study (amikacin, colistin and tobramycin) were not classified as hazardous drugs, with less comparable guidelines for administering them available.  Results from the survey findings showed:

  • Respondents who administered pentamidine were more likely to be trained, to be familiar with employer standard procedures, to have engineering controls in place, and to use eye/face protection and respirators than those who administered antibiotics.
  • However, adherence to safe handling precautions was not universal; protective gloves and gowns were not always worn by more than 20% and nearly 70% of the respondents, respectively, while administering pentamidine.
  • One fourth of respondents administering pentamidine were never trained.
  • Those who administered pentamidine were more likely to take home potentially contaminated clothing than those who administered antibiotics.
  • The differences in reported reasons for not using PPE by respondents who administered pentamidine versus antibiotics may be attributable to the presence of safe handling guidelines for hazardous drugs, which applied only to pentamidine.

The major barriers to using PPE for those who administered both pentamidine and antibiotics include the perception that aerosolized medications are not as dangerous as other chemicals.  There was also a belief that employers do not fully appreciate the potential adverse health effects associated with exposure to these drugs and therefore do not prioritize adherence.

Although the antibiotics evaluated are not considered hazardous drugs, respiratory care practitioners should nonetheless follow safety guidelines as a precautionary measure, as adverse health effects have been observed with exposure to these antibiotics. This precautionary approach should minimize exposure of practitioners and bystanders to fugitive aerosols while patients receive aerosol therapy.

The findings from this survey are expected to help NIOSH, partners, employers and healthcare workers better understand current health and safety practices relative to working with hazardous chemical agents, identify gaps in current knowledge about those practices, and, in collaboration with partners, design further research for addressing those gaps. To access the current article online, visit

NIOSH is the federal agency that conducts research and makes recommendations for preventing work-related injuries, illnesses and deaths. To learn more about healthcare safety and health, visit: More information can be found at