News & Events

CDC releases NIOSH Alert: preventing exposures’ to hazardous drugs in healthcare setting

From the Massachusetts Nurse Newsletter
September 2004 Edition

By Evelyn Bain, M Ed, RN, COHN-S
Associate Director/Coordinator, Health & Safety

According to the document foreword by the National Institute for Occupational Safety and Health (NIOSH), the purpose of the alert "is to increase awareness among healthcare workers and their employers about the health risks posed by working with hazardous drugs and to provide them with measures for protecting their health."


"Healthcare workers who prepare or administer hazardous drugs, or who work in areas where these drugs are used may be exposed to these agents in the air or on work surfaces, contaminated clothing, medical equipment, patient excreta, and other surfaces. Studies have associated workplace exposures to hazardous drugs with health effects such as skin rashes and adverse reproductive outcomes (including infertility, spontaneous abortions, and congenital malformations) and possibly leukemia and other cancers. The health risk is influenced by the extent of the exposure and the potency and toxicity of the hazardous drug. Potential health effects can be minimized through sound procedures for handling hazardous drugs, engineering controls and proper use of protective equipment to guard workers to the greatest degree possible."

The document continues, "To provide workers with the greatest protection, employers should: 1) implement necessary administrative and engineering controls, and 2) assure that workers use sound procedures for handling hazardous drugs and proper protective equipment."

This alert applies to all workers who handle hazardous drugs (e.g. pharmacy and nursing personnel, physicians, operating room personnel, environmental services workers, veterinary care workers and shipping and receiving personnel).

A five-page listing of drugs considered to be hazardous is contained in the document. It lists antineoplastic agents; unclassified therapeutic agents; antivirals; oxytocics; antiretroviral agents; androgens; estrogens; gonadotropins; and other classes of drugs.

This 93-plus page document can be accessed in a PDF format on the NIOSH Web site at

OSHA Hazard Communication Standard (1910-1200) educational requirement applies to workplace exposure to "antineoplastic and other hazardous drugs in healthcare settings."

Employers are required to educate nurses and others who work in hospitals and healthcare settings about proper selection and utilization of personal protective equipment and to recognize health hazards associated with antineoplastic and other hazardous drugs through employers’ hazard communication training programs.

The OSHA Technical Manual – Section VI, Chapter 2 addresses Controlling Occupational Exposure to Hazardous Drugs. This 35-page document can be obtained by visiting the OSHA Web site at and clicking on "Technical Links." Part III of this document (page 24) addresses the content and frequency of worker education. Drugs which are in "solid, final form for direct administration to the patient" are exempt from the Hazard Communication labeling requirements under (1910.1200 (b)(4)(vii)).

MNA members who have questions about hazard communication and education programs related to antineoplastic and other hazardous drugs are encouraged to call the MNA Health and Safety Program.