NIOSH updates list of hazardous drugs

Comments accepted through Sept. 20

As many as 62 new drugs may be added to the list of potential workplace hazards by the National Institute for Occupational Safety and Health.

NIOSH first identified hazardous drugs in its 2004 in its alert titled Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Since then, the Food and Drug Administration has approved about 70 news drugs and another 60 drugs have received warnings based on reports of adverse events among patients. The National Institutes of Health also has updated a hazardous drugs list.

NIOSH evaluated those drugs and compiled a list of 62 that potentially could present an occupational hazard to health care workers. NIOSH is accepting comments on the list, and some of the drugs may be removed if they are determined to present a minimal hazard.

The drugs are rated according to their toxicity and other characteristics. For example, cyclophosmide, an antineoplastic drug, is often administered in a liquid form through an IV bag. The coated tablet may not be hazardous to health care workers, however, says Thomas Connor, PhD, a research biologist with NIOSH in Cincinnati who specializes in occupational hazards of hazardous drugs.

"Whether it's an occupational risk depends on how it's used and the dosage," he says.

NIOSH is soliciting comments on its list of hazardous drugs. It uses five criteria to define a drug as hazardous in the workplace: Carcinogenicity, teratogenicity or other developmental toxicity, reproductive toxicity, organ toxicity at low doses, genotoxicity, and structure and toxicity profiles of new drugs that mimic existing drugs determined hazardous by the above criteria.

"We want to make the process as visible as possible. That's why we're going through an extended review process," says Connor.

The revision of the list of hazardous drugs is just one step NIOSH has taken to increase safety in the workplace in this area. NIOSH has issued guidance on protecting health care workers and conducting medical surveillance.

"We are raising awareness of this problem," says Connor, noting that NIOSH has been getting more inquiries about how to best protect health care workers from exposure to hazardous chemicals.

(Editor's note: The proposed list of hazardous chemicals is available at www.cdc.gov/niosh/review/public/105/default.html. NIOSH is accepting comments through Sept. 20 through an online form, PublicReviewForm2006-05-01-07.xls, e-mail nioshdocket@cdc.gov, fax (513) 533-8285, or written comments to NIOSH Mailstop: C-34, Robert A. Taft Lab, 4676 Columbia Parkway, Cincinnati, OH 45226.)