Safety precautions for health care workers who work with hazardous drugs
Health care workers may be exposed to health risks during handling, preparation or administration of hazardous drugs. The Occupational Safety & Health Administration (OSHA) and National Institute for Occupational Safety & Health (NIOSH) have published guidelines, alerts and recommendations for health care workers who handle hazardous drugs.
Understanding hazardous drugs is crucial to understanding guidelines
Although concern for exposure to hazardous drugs was expressed in the 1970s, the first recognized definition of hazardous drugs appeared in an alert based on a 1990 definition by the American Society of Hospital Pharmacists (ASHP), now known as American Society of Health System Pharmacists. Organizations such as NOISH continue gathering data regarding toxicity of known hazardous drugs as well as new drugs as they come on the market. Investigational drugs should be considered HDs and handled as such unless there is information available to exclude them. OSHA shares the concern of ASHP in defining characteristics of hazardous drugs, based on “genotoxicity, carcinogenicity, teratogenicity or other fertility impairment and serious organ or other toxic manifestations at even low doses. Lists of hazardous drugs may be found at OSHA’s “Some Common Drugs That Are Considered Hazardous,” or the “NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010.”
Patient safety has been primary concern
In preparation, handling and administration of hazardous drugs, patient safety has been of primary concern, not the health care worker. In “Safe Handling of Hazardous Drugs,” published in the Online Journal of Issues in Nursing, author Martha Polovich, MN, RN, AOCN, points to several studies related to IVs, demonstrating the potential for health care workers potentially suffering HD exposure without realizing it. Although better equipment is available to minimize the potential for exposure, more effective systems are often not used, with cost being a primary issue. Some health care workers have given more than time to try to prove the risks and the need for stricter and universal safety guidelines. Bruce Harrison, an oncology pharmacist, was one of the authors of the 2004 NIOSH guidelines for safe handling of chemo and other hazardous drugs by health care workers. He never smoked and had no other risk factors. He did, however, mix chemo for many patients. He died at age 59, unable to prove the correlation between his handling hazardous drugs and his own cancer. Sue Crump died of cancer after mixing chemo and handling other hazardous drugs for more than two decades at her job.
Hazardous drug safety and health plan crucial to protect health care workers
Failure to take proper precautions when exposed to hazardous drugs can have devastating consequences. An OSHA Communication Standard mandates that employers develop a hazard communication program for their workplace, including identification of all hazardous drugs workers may be exposed to. There are specific considerations as well as precautions that must be undertaken to protect health care workers. Inhalation of dusts or aerosols, dermal absorption and ingestion are the primary routes of exposure according to OSHA’s “Controlling Occupational Exposure to Hazardous Drugs.” In drug prep areas, there should be no eating, smoking, drinking or storing food. The use of a proper biological safety cabinet is necessary to minimize exposure during preparation. Strict decontamination guidelines must be followed to clean the BSC. BSCs must also be certified and serviced by qualified technicians. Health care worker protection must include other safe work practices such as participating in all training regarding hazardous drugs, being familiar with and recognizing potential sources of exposure. Some of the health care worker responsibilities for minimizing exposure to hazardous drugs also include:
- Using two pairs of powder-free disposable chemotherapy gloves.
- Making sure the outer pair covers the cuff of the gown.
- Wearing a disposable gown made of polyethylene-coated polypropylene material.
- Proper hand washing and proper cleanup and disposal of all contaminated materials.
Employers, according to NIOSH, must take safety precautions to protect employees, such as training and providing them with all necessary information regarding exposure to hazardous drugs, providing proper equipment to minimize exposure and properly supervising all aspects of protecting health care workers from hazardous drugs. Both health care employers and employees must be properly educated regarding health care worker exposure to hazardous drugs and minimizing risks of exposure to the harmful effects.
