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Health hazard evaluation report: evaluation of chemotherapy drug exposure in an outpatient infusion center.

West C; Beaucham C
Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2013-0019-3205, 2014 Mar; :1-23
The Health Hazard Evaluation Program received a request from a regional hospital. The employer was concerned about health symptoms (burning and itchy eyes, itchy skin, hair loss, and metallic taste in the mouth) among outpatient cancer and infusion center employees working with or around chemotherapy drugs. The center employed 10 clinical and administrative staff who typically treated about 4 patients per day. During our visit we talked to employees about their work and health concerns; observed how they received, stored, administered, and disposed chemotherapy drugs; took samples from work surfaces to look for chemotherapy drugs; and evaluated the airflow direction in the center and in an isolator cabinet. Additionally, we reviewed workplace injury and illness logs and employee health records, environmental sampling and inspection reports, training documents, and standard operating procedures for handling hazardous drugs. We found low but detectable levels of chemotherapy drugs in surface wipe samples collected throughout the center, including one drug not in use during our visit. During interviews and as recorded by medical surveillance, staff reported mucous membrane irritation, nausea, metallic taste, and intermittent tiredness. Although we cannot definitively link the symptoms to chemotherapy drug exposures, many were consistent with what is reported in the literature and in other settings where chemotherapy drugs are handled. In our interviews, employees reported inconsistent personal protective equipment use. We noted that procedures for handling hazardous drugs did not apply to all personnel who are exposed to chemotherapy drugs and procedures for proper storage, routine housekeeping, medical surveillance, and the hazardous drug list were incomplete. Air from the pharmacy was not being drawn into the pass-through chamber on the isolator cabinet, as employees believed. We recommended the employer (1) require employees to wear chemotherapy gowns and gloves whenever handling chemotherapy drugs, (2) ensure employees who receive chemotherapy drug shipments are aware of the potential for contamination of outer surfaces of drug containers and protect themselves, (3) update procedures for handling hazardous drugs safely, (4) ensure the isolator cabinet is working as designed, (5) start a medical surveillance program for employees who handle chemotherapy drugs, (6) train all employees about the short- and long-term health effects of chemotherapy drug exposures, and (7) encourage employees to participate in the safety committee and report work-related illnesses to hospital occupational health and safety representatives.
Region-4; Health-hazards; Health-care; Medical-care; Medicinal-chemicals; Medical-treatment; Cancer; Chemotherapy; Oncogenic-agents; Drugs; Drug-therapy; Health-care-personnel; Medical-personnel; Employee-exposure; Employee-health; Outpatient-facilities; Health-surveys; Hazardous-materials; Surveillance-programs; Antineoplastic-agents; Work-practices; Biological-effects; Personal-protective-equipment; Protective-clothing; Gloves; Training; Safety-measures; Sensory-disorders; Author Keywords: General Medical and Surgical Hospitals; sensory system; chemotherapy drugs; oncology clinic
7440-06-4; 15663-27-1; 50-18-0; 51-21-8; 41575-94-4; 97682-44-5; 63121-00-6; 103882-84-4
Publication Date
Document Type
Field Studies; Hazard Evaluation and Technical Assistance
Fiscal Year
NTIS Accession No.
NTIS Price
Identifying No.
HETA-2013-0019-3205; M042014
NIOSH Division
Priority Area
SIC Code
Source Name
National Institute for Occupational Safety and Health
Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division