Pharmacists, pharmacy technicians:

• Handling drug-contaminated vials

• Reconstituting powdered or lyophilized drugs and further diluting either the reconstituted powder or concentrated liquid forms of hazardous drugs

• Expelling air from syringes filled with hazardous drugs

• Compounding HD powders into custom-dosage forms

• Transferring drug solution to IV bag or bottle

Pharmacists, pharmacy technicians, nursing personnel:

• Counting out individual, uncoated oral doses from multidose bottles

• Unit-dosing uncoated tablets in a unit-dose machine

• Crushing tablets or opening capsules to make oral liquid dose

• Opening ampoules

• Preparing topical drugs

Nursing personnel:

• Administering antineoplastic drugs by injection (intramuscular, subcutaneous or intravenous (IV)), by inhalation or by nasogastric tube

• Spiking the IV set into an HD-containing IV bag (without a closed system)

• Priming the IV set with a drug-containing solution at the administration location

• Connecting and disconnecting the IV set to an IV pump or patient

Nursing personnel, support staff, housekeeping personnel, laundry personnel:

• Handling body fluids or body-fluid-contaminated clothing, dressings, linens, bedpans, urinals and other materials

• Handling contaminated wastes generated at any step of the preparation or administration process

Pharmacists, pharmacy technicians, nursing personnel, housekeeping personnel, environmental services personnel:

• Contacting hazardous drugs present on drug vial exteriors, work surfaces, floors, and final drug products (bottles, bags, cassettes, and syringes)

• Handling unused antineoplastic drugs or antineoplastic drug-contaminated waste

• Decontaminating and cleaning drug preparation or clinical areas

• Cleaning hazardous drug spills

Physicians, nursing personnel, operating room personnel:

• Performing certain specialized hazardous drug administration procedures such as intraperitoneal

chemotherapy (in the operating room or other locations), bladder instillation, isolated limb perfusion

Support staff:

• Transporting hazardous [drugs] in the facility

Nursing personnel, housekeeping personnel, waste disposal personnel:

• Transporting hazardous waste containers

Pharmacists, pharmacy technicians, nursing personnel, housekeeping personnel:

• Removing and disposing of personal protective equipment after handling hazardous drugs or waste.

Source: National Institute for Occupational Safety and Health, Current Intelligence Bulletin (draft), Reproductive Risks Associated with Hazardous Drug Exposures in Healthcare Workers and Recommendations for Reducing Exposures, 2015.