OSHA says worker exposure to hazardous drugs is a major health concern for workers in healthcare facilities and the pharmaceutical industry. The preparation, administration, manufacturing, and disposal of hazardous medications may expose hundreds of thousands of workers to potentially significant workplace levels of these chemicals.
Potentially harmful exposure can occur when you handle or work around hazardous drugs. These drugs include antineoplastic cytotoxic medications, anesthetics, anti-viral drugs, hormones, and others.
Hazardous drugs can cause serious acute and chronic health effects such as skin rashes, fertility problems, genetic damage, birth defects, organ toxicity, and possibly leukemia and other cancers.
A 41-year-old patient-care assistant working on an oncology floor developed an itchy rash approximately 30 minutes after emptying a commode of urine into a toilet. She denied any direct contact with the urine, wore a protective gown and nitrile gloves, and followed hospital policy for the disposal of materials contaminated with antineoplastic drugs. The rash subsided after 1 to 2 days. Three weeks later, she had a similar reaction approximately 1 hour after performing the same procedure for another patient.
Upon investigation, it was found both hospital patients had recently been treated with vincristine and doxorubicin. The patient-care assistant had no other signs or symptoms and reported no changes in lifestyle and no history of allergies or recent infections. After treatment with diphenhydramine (intramuscular) and oral corticosteroids, her symptoms disappeared.
Although the cause could not be definitely confirmed, both vincristine and doxorubicin have been associated with allergic reactions when given to patients. The aerosolization of the drug present in the urine may have provided enough exposure for symptoms to develop.
Exposure occurs during manufacturing and packaging, receiving, preparation and administration, and cleaning and disposal activities. Clinical and non-clinical workers with potential exposure include:
The exposure to these hazardous chemicals and drugs due to untrained or unaware workers can cause problems, such as:
Employers should implement a written program which meets the requirements of the Hazard Communication Standard (HCS) for employees who are handling or exposed to the chemicals, including drugs that represent a health hazard to employees. The written program must provide for worker training, warning labels, and access to Material Safety Data Sheets (MSDSs).
When a Hazardous Drug Safety and Health Plan is developed, it should be readily available and accessible to all employees, including temporary employees, contractors, and trainees.
OSHA says the plan should include each of the following elements and indicate specific measures that the employer is taking to ensure employee protection:
Employees must also be informed of the requirements of the Hazard Communication Standard, including:
The HCS only applies to pharmaceuticals the drug manufacturer has determined to be hazardous. It also applies to workplaces where employees are exposed under normal conditions of use or in a foreseeable emergency.
Departments with employees who handle hazardous drugs on a regular basis must:
Employees who handle hazardous drugs should:
The hazard assessment is conducted to help you identify what tasks have the potential for exposure, which employees may be exposed, and how to control exposure. It will form the foundation of your Hazardous Drug Control Program.
Here are some steps to help you conduct your hazard assessment:
There are some exceptions to the standard, such as:
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