Warning! Handling Hazardous Drugs

Health care workers who prepare or administer hazardous drugs or who work in areas where these drugs are used may be exposed to these agents in the air or on work surfaces, contaminated clothing, medical equipment, patient excreta, or other sources. Studies have associated workplace exposures to hazardous drugs with health effects such as skin rashes and adverse reproductive events (including infertility, spontaneous abortions, or congenital malformations) and possibly leukemia and other cancers.

The health risk is influenced by the extent of the exposure and the potency and toxicity of the hazardous drug. Potential health effects can be minimized through sound procedures for handling hazardous drugs, engineering controls, and proper use of protective equipment to protect workers to the greatest degree possible.

 

Employers of health care workers should:

  • Ensure that written policies address medical surveillance of health care workers and all phases of hazardous drug handling including receipt and storage, preparation, administration, housekeeping, deactivation, and cleanup and disposal of unused drugs and contaminated spills and patient wastes.
  • Formally seek input from employees who handle drugs in developing a program for preventing exposure.
  • Prepare a written inventory identifying all hazardous drugs used in the workplace, and establish a procedure for regular review and update of the inventory.
  • Make guidance documents, Material Safety Data Sheets (MSDSs) and other information available to those who handle hazardous drugs or work in an area where hazardous drugs are handled.
  • Provide training to employees on the recognition, evaluation, and control of hazardous drugs.
  • Ensure that horizontal laminar flow workstations that move the air from the drug toward the worker are never used for the preparation of hazardous drugs.
  • For hazardous drug preparation, provide and maintain ventilated cabinets designed for worker protection. Examples of these include biological safety cabinets (BSCs) and containment isolators that are designed to prevent hazardous drugs inside the cabinet from escaping into the surrounding environment. The exhaust from these cabinets should be HEPA-filtered and whenever feasible exhausted to the outdoors (away from air intake locations). Additional equipment, such as closed-system drug-transfer devices, glove bags, and needleless systems will further protect workers from exposures when used properly.
  • Establish and oversee the implementation of appropriate work practices when hazardous drugs, patient wastes and contaminated materials are handled.
  • Ensure training in and the availability and use of proper personal protective equipment (PPE) to reduce exposure via inhalation, ingestion, skin absorption, and injection of hazardous drugs as required based on the results of a risk assessment and the OSHA PPE Standard. PPE includes chemotherapy gloves, low-lint, low-permeability disposable gowns and sleeve covers, and eye and face protection. NIOSH-certified respiratory protection is needed when equipment such as biological safety cabinets are not adequate to protect against inhalation exposure. Surgical masks do not provide adequate respiratory
    protection.
  • Provide syringes and intravenous (IV) sets with Luer-Lok fittings for preparing and administering hazardous drugs, as well as containers for their disposal. Closed-system, drug-transfer devices and needleless systems should be considered to protect nursing personnel during drug administration.
  • Complete a periodic evaluation of workplace hazardous drugs, equipment, training effectiveness, policies, and procedures to reduce exposures to the greatest degree possible.
  • Comply with all relevant U.S. Environmental Protection Agency Resource Conservation and Recovery Act regulations related to the handling, storage, and transportation of hazardous waste.

Health care workers should:

  • Participate in standardized training on the hazards of the drugs handled and equipment and procedures used to prevent exposure.
  • Review guidance documents, MSDSs, and other information resources for hazardous drugs handled.
  • Be familiar with and be able to recognize sources of exposure to hazardous drugs.
  • Prepare these agents in a dedicated area where access is restricted to authorized personnel only.
  • Prepare these agents within a ventilated cabinet designed to protect workers and adjacent personnel from exposure and to provide product protection for all drugs that require aseptic handling.
  • Use two pairs of powder-free, disposable chemotherapy gloves with the outer one covering the gown cuff whenever there is risk of exposure to hazardous drugs.
  • Avoid skin contact by using a disposable gown made of a low-lint and low permeability fabric. The gown should have a closed front, long sleeves, and elastic or knit closed cuffs and should not be reused.
  • Wear a face shield to avoid splash incidents involving eyes, nose, or mouth when adequate engineering controls are not available.
  • Wash hands with soap and water immediately before using and after removing personal protective clothing, such as disposable gloves and gowns.
  • Use syringes and IV sets with Luer-Lok fittings for preparing and administering these agents and place drug-contaminated syringes and needles in chemotherapy sharps containers for disposal.
  • When additional protection is necessary, use closed-system, drug-transfer devices, glove bags and needleless systems within the ventilated cabinet.
  • Handle hazardous wastes and contaminated materials separately from other trash.
  • Decontaminate work areas before and after each activity with hazardous drugs and at the end of each shift.
  • Clean up spills immediately while using appropriate safety precautions and PPE unless the spill is large enough to require an environmental services specialist.

Source: National Institute for Occupational Safety and Health, Cincinnati.