DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Safe Handling of Hazardous Drugs 

for Veterinary Healthcare Workers

Summary

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. NIOSH 

recommends establishing a program to provide appropriate protective measures for veterinary 

healthcare workers exposed to 

hazardous drugs.

Description of 

Exposure

Hazardous drugs are defined as having specific health effects (such as 

skin rashes, cancer, and reproductive effects) and high toxicity at low 

doses [NIOSH 2004]. Most hazardous drugs in veterinary medicine are 

used to treat animal illnesses such as 

cancer [Mair and Couto 2006]. The 

risk of exposure for veterinary health 

care workers is similar to that for human healthcare settings.

In the United States, an estimated 

500,000 veterinary healthcare workers are potentially exposed to hazardous drugs or drug waste at their worksites [BLS 2007]. Many are women 

of reproductive age. These workers include veterinarians, technicians, 

kennel workers, cleaning and maintenance workers, and office staff.

Veterinary workers may be exposed 

to hazardous drugs when they handle drug vials; compound, administer, or dispose of hazardous drugs; 

clean up spills; touch surfaces that 

are contaminated with these drugs; 

or clean bedding, cages, kennels, or 

waste of treated animals [Meijster 

et al. 2006]. Skin absorption, inhalation, and ingestion are the most likely ways these workers may be exposed. Needlestick or sharps injuries 

pose a risk of exposure in veterinary 

health care settings [NIOSH 2007a].

Administration of medications to animals presents additional exposure opportunities for workers not encountered with human patients. Many 

hazardous drugs and their metabolites 

can be excreted in urine and feces for 

up to 72 hours or more [Cass and Musgrave 1992]. In addition, oral medications may be present in vomitus for 

several hours [Mader et al. 1996].

Controls

Recommendations on handling hazardous drugs and waste are summarized below [OSHA 1999; NIOSH 

2004; ASHP 2006; USP 2008; Polovich 2009]. Specific recommendations 

for the safe handling of antineoplastic drugs in veterinary medicine are 

available [Lucroy 2001; Takada 2003; 

Fielding and Lacroix 2009].

Policies and Procedures 

 Ensure that hazardous drugs are 

prepared or administered only by 

trained personnel in designated areas that are limited to authorized 

personnel.

 Post a sign to warn employees that 

they are working in an environment where hazardous drugs are 

handled.

 Warn employees who are pregnant, breastfeeding, or of reproductive age of the potential health 

effects, especially during the first 

trimester when a woman may not 

know she is pregnant.

 Document and retain evidence 

that workers have been trained in 

and understand these procedures.
Training Requirements

 Train workers to recognize and understand the risks of 

working with hazardous drugs, and the risks of working in an environment where these drugs are handled.

 Train workers how to care for and use personal protective equipment (PPE) [NIOSH 2009].

Receiving and Storage 

 Begin exposure control when hazardous drugs enter 

the facility.

 Ensure that all personnel are able to identify hazardous inventory upon arrival. Handle all hazardous inventory with gloves. Label clearly with a hazardous 

designation.

 Store hazardous drugs separately from other inventory, and separate from food/drink.

 Keep a spill kit available in case inventory arrives damaged [ASHP 2006].

Drug Preparation

 Prohibit eating, drinking, chewing gum, applying cosmetics, or storing food or drinks within the hazardous 

drug preparation area.

 Use PPE, including chemotherapy gloves [ASTM 

2005], non-permeable gowns, respiratory protection, 

underpads, eye and/or splash protection, shoe covers 

and spill kit [NIOSH 2009].

 Use a proper containment device: preferably a 100% 

vented biological safety cabinet or compounding aseptic containment isolator. A horizontal laminar flow hood 

(clean bench) only protects the drug and not the worker. 

[OSHA 1999; NIOSH 2004; ASHP 2006; USP 2008]. 

 Use a proper closed-system drug transfer device 

(CSTD) in low-volume facilities (e.g. 2 or less drug 

preparations per week) without a clean room [NIOSH 

2004; USP 2008].

 Properly clean all equipment, counters, and other surfaces. No universal cleaner exists for all chemotherapy drugs. Bleach solution can be used to disinfect and 

a strong detergent and water rinse may remove most 

drug residues. Repeating the cleaning steps should 

provide addition drug removal.

 Wash hands with soap and water after drug compounding.

Drug Transportation

 When drug preparation is complete, seal the final 

product in a plastic bag or other sealable container before taking it out of the ventilated cabinet. 

 Seal and wipe all waste containers inside the ventilated cabinet before removing them from the cabinet.

 Store and transport hazardous drugs in closed containers that minimize the risk of breakage.

Drug Administration

 Use dedicated cages, kennels or stalls with dedicated 

drains for animals undergoing treatment with hazardous drugs.

 Use proper PPE and technique during administration.

 Attach drug administration sets to the IV bag, and 

prime them before adding the drug to the bag. Prime 

tubing in the containment device or with non-toxic solution whenever possible.

 Remove the IV bag and tubing intact, dispose of items 

directly in a chemotherapy waste container, and close 

the lid.

 Remove outer gloves and gowns, and bag them for disposal in the chemotherapy waste container at the location where drug administration was performed.

 Wash hands with soap and water after administering 

the drug.

Waste Cleaning and Disposal

 PPE should be worn during waste cleanup and disposal procedures, and footwear should not be worn outside the facility.

 Dispose of all hazardous drug waste according to Federal, State, and local regulations (separately from regular waste).

 Double-bag all chemotherapy waste including partially 

filled vials, undispensed products, unused IVs, needles 

and syringes, gloves, gowns, mats, and contaminated materials from spill cleanups or animal bodily fluids/waste. 

 Place materials with trace wastes (those that contain 

less than 3% by weight of the original quantity of hazardous drugs)—such as needles, empty vials and syringes, gloves, gowns, and tubing—in chemotherapy 

waste containers. Assure that such containers protect 

from sharps injuries. Do not use red sharps containers 

for drug disposal.

 Dispose of P-listed arsenic trioxide and its containers and any bulk amounts of U-listed drugs [40 CFR* 

261.33] in hazardous waste containers at an EPA/Resource Conservation and Recovery ACT (RCRA)-

permitted incinerator [EPA 2001].

 Consider disposing of other bulk hazardous drugs (expired or unused vials, ampoules, syringes, bags, and 

*Code of Federal Regulations. See CFR in references.
bottles of hazardous drugs or solutions of any other items 

with more than trace contamination) in a manner similar to that required for RCRA-defined hazardous wastes. 

 Avoid using sprayers or pressure washers to clean the 

cages, kennels or stalls of treated animals to minimize 

the aerosolization of hazardous wastes.

 Clean the cages and kennels of treated animals with 

disposable towels if possible and use disposable towels 

to clean bodily waste from treated animals.

Spill Control

 Manage hazardous drug spills according to the established, written policies and procedures for each workplace [NIOSH 2004; ASHP 2006].

 Ensure that the written policies and procedures address PPE required for various spill sizes, the possible 

spreading of material, restricted access to hazardous 

drug spills, and signs to be posted.

 Ensure that cleanup of a large spill is handled by workers who are trained in handling hazardous materials 

[29 CFR 1910.120].

 As required by OSHA, follow a complete respiratory 

protection program, including fit-testing, if you wear 

respirators such as those contained in some spill kits 

[29 CFR 1910.134]. Use NIOSH-certified respirators 

[42 CFR 84]. Surgical masks do not provide adequate 

protection.

 Dispose of all spill cleanup materials in a hazardous 

chemical waste container, in accordance with EPA/

RCRA regulations regarding hazardous waste—not in 

a chemotherapy waste or biohazard container.

Medical Surveillance Program

 Conduct reproductive and general health questionnaires at the time of hire and periodically thereafter 

[NIOSH 2007b].

 Conduct physical examination at the time of hire and 

then as needed for any worker whose health questionnaire or blood work indicates an abnormal finding. 

 Conduct followup for those workers who have shown 

health changes or have had a significant exposure (substantial skin contact, cleaning a large spill a broken 

bag, leaking IV line etc.).

Acknowledgments

The principal authors of this document were Thomas H. 

Connor, NIOSH, and Brett Cordes, DVM, The Apothecary Shop Specialty Pharmacies.

References

ASTM [2005]. Standard practice assessment of resistance 

of medical gloves to permeation by chemotherapy drugs. 

West Conshohocken, PA: American Society for Testing and 

Materials. ASTM D 6978–05.

ASHP [2006]. ASHP guidelines on handling hazardous drugs. 

Am J Health Syst Pharm 63:1172–1193.

BLS [2007]. Occupational employment and wage estimates, 

May 2006. http://146.142.422/oeshome.htm#overview

Cass Y, Musgrave CF [1992]. Guidelines for the safe handling 

of excreta contaminated by cytotoxic agents. Am J Hosp 

Pharm 49:1957–1958.

CFR. Code of Federal Regulations. Washington, DC: U.S. 

Government Printing Office, Office of the Federal Register.

