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Hazardous Drug Exposures in Health Care

	Multi-channel infusion pump for delivery of chemotherapy

Multi-channel infusion pump for delivery of chemotherapy

Health care workers who prepare or administer hazardous drugs (e.g., those used for cancer therapy, and some antiviral drugs, hormone agents, and bioengineered drugs) or who work in areas where these drugs are used may be exposed to these agents in the workplace. About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs, including pharmacy and nursing personnel, physicians, operating room personnel, environmental services workers, workers in research laboratories, veterinary care workers, and shipping and receiving personnel.

It seems counter-intuitive that the health care industry, whose mission is the care of the sick, is itself a "high-hazard" industry for the workers it employs. In fact, published studies have shown that workplace exposures to hazardous drugs can cause both acute and chronic health effects such as skin rashes, adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations), and possibly leukemia and other cancers. The health risk depends on how much exposure a worker has to these drugs and how toxic they are. Workers can be protected from exposures to hazardous drugs through engineering and administrative controls, and proper protective equipment.

NIOSH will hold a public meeting to discuss a universal closed system drug-transfer device (CSTD) testing (draft) protocol entitled, A Performance Test Protocol for Closed System Transfer Devices Used During Pharmacy Compounding and Administration of Hazardous Drugs . The meeting will allow commenters the opportunity to address the new draft protocol, the proposed list of hazardous drug test surrogates, and to discuss NIOSH questions regarding the new protocol. The public meeting will be held at the Alice Hamilton Laboratories, Conference Room C, 5555 Ridge Avenue, Cincinnati, OH 45213. Virtual attendance using LiveMeeting and audio conference will be available. FOR FURTHER INFORMATION CONTACT: Deborah V. Hirst, NIOSH, Division of Applied Research and Technology, Alice Hamilton Laboratories, 1090 Tusculum Ave, MS R-5, Cincinnati, OH 45226. (513) 841-4141 (not a toll free number) or email DHirst@cdc.gov.

NIOSH-Funded study to examine hazardous drug handling by nurses

DEFENS - Drug Exposure Feedback and Education for Nurses’ Safety: study protocol for a randomized controlled trial

Friese CR et. al. Trials (2015) 16:171

University of Michigan School of Nursing, 400 North Ingalls, #4162, Ann

Arbor, MI, USA. Christopher Friese

Feedback and Education for Nurses’ Safety (DEFENS) study will compare the efficacy of education (control) versus an audit and feedback intervention (treatment) on nurses’ self-reported use of personal protective equipment when handling hazardous drugs. The treatment intervention will include tailored messages based on nurses’ reported barriers to protective equipment use. The study is recruiting nurses from 11 major cancer centers across the U.S.

Research support

This paper was supported by Grant Number, 1 R01 OH 010582–01, funded by the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

If you have any questions regarding hazardous drugs please submit them to hazardousdrugs@cdc.gov.

Publication

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016
DHHS (NIOSH) Publication Number 2016-161 (Supersedes 2014-138) (September 2014)
The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) has made updates to its list of hazardous drugs (2016). This list includes drugs reviewed by NIOSH from January 2012 to December 2013. The current proposed additions to the list of hazardous drugs supersede the 2004 list in the NIOSH Alert: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings and the 2014 list of hazardous drugs. The format for the 2014 list was revised to include three groups of hazardous drugs: (1) Antineoplastic drugs; (2) Non-antineoplastic hazardous drugs; and (3) Drugs with reproductive effects.

 

NIOSH Alert: Preventing Occupational Exposures to Antineoplastic and other Hazardous Drugs in Healthcare Settings
DHHS (NIOSH) Publication No. 2004-165 (2004)
In this Alert, NIOSH presents a standard precautions or universal precautions approach to handling hazardous drugs safely: that is, NIOSH recommends that all hazardous drugs be handled as outlined in this Alert. Therefore, no attempt has been made to perform drug risk assessments or propose exposure limits. The area of new drug development is rapidly evolving as unique approaches are being taken to treat cancer and other serious diseases.

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016
DHHS (NIOSH) Publication No. 2016-161 (September 2016)

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014
DHHS (NIOSH) Publication No. 2014-138 (September 2014)

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2012
DHHS (NIOSH) Publication No. 2012-150 (June 2012)

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010
DHHS (NIOSH) Publication No. 2010-167 (September 2010)

Workplace Solutions: Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers
DHHS (NIOSH) Publication No. 2010-150 (June 2010)
Veterinary healthcare employees working where hazardous drugs are handled may face health risks. Many of these workers treat small companion animals (primarily cats and dogs), but also larger animals such as horses, with antineoplastic and other drugs that may be hazardous to humans.

Personal Protective Equipment for Health Care Workers Who Work with Hazardous Drugs
DHHS (NIOSH) Publication No. 2009-106 (2008)
Health care workers who handle hazardous drugs are at risk of skin rashes, cancer, and reproductive disorders. NIOSH recommends that employers provide appropriate personal protective equipment (PPE) to protect workers who handle hazardous drugs in the workplace.

Workplace Solutions: Medical Surveillance for Healthcare Workers Exposed to Hazardous Drugs
DHHS (NIOSH) Publication No. 2013-103 (2013) - supersedes 2007-117
Health care workers who handle, prepare, or administer hazardous drugs may face risks to their own health such as skin rashes, cancer, and reproductive disorders.

Workplace Solutions: Preventing Worker Deaths and Injuries When Handling Micotil 300®
DHHS (NIOSH) Publication No. 2007-124 (2007)
Livestock producers, veterinarians, and other workers may be exposed to the toxic hazards of the animal antibiotic Micotil 300® through needlestick injuries, skin cuts, puncture wounds, and contact with skin and mucous membranes.

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