NIOSH Publications

This page includes NIOSH numbered publications on occupational exposure to antineoplastic and other hazardous drugs.


Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care 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.

Hazardous Drug List

Managing Hazardous Drug Exposures: Information for Healthcare Settings
DHHS (NIOSH) Publication No. 2023-130 (April 2023)
This document contains risk management information and a Table of Control Approaches describing some of the possible scenarios that workers may encounter in healthcare settings when handling hazardous drugs. The potential exposure of workers from handling a hazardous drug depends on several factors unique to each work setting. Such factors include: (1) the dosage form of the drug, (2) the routes of exposure, (3) the frequency, duration, and magnitude of exposure, (4) work practices, and (5) the presence or absence of any exposure controls such as engineering controls, administrative controls, or personal protective equipment. The National Institute for Occupational Safety and Health (NIOSH) encourages healthcare settings to conduct a facility-specific assessment to determine the most effective exposure control strategies for controlling the risks identified in the assessment.

Procedures for Developing the NIOSH List of Hazardous Drugs in Healthcare Settings
DHHS (NIOSH) Publication No, 2023-129 (April 2023)
This document lays out the methodology the National Institute for Occupational Safety and Health (NIOSH) uses to determine if a drug meets the criteria for placement on the NIOSH List of Hazardous Drugs in Healthcare Settings. It also sets forth the process parties can use to request that a drug be added to the list or reconsidered for removal or a different placement on the list.

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016
DHHS (NIOSH) Publication No. 2016-161 (September 2016)
This document supercedes DHHS (NIOSH) Publication No. 2016-161 (September 2016)
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. The current update (2016) adds 34 drugs and includes a review of the 2004 list.

Health Hazard Evaluations

Exposures to healthcare personnel from cisplatin during a mock interperitoneal operation, University Medical Center, Las Vegas, Nevada
HETA-2009-0121-3106 (2010)
NIOSH investigators evaluated potential cisplatin exposures before, during, and after a mock interperitoneal procedure. We detected no cisplatin in any air or hand-wipe samples. We did detect cisplatin in one surface wipe sample collected on the operating room floor after the mock procedure before the room was sanitized. No cisplatin was found at this same location after the room was sanitized. We recommend that surgical staff continue to use chemotherapy-approved gloves and handle the cisplatin solution carefully

Chemotherapy drug evaluation at a medical laboratory, Pennsylvania
HETA-2010-0118-3142 (2011)
NIOSH evaluated potential exposures to chemotherapy drugs among employees of a medical laboratory and did not detect cyclophosphamide, a chemotherapy drug commonly used at the laboratory, on any work surfaces. Employees were observed using safe work practices and wearing appropriate protective equipment. We also found no adverse medical symptoms among employees that can be linked to occupational exposures at the laboratory

Multiple sclerosis cluster evaluation in an inpatient oncology ward, Wisconsin
HETA-2011-0047-3143 (2011)
NIOSH investigators evaluated workplace exposures to acrolein, CO, and chemotherapy drugs in an inpatient oncology unit. We also investigated a potential cluster of MS. We found no association between the MS cases and the work environment. The CO levels were well below OELs, but some employees could smell helicopter exhaust, which they associated with headache, dizziness, and nausea. We found small amounts of cyclophosphamide and ifosfamide on some surfaces, including the family areas of the hospital wing, which could indicate breaches in the handling of chemotherapeutic agents in this unit.

Exposures to pharmaceutical dust at a mail order pharmacy, Illinois
HETA-2010-0026-3150 (2011)
NIOSH evaluated health symptoms, pharmaceutical dust, and noise exposures among employees at a mail order pharmacy. We found that dust was released, particularly during the cleaning, repairing, and refilling of cells and canisters. This dust contained APIs and lactose, a common ingredient in pharmaceuticals. Exposures to pharmaceutical dust could have contributed to eye and upper respiratory irritation reported by employees. High noise exposures were caused by release of compressed air, which could be reduced by installing noise controls.

Chemotherapy drug evaluation at a veterinary teaching hospital, Michigan
HETA-2010-0068-3156 (2012)
NIOSH investigators evaluated chemotherapy drug exposures and their possible relationship to reproductive problems and hair loss among employees at a veterinary teaching hospital. Cyclophosphamide and ifosfamide were detected on some surface wipe samples, but not in the air. We could not determine if the health effects reported by employees were work related; however, similar effects have been reported with occupational exposure to chemotherapy drugs in other studies.

Chemotherapy drug exposures at an oncology clinic, Florida
HETA-2009-0148-3158 (2012)
NIOSH investigators evaluated potential occupational exposures to chemotherapy drugs at an oncology clinic. We sampled for platinumcontaining chemotherapy drugs, cyclophosphamide, ifosfamide, and doxorubicin on surfaces. We found platinum-containing chemotherapy drugs and cyclophosphamide and ifosfamide. We recommend that the clinic review cleaning practices and PPE use to reduce employee exposures to chemotherapy drugs.

Evaluation of safety climate, health concerns, and pharmaceutical dust exposures at a mail order pharmacy
HETA-2012-0044-3199 (2013)
NIOSH investigators evaluated possible health effects from exposures to hazardous drugs and pharmaceutical dust at a mail order pharmacy. Employees were exposed to pharmaceutical dust. We recommended filling hazardous drug prescriptions and doing other dust-generating tasks under a local exhaust hood.

Evaluation of pharmaceutical dust exposures at an outpatient pharmacy
HETA-2010-0078-3177 (2013)
NIOSH investigators evaluated an outpatient pharmacy for potential exposure to pharmaceutical dust. Work activities in the outpatient pharmacy generated dusts that exposed employees to pharmaceutical ingredients. One employee had personal air concentrations of lisinopril near or above the manufacturer’s exposure limit. We recommended doing dust-generating tasks under a local exhaust hood and using a vacuum with high-efficiency particulate air filtration to clean canisters.

Evaluation of chemotherapy drug exposure in an outpatient infusion center
HETA-2013-0019-3205 (2014)
NIOSH investigators evaluated employee exposure to chemotherapy drugs at an outpatient infusion center. We found low levels of surface contamination of platinum throughout the workplace. Handling platinumcontaining compounds is the likely source of this contamination. Although we cannot definitively link all of the reported symptoms to chemotherapy drug exposures, many were consistent with those reported in the literature. Employees inconsistently used personal protective equipment. We recommended employees use chemotherapy gowns and gloves when handling chemotherapy drugs, and the company implement a medical surveillance program for employees potentially exposed to chemotherapy drugs

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.

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.

Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers
DHHS (NIOSH) Publication No. 2010-150 (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.

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