Safety First

"Health care workers who prepare or administer hazardous drugs (e.g., those used for cancer therapy, and some antiviral drugs, hormone agents, and bioengineered drugs) or who work in areas where these drugs are used may be exposed to these agents in the workplace. About 8 million U.S. healthcare workers are potentially exposed to hazardous drugs, including pharmacy and nursing personnel, physicians, operating room personnel, environmental services workers, workers in research laboratories, veterinary care workers, and shipping and receiving personnel."  

"Many hazardous drugs used to treat cancer (for example, alkylating agents) bind to or damage DNA. Other antineoplastic drugs, some antivirals, antibiotics, and bioengineered drugs interfere with cell growth or proliferation, or with DNA synthesis. In some cases, the nonselective actions of these drugs disrupt the growth and function of both healthy and diseased cells, resulting in toxic side effects for treated patients and their offspring. These nonselective actions can also cause adverse effects in health care workers who are inadvertently exposed to hazardous drugs."  The National Institute for Occupational Safety and Health hazardous (NIOSH) considers a drug to be hazardous if it exhibits one or more of the following six characteristics in humans or animals:

Workplace exposures to hazardous drugs (HDs) can cause both acute and chronic health effects including: skin rashes, adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations), and possibly leukemia and other cancers. Health risks depend on how much exposure a worker has to these drugs and how toxic they are. NIOSH recommends implementation of a practice-specific standard precautions approach to handling hazardous drugs safely.


NIOSH recommends minimizing exposure to HD's through primary prevention measures such as engineering controls, administrative controls, and personal protective equipment (PPE).

A recent NIOSH survey of nurses and other oncology healthcare personnel investigated their implementation of administrative and engineering control practices, personal protective equipment (PPE), and barriers to using recommended PPE when administrating antineoplastic drugs. Approximately 2000 respondents revealed "best practices are not always used".

Below are examples of practices which may increase exposure risk, expressed as percent of respondents:

  • Not always wearing two pairs of chemotherapy gloves (80%) or not even a single pair (15%).
  • Failure to always wear nonabsorbent gown with closed front and tight fitting cuffs (42%).
  • Intravenous (I.V.) tubing primed with antineoplastic drug instead of a non-drug containing liquid by the respondent (6%) or by the pharmacy department (12%).
  • Potentially contaminated clothing taken home (12%).
  • Spill or leak of antineoplastic drug during administration (12%).
  • Lack of hazard awareness training (4%).
  • Skin contact with antineoplastic drug (4%).


Emergency procedures to cover spills or inadvertent release of hazardous drugs should be included in the facility's overall health and safety program. A properly protected person trained in the appropriate procedures should clean up spills and breakages immediately. The area should be identified with a warning sign to limit access to the area. An incident reports should be filed to document the spill and persons exposed.

PPEs should be worn by all staff handling patient excreta (urine, vomit, feces) for seven days after the administration of chemotherapy: