News Corner: Safe Handling of Hazardous Drugs: Guidelines or Requirements?

Over 10 years after the publication of the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert, “Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings,” there remains a lack of emphasis on safe handling practices. Though over 300 articles outlining guidelines and best practices have been published since, evidence shows that these recommendations aren’t always followed.

Guidelines, Not Requirements

According to an article in Pharmacy Practice News, part of the reason behind low adherence to handling practices is that they are often referred to as “guidelines,” making them seem voluntary for healthcare workers. Instead, these items should be viewed as practice standards or rules around hazardous drug (HD) handling to keep employees and patients safe.

Continuing HD exposure may also be due to:

  • A lack of awareness among employees around this issue or the risks
  • Poor facility design
  • A lack of vigilance in work practice or personal protective equipment

If handling practices are viewed only as recommended guidelines, providers may not feel the need to adhere to them as some may be a hindrance to provider workflows.

Facility-wide Issue

Studies that examined levels of HD residue in health settings found high levels of toxicity on items from pencils to doorknobs, putting providers at risk. Two separate studies found that 75% of surfaces sampled in the pharmacy were found to have residue of at least one of the HDs being examined. When workers are exposed to even low to moderate HD levels, they may experience adverse effects. While annual training is currently required, beyond this there are few hard requirements around HD handling.

Automation Improving Safety

New automated technologies, such as robotics, hold promise to help reduce the dangers to employees from HD handling. These tools streamline workflows for providers who handle and prepare these medications.

In addition to reducing employee contact for HDs, robotic solutions for compounding increase accuracy and patient safety not achievable with manual compounding. While robotics don’t completely eliminate risk for providers, particularly during transportation and delivery stages, they significantly reduce risk during compounding.

While technology advances continue to improve patient and provider safety around HDs, there will not be significant progress until there is universal acceptance and implementation of current safe-handling guidelines. Reframing these guidelines as practice requirements is the first step in compelling providers to protect themselves. Hospital leadership and administration need to elevate the importance of protection against HD exposure as an employee safety issue. Widespread education of potential harm is also essential so providers and those exposed to HDs understand the need for protective equipment.

Related Articles:

American Pharmacists Association

Formulary Watch

Digital Journal

One thought on “News Corner: Safe Handling of Hazardous Drugs: Guidelines or Requirements?

  1. You made a good point about why there is low adherence to handling practices because they are being referred to as mere “guidelines”. It is important for people to understand that handling of this HD is very important and critical. If I were involved in the medical industry, I would make sure that the rules and regulations for proper handling are strictly followed. Thanks.


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