Possible Solutions

Institutions should have formal written programs to manage hazards. Such programs should include training, exposure assessment, emergency procedures for spills, policies for managing staff with reproductive concerns, and most importantly, ways to ensure that the institution is adhering to critical national standards.

Although OSHA has no explicit standard, USP 800 focuses explicitly on protecting workers from exposures to hazardous drugs. It, and USP 797, represent professionally expected requirements in healthcare that incorporate national consensus standards on infrastructure maintenance (ASTM).

Since 2008, the Oncology Nursing Society and the American Society of Clinical Oncology have developed a joint program with best practices and implementation guidance.

In addition to infrastructure management, employers should address reproductive concerns of employees. Examples that three health care organizations provided to OSHA contain essential elements of a program. Although none of the organizations had a formal written program, they all had processes in place to assure consistency across situations. Importantly, all were deeply familiar with the complexities of work and knew the ONS guidelines and USP 797 (in force at the time) in detail. All three carefully addressed employee concerns for health and safety and were able to consistently implement pay retention, a topic addressed in several formal documents.

• Work Precautions for Handling Hazardous Drugs Letter. OSHA, the Joint Commission and NIOSH, (April 4, 2011).
• Safe Handling of Hazardous Drugs for Veterinary Healthcare Workers. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2010-150, (June 2010).
• Occupational Exposure to Antineoplastic Agents and Other Hazardous Drugs. National Institute for Occupational Safety and Health (NIOSH) Workplace Safety and Health Topic.
• NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2014. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2014-138, (September 2014).
• Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 2004-165, (September 2004). Provides health care workers and employers with measures for minimizing exposure to hazardous drugs.
  • Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings. Worker/Employer Summary Sheet.
• National Occupational Research Agenda (NORA)
  • Collaborative Partnerships and Products of the NIOSH Hazardous Drug Working Group, 2011.
• Controlling Occupational Exposure to Hazardous Drugs: Medical Screening and Surveillance. OSHA, (August 1, 2016).
• Controlling Exposures to Nitrous Oxide During Anesthetic Administration. U.S. Department of Health and Human Services (DHHS), National Institute for Occupational Safety and Health (NIOSH) Publication No. 94-100, (1994). Provides occupational exposure limits, guidelines for minimizing worker exposure, engineering controls, and maintenance procedures.