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Clarification about hazardous drugs.

Connor-TH; MacKenzie-BA; DeBord-DG
Am J Health Syst Pharm 2012 Nov; 69(22):1949-1950
We read with interest the article by Traynor that appeared in the September 1 issue of AJHP and would like to clarify a potential misconception - that the National Institute for Occupational Safety and Health (NIOSH) recommends all hazardous drugs be handled in the same manner, regardless of dosage form. The 2004 NIOSH alert on this topic recommends a "universal" or "standard" precautions approach to safe handling but does not recommend that all formulations be handled in the same manner. The NIOSH alert reflects an understanding that many factors affect the determination of handling procedures for hazardous drugs. The purpose of the list of hazardous drugs provided in the alert, updated in 2010 and 2012, is to identify hazardous drugs and assist health care facilities in developing their own risk management procedures based on the drugs and formulations used in their facility. The most recent update to the hazardous-drugs list states the following: Some drugs defined as hazardous may not pose a significant risk of direct occupational exposure because of their dosage formulation (for example, coated tablets or capsules - solid, intact medications that are administered to patients without modifying the formulation). Uncoated tablets may present a risk of exposure from dust by skin contact and/or inhalation when the tablets are counted and if solid drug formulations are altered, such as by crushing tablets or making solutions from them. It is the goal of NIOSH to provide occupational health guidance to pharmacy and other health care personnel who work with drugs that are potentially hazardous to their health. NIOSH does not recommend a multitier approach at this time, as such approaches can place the burden on the health care worker to determine the proper precautions required for specific drugs. NIOSH encourages institutions to adapt the recommendations in the alert and the hazardous-drugs list to their unique situations.
Health-care; Health-care-facilities; Health-care-personnel; Health-protection; Hazardous-materials; Drugs; Manual-materials-handling; Safety-measures; Work-organization; Work-practices; Medicinal-chemicals; Pharmaceuticals; Personal-protection; Risk-analysis
Thomas H. Connor, Ph.D., Division of Applied Research and Technology National Institute for Occupational Safety and Health, 4676 Columbia Parkway MS R-2, Cincinnati, OH 45226
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Healthcare and Social Assistance
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American Journal of Health-System Pharmacy