Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs Recommended in New NIOSH Report


NIOSH Update:

Contact: Fred Blosser (202) 401-3749
May 18, 2007

A new report from the National Institute for Occupational Safety and Health (NIOSH) recommends that employers institute medical surveillance programs for health-care workers who are occupationally exposed to hazardous drugs, and suggests practical strategies and components for such programs.

The document, Workplace Solutions: Medical Surveillance for Health Care Workers Exposed to Hazardous Drugs, supplements previous NIOSH resources that highlighted potential health risks for health-care employees who are exposed to hazardous drugs.

The U.S. health care industry is one of the fastest growing sectors, with over 16.6 million workers in 2005. It is estimated that 5.5 million of these health care workers are potentially exposed to hazardous drugs or drug waste, including pharmacists, nurses, physicians, maintenance workers, operating room personnel, and others who may come into contact with these drugs while performing their job.

Hazardous drugs are those that have been determined through research studies to have a potential for causing harm to healthy individuals, including potential risks of cancer, skin rashes, birth defects, and reproductive toxicity. These same drugs also play a critical role in treatment of patients with serious illnesses like cancer and HIV infection. Although the potential therapeutic benefits of hazardous drugs outweigh the risks of side effects for ill patients, exposed health care workers risk these same side effects with no therapeutic benefit.

Health care workers can be exposed through inhalation, skin contact, skin absorption, ingestion or injection. Because of the multiple routes of potential exposure, NIOSH recommends a comprehensive approach to minimizing worker exposure. This comprehensive safety and health program should include engineering controls, good work practices, and proper personal protective equipment. In addition to these aspects of the program, NIOSH is also recommending that a medical surveillance program be used to support these efforts, collecting and interpreting data to better find out if there are changes in the health of workers.

“Medical surveillance programs are important in the workplace for establishing a baseline for individuals’ health and monitoring their health over time,” said NIOSH Director John Howard, M.D. “The recommendations in this document, which were developed in partnership with health care professionals, offer practical and effective measures for instituting and maintaining safe, efficient procedures for handling hazardous drugs.”

In the report, NIOSH outlines the basic elements a medical surveillance program should include to help employers establish this plan and ensure that those workers who are exposed to hazardous drugs are routinely monitored. The recommendations include these:

  • Health questionnaires, laboratory tests, and a physical examination completed at the time the worker is hired, and updated periodically.
  • Follow-up with those workers who have shown changes in their health or have had a significant exposure.

Establishing a medical surveillance program helps to detect changes in workers health, allowing employers to evaluate the current practices to see if changes are needed to help protect other workers from exposure.

To view the complete report and all the recommendations made by NIOSH go to

For more information about other areas of NIOSH research and recommendations to prevent work-related injuries, illnesses, and deaths, call toll-free 1-800-CDC-INFO (1-800-232-4636) or visit the NIOSH web page at

Page last reviewed: August 6, 2012