NIOSH proposes update to hazardous drugs
HCWs at risk from workplace residue
As the Food and Drug Administration approves new drugs for new uses, the list of potential occupational hazards grows. The National Institute for Occupational Safety and Health has proposed an update to its list of hazardous drugs, adding 24 new drugs. This will be the first update since NIOSH first published its hazardous drug alert in 2004. (See chart.)
NIOSH reviewed about 70 new drugs, 60 drugs that received new warnings from the FDA, and 18 drugs that were added to the National Institutes of Health Hazardous Drugs list. The drugs can cause a variety of potential problems, including reproductive or organ toxicity and carcinogenic effects.
Health care workers may be exposed by inhaling aerosolized droplets of liquid drugs as they administer them to patients or dust from uncoated tablets, especially if they are crushed to help patients ingest them, says Thomas Connor, PhD, a research biologist at NIOSH in Cincinnati who specializes in chemotherapeutic agents and hazardous drugs. Coated tablets or capsules that are not cut or crushed are less likely to lead to exposure, he says.
Sampling in patient care areas have found residues of hazardous drugs on surfaces, including computer keyboards, floors, equipment, and countertops, says Connor. In fact, if someone unpacks vials from a shipping box in the pharmacy without wearing gloves, they are likely exposed to contamination on the surface of the vials, he says.
"Every study that's been done has shown some background level [in the work environment]," says Connor. "Sometimes it's quite low, but other times it's fairly substantial."
In drafting the list of hazardous drugs, a NIOSH review panel considered the toxicity of the drugs at low levels. They also acknowledged that health care workers have a long-term exposure, he says. "It's a chronic, low-dose exposure to multiple drugs [that causes special concern]," he says. "We don't know the combined effect of all of those drugs."
The list does not address the special considerations that may apply to pregnant workers. The fetus is sensitive to very low doses of chemicals, but little is known about what level would be considered safe, Connor notes.
"Each individual person who is pregnant and is working with these should discuss it with their supervisor and make a decision [about their work restrictions]," he advises, adding, "The best thing to do would be [for pregnant employees] to work in an area where they're not handling these drugs during their pregnancy, if that's an option."
Although health care workers should have access to detailed information on each drug they work with through Material Safety Data Sheets or MSDS, the NIOSH list provides a simple way to learn about potential hazards. The list will be updated every year or two as new drugs and drug warnings are reviewed, he says. In some cases, drugs may be taken off the list as well.
"Our goal is to increase awareness, so health care workers know which drugs should be handled with caution and what kind of precautions they should use," Connor says.
As the Food and Drug Administration approves new drugs for new uses, the list of potential occupational hazards grows.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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