# Engineering Controls Database

Minus

## Control of Exposure of Healthcare Workers to Hazardous Drugs

| Problem:                                        | Drugs are considered hazardous if studies in animals or humans show that exposures to them have a potential for causing cancer, reproductive toxicity, birth defects, or acute harm to health. Many hazardous drugs are used to treat illnesses such as cancer or HIV infection. For patients, the potential benefits of hazardous drugs outweigh the possible negative side effects. However, exposed healthcare workers risk the same side effects with no positive benefit.  In the United States, an estimated 5.5 million workers in the healthcare field are potentially exposed to hazardous drugs or drug waste at their worksites.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
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| What this means to you:                         | Workers exposed to hazardous drugs have developed skin rashes, adverse reproductive effects, and possibly leukemia and other cancers. For example, nurses and pharmacists who were exposed to hazardous drugs at their worksite reported an increase in adverse reproductive events including spontaneous abortions, stillbirths, and congenital malformations compared with unexposed healthcare workers.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
| Description of control:                         | NIOSH personnel were instrumental in preparing the following three documents for protecting workers in the healthcare field who may be exposed to hazardous drugs: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.NIOSH [2007]. NIOSH Workplace Solution: medical surveillance for health care workers exposed to hazardous drugs. Cincinnati, OH:  U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2007-117.NIOSH [2009]. NIOSH Workplace Solution: personal protective equipment for health care workers who work with hazardous drugs. Cincinnati, OH:  U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2009-106.The NIOSH alert provides overall recommendations for controlling worker exposures to hazardous drugs.   The alert also includes five case reports illustrating the range of occupational health effects and a sample listing of some drugs which meet a definition of hazardous drug. The two NIOSH workplace solutions provide recommendations on personal protective equipment and medical surveillance in greater detail than provided in the alert.General recommendations made by NIOSH include the following:•	Employers of healthcare workers should have written policies for medical surveillance of their employees, and for all phases of handling hazardous drugs, including receipt and storage, preparation, administration, housekeeping, deactivation, and cleanup and disposal of unused drugs, spills, and patient wastes. •	Employers should formally seek input from employees who handle drugs. •	Guidance documents, material safety data sheets, and training should be provided to employees. •	Proper controls should be provided and used to reduce potential exposures. For example, properly ventilated safety cabinets should be provided for drug preparation. Horizontal laminar flow workstations that move the air from the drug toward the employee should never be used. •	Syringes and intravenous (IV) sets used for preparing and administering hazardous drugs should have Luer-lok TM fittings to reduce risk of needlesticks, consistent with recommendations by the Occupational Safety and Health Administration and other organizations. Employers should consider closed-system drug-transfer devices and needle-less systems to protect nursing personnel during the administration of drugs. •	Personal protective equipment should be provided and used, including chemotherapy gloves; low-lint, low-permeability disposable gowns and sleeve covers, and eye and face protection. Proper respiratory protection should be provided and used when controls such as safety cabinets are not adequate to protect against exposure through inhalation.**Figure 1**Figure 1.  Multi-channel infusion pump for delivery of chemotherapy.             |
| Engineering and Physical Hazard Report Numbers: | 275-05-A;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
| NAICS Codes:                                    | 44611;54194;62;621;6211;62111;621111;622;6221;62211                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
| Keywords:                                       | clinicshealthcarehealthcare workershospitalslaundry workersmaintenance workersnursespharmacistspharmacyphysiciansveterinariansveterninarywaste handlers                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |

November 16, 2018
National Institute for Occupational Safety and Health