EPA [2001]. Managing hazardous waste: a guide for small 

businesses. Washington, DC: U.S. Environmental Protection 

Agency, Report No. EPA530–K–01–005.

Fielding SL, Lacroix C [2009]. Chemotherapy safety in small 

animal practice. NAVTA J Fall, 2009.

Lucroy MD [2001]. Chemotherapy safety in veterinary 

practice: Hazardous Drug Preparation. Comp Cont Educ 

Pract Vet 24:140–146.

Mader RM, Rizovski B, Steger GG, Wachter A, Kotz R, Rainer 

H [1996] Exposure of oncologic nurses to methotrexate in the 

treatment of osteosarcoma. Arch Environ Health 51:310-314.

Mair TS, Couto CG [2006]. The use of cytotoxic drugs in 

equine practice. Equine Vet Educ 18:149–156.

Meijster T, Fransman W, Veldhof R, Kromhout H [2006]. Exposure 

to antineoplastic drugs outside the hospital environment. Ann 

Occup Hyg 50:657–664.

NIOSH [2004]. NIOSH Alert: preventing occupational exposures 

to antineoplastic and other hazardous drugs in health care 

settings. Cincinnati, OH: U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, 

National Institute for Occupational Safety and Health, DHHS 

(NIOSH) Publication No. 2004–165. http://www.cdc.gov/

niosh/docs/2004-165/

NIOSH [2005]. NIOSH respirator selection logic 2004 Cincinnati, OH: U.S. Department of Health and Human 

Services, Centers for Disease Control and Prevention, 

National Institute for Occupational Safety and Health, 

DHHS (NIOSH) Publication No. 2005–100. http://

www.cdc.gov/niosh/docs/2005-100/default.html

NIOSH [2007a]. Preventing worker deaths and injuries when 

handling Micotil 300®. Cincinnati, OH: U.S. Department of 

Health and Human Services, Centers for Disease Control 

and Prevention, National Institute for Occupational Safety 

and Health, DHHS (NIOSH) Publication No. 2007–124. 

http://www.cdc.gov/niosh/docs/wp-solutions/2007-124/

NIOSH [2007b]. Medical surveillance for health care workers 

exposed to hazardous drugs. Cincinnati, OH: U.S. Department 

of Health and Human Services, Centers for Disease Control 

and Prevention, National Institute for Occupational Safety 

and Health, DHHS (NIOSH) Publication No. 2007–117. 

http://www.cdc.gov/niosh/docs/wp-solutions/2007-117/

NIOSH [2009] Personal protective equipment for health care 

workers who work with hazardous drugs. Cincinnati, OH: U.S. 

Department of Health and Human Services, Centers for Disease 

Control and Prevention, National Institute for Occupational 
Safety and Health, DHHS (NIOSH) Publication No. 2009–

106. http://www.cdc.gov/niosh/docs/wp-solutions/2009-106/

Polovich M, Whitford JM, Olsen M (eds.) [2009]. Chemotherapy

 and biotherapy guidelines and recommendations for practice. 3rd ed. 

Pittsburgh, PA: Oncology Nursing Society.

Takada S [2003]. Principles of chemotherapy safety procedures. Clin 

Tech Small Anim Pract 18:73–74.

U.S. Pharmacopeial Convention [2008]. Pharmaceutical compounding 

sterile preparations (797). 31st ed. Rockville, MD: United States 

Pharmacopeial Convention.

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention 

National Institute for Occupational Safety and Health 

4676 Columbia Parkway 

Cincinnati, OH 45226–1998

Official Business

Penalty for Private Use $300

This document is in the public domain and may be 

freely copied or reprinted. NIOSH encourages all 

readers of the Workplace Solutions to make them 

available to all interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting research and making recommendations to prevent work-related 

illness and injuries. All Workplace Solutions are based on research studies that show how worker exposures to hazardous 

agents or activities can be significantly reduced.

Safer • Healthier • PeopleTM

For More Information

For more information about hazardous drugs in health care, 

visit the NIOSH Web site: http://www.cdc.gov/niosh/topics/

hazdrug/ 

To obtain information about other occupational safety and 

health topics, contact NIOSH at 

Telephone: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348 ■ E-mail: cdcinfo@cdc.gov

or visit the NIOSH Web site at www.cdc.gov/niosh

For a monthly update on news at NIOSH, subscribe to NIOSH 

eNews by visiting www.cdc.gov/niosh/eNews.

Safe Handling of Hazardous Drugs for Veterinary 

Health Care Workers

DHHS (NIOSH) Publication No. 2010–150

June 2010