Hazardous drugs include those used for cancer chemotherapy, antiviral drugs, hormones, some bioengineered drugs, and other miscellaneous drugs (see OSHA's Controlling Occupational Exposure to Hazardous Drugs). The staff who prepare or administer hazardous drugs or who work in areas where these drugs are being administered may be exposed to these agents in the air or on work surfaces, contaminated clothing, medical equipment, patient excreta, and other surfaces. For example, ribavirin is an antiviral drug used to treat some infants and young children with lower respiratory syncytial virus (RSV) infections. Staff administering ribavirin to a patient or otherwise caring for the patient can be exposed to this drug because the drug is aerosolized to a respirable size of approximately 1.3 microns and is usually administered to the patient in an oxygen tent or face mask.

Hazard

Exposure of personnel to hazardous drugs during administration, including aerosolized drugs.

OSHA Requirements

• Personal Protective Equipment (PPE) Standards, 29 CFR Part 1910 Subpart I. OSHA's PPE standard [29 CFR 1910.132] requires employers to provide, and ensure the use of, appropriate PPE (e.g., gloves, gowns, chemical splash goggles or equivalent safety glasses, splash aprons) for workers who may handle or be otherwise exposed to hazardous drugs. [Controlling Occupational Exposure to Hazardous Drugs (Section V, F)] This includes, for example:
  • Personnel administering or exposed to hazardous drugs. [Controlling Occupational Exposure to Hazardous Drugs (Section V, F)]
  • Personnel (nursing, housekeeping) handling or exposed to excreta, primarily urine, from patients who received hazardous drugs in the previous 48 hours.
  • When administering aerosolized drugs, additional precautions may be required under 29 CFR 1910.134 to protect employees from exposure, such as:
    • Wearing NIOSH-certified respirators.
    • The use of treatment booths with local exhaust ventilation systems, or isolation rooms with separate HEPA filtered ventilation systems.
• Bloodborne Pathogens Standard, 29 CFR 1910.1030.
  • The Bloodborne Pathogens Standard applies to exposure to any body fluid that is visibly contaminated with blood and all body fluids in situations where it is difficult or impossible to differentiate between body fluids. (See definition of OPIM in the Bloodborne Pathogens standard for complete description of what constitutes OPIM).
  • Universal precautions must be observed to prevent contact with blood or other potentially infectious materials. [29 CFR 1910.1030(d)(1)]

Recognized Controls and Work Practices

• Allow only trained workers to administer hazardous drugs.
• Require the use of disposable gloves and gowns. Wear the gloves and gown cuffs in a manner that produces a tight fit (e.g., loose glove tucked under gown cuff; tight glove fitted over gown cuff).
  • Discard gloves after each use and immediately if contaminated.
  • Discard gowns on leaving the patient room and immediately if contaminated.
• Do not use intravenous containers designed with venting tubes.
• Use plastic-backed absorbent liners under I.V. tubing during administration of hazardous drugs to absorb any leakage and prevent the solution from spilling onto the patient's skin (which is a source of exposure to workers).
• Work at waist level, if possible; avoid working above the head or reaching up for connections or ports.
• Avoid contact with these drugs if pregnant or breast-feeding.
• Wash hands thoroughly after hazardous drugs are handled.
• Use disposable linen or protective pads for incontinent or vomiting patients.

Additional Information

• Guidelines on Handling Hazardous Drugs. The American Society of Hospital Pharmacists (ASHP), (2004).
• General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings. The United States Pharmacopeial Convention (USP), (2017).
• Oncology Nursing Society.
• Also see the Pharmacy - Preparation & Handling of Hazardous Drugs section.