This is the last article of a 4-part series on the toxic effects and safe handling of hazardous drugs by Roussel and Connor. The previous 3 articles have covered the adverse health effects of hazardous drugs, contamination of the workplace, and biomarkers of effect and exposure. The present article addresses several emerging issues that healthcare providers will need to be aware of, including hazardous drug assessment, use of antineoplastic drugs in nononcology settings, oral chemotherapy, decontamination/cleaning, state legislative activities, and US Pharmacopeial Convention (USP) Chapter 800. The clinical utility of hazardous drugs is expanding rapidly, and new challenges are arising for their safe use and handling. Occupational safety and health organizations and healthcare professionals are working hard to create safety guidance documents that keep pace with the changing environment. The growing use of hazardous drugs in nononcology practices and the increased utilization of oral hazardous drugs require the scope of safe handling practices to extend beyond traditional settings. The promulgation of new legislation related to safe handling of hazardous drugs by several states has forever changed the climate in which safe handling guidelines have been perceived. With the revamped USP Chapter 800 for hazardous drug compounding, oncology pharmacists' and nurses' unique skill sets should be shared beyond their disciplines. Historically, safe handling guidance documents have been recommendations that are only followed on a voluntary basis. Occupational Safety and Health Administration (OSHA) inspections are infrequent and generally conducted only in response to reports of violations. However, states like Washington, California, and North Carolina are leading the charge in establishing state laws for the safe handling of hazardous drugs with consequences for when they are not followed. With guidance from OSHA, the National Institute for Occupational Safety and Health (NIOSH), the American Society of Health-System Pharmacists, the Oncology Nursing Society, and USP, it is important for senior management in hospitals and private oncology practices, and for owners and managers of retail pharmacies, to perceive this information as mandatory requirements to ensure employee protection. While implementation of medical surveillance may meet with greater resistance, proper policies for the identification and labeling of hazardous drugs, as well as adequate facilities, equipment, and personal protective equipment (PPE), should be clear in standard operating procedures. The hope is that this article challenges the oncology community to reach out to other practice sites where hazardous drugs are handled and share the safety practices that have evolved over the past few decades. With new challenges to both employees and employers to ensure a safe working environment when antineoplastic and other hazardous drugs are present, it will be imperative that all parties are aware of new recommendations and regulations that will affect their work practices. Washington State and California already have legislation focused on the safe handling of hazardous drugs, and other states are following close behind with their own legislation or regulations. As NIOSH, USP, and other organizations move forward on activities aimed at protecting workers from hazardous drugs, healthcare workers everywhere will benefit from safer working conditions in their endeavors to treat seriously ill patients with an ever-expanding armament of drugs.
Regulations; Health-standards; Health-protection; Safety-practices; Work-practices; Workers; Worker-health; Administration; Management-personnel; Safety-personnel; Health-care-personnel; Medical-personnel; Nurses; Pharmacists; Pharmacy-workers; Physicians; Toxic-effects; Drugs; Antineoplastic-agents; Chemotherapy; Oncogenic-agents; Cancer; Drug-therapy; Pharmaceuticals; Medicinal-chemicals; Medical-treatment; Decontamination