Protect HCWs from hazardous drugs

NIOSH, OSHA, TJC align on message

Make sure your health care workers are handling hazardous drugs safely. That is the key message to hospitals in a joint letter from three leading safety agencies: the U.S. Occupational Safety and Health Administration, the Joint Commission accrediting body, and the National Institute for Occupational Safety and Health.

The letter, which was to be mailed to all U.S. hospitals, does not add any new information or regulatory action. Instead, it underscores the importance of the 2004 NIOSH alert ( and the 2010 updated list of antineoplastics and other hazardous drugs (

Recent research demonstrates the continuing hazard to health care workers, even when they use protective equipment and safe work practices, such as biological safety cabinets. A study by NIOSH research biologist Thomas Connor, PhD, found that 60% of wipe samples in work areas tested positive for contamination with antineoplastic drugs, including carts, trays, countertops, IV bags, and even floors in patient rooms.1

In a companion study, Melissa A. McDiarmid, MD, MPH, DABT, director of the Occupational Health Program at the University of Maryland School of Medicine in Baltimore, found that nurses and pharmacists were 20% more likely to have a chromosomal abnormality than a control group if they had 100 or more chemotherapeutic drug-handling events. The likelihood of chromosomal abnormalities rose with greater exposure.2

Meanwhile, Washington became the first state in the nation to enforce protections for health care workers working with hazardous drugs. In April, Gov. Chris Gregoire signed a law that requires health care facilities to comply with the NIOSH alert and 2010 update and to protect health care workers from exposure.

The Washington legislature passed the law unanimously after a series of stories in the Seattle Times told of health care workers who had handled chemotherapy drugs and later developed cancer. The Department of Labor & Industries will draft regulations that are "consistent with and [do] not exceed provisions" of the NIOSH recommendations. The regulations also can be updated to incorporate any future changes by NIOSH.


1. Connor TH, DeBord DG, Pretty JR et al. Evaluation of antineoplastic drug exposure of health care workers at three university-based US cancer centers. J Occup Environ Med 2010; 52:1019-1028.

2. McDiarmid MA, Oliver MS, Roth TS et al. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. J Occup Environ Med 2010; 52:1028-1034.