NIOSHTIC-2 Publications Search

Adherence to safe handling guidelines by healthcare workers who administer antineoplastic drugs.

Boiano JM; Steege AL; Sweeny MH
J Occup Environ Hyg 2014 Nov; 11(11):728-740
The toxicity of antineoplastic drugs is well-documented. Many are known or suspected human carcinogens where no safe exposure level exists. Authoritative guidelines developed by professional practice organizations and federal agencies for the safe handling of these hazardous drugs have been available for nearly three decades. As a means of evaluating the extent of use of primary prevention practices such as engineering, administrative and work practice controls, personal protective equipment (PPE) and barriers to using PPE, NIOSH conducted a web survey of healthcare workers in 2011. The study population primarily included members of professional practice organizations representing healthcare occupations which routinely use or come in contact with selected chemical agents. All respondents who indicated that they administered antineoplastic drugs in the past week were eligible to complete a hazard module addressing self-reported health and safety practices on this topic. Most (98%) of the 2,069 respondents of this module were nurses. Working primarily in hospitals, outpatient care centers and physician offices, respondents reported that they collectively administered over 90 specific antineoplastic drugs in the past week, with carboplatin, cyclophosphamide and paclitaxel the most common. Examples of activities which increase exposure risk, expressed as percent of respondents, included: failure to wear nonabsorbent gown with closed front and tight cuffs (42%); intravenous (I.V.) tubing primed with antineoplastic agent by respondent (6%) or by pharmacy (12%); potentially contaminated clothing taken home (12%); spill or leak of antineoplastic agent during administration (12%); failure to wear chemotherapy gloves (12%); and lack of hazard awareness training (4%). The most common reason for not wearing gloves or gowns was "skin exposure was minimal"; 4% of respondents, however, reported skin contact during handling and administration. Despite the longstanding availability of safe handling guidance, recommended practices are not always followed, underscoring the importance of training and education for employers and workers.
Drugs; Antineoplastic-agents; Toxins; Toxic-effects; Carcinogens; Exposure-levels; Hazards; Chemical-properties; Health-care-personnel; Medical-personnel; Humans; Men; Women; Nurses; Safety-measures; Education; Training; Chemotherapy; Risk-factors; Surveillance-programs; Author Keywords: antineoplastic drug administration; safe handling practices; healthcare workers; hazardous drugs; chemotherapy; web based survey
James M. Boiano, National Institute for Occupational Safety and Health, Division of Surveillance Hazard Evaluations and Field Studies, 1090 Tusculum Ave., MS R-17, Cincinnati, OH 45226-1998
Publication Date
Document Type
Journal Article
Email Address
Fiscal Year
Identifying No.
Issue of Publication
NIOSH Division
Priority Area
Healthcare and Social Assistance
Source Name
Journal of Occupational and Environmental Hygiene
Page last reviewed: June 3, 2022
Content source: National Institute for Occupational Safety and Health Education and Information Division