The National Institute for Occupational Safety and Health (NIOSH) made a revision to the list of hazardous drugs found in health care facilities. The latest update, made in late November, now accounts for workers’ exposure risks, and now categorizes drugs by type.
The 2014 NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings divides the hazardous drugs into three groups, though there is some overlap. The three groups are: antineoplastic drugs, non antineoplastic drugs, and drugs whose hazards pose reproductive risks to men or women.
NIOSH says that not all workers exposed to drugs in the last category will post serious risks to some workers. The agency says they have not attempted to define exposure limits or do risk assessments for any of the hazardous drugs.
The 2014 version of the document says that some formulations of hazardous drugs, like coated tablets and capsules may not pose any significant risk to health care workers who come in contact with the medicines without alternating them. However, crushing the tablets or capsules may add to exposure risks.
According to NIOSH, all hazardous drugs, regardless of formula, should be labeled as such to curb and prevent improper handling.
To assist in managing exposure risks, the 2014 update also includes recommendations for using personal protective equipment, or PPE, such as gloves, in specific situations. NIOSH says a pair of gloves may be all the PPE a worker needs to administer intact capsules and tablets from unit dose packaging. However, when health care workers must prepare an IV solution that contains a hazardous drug, they are advised to wear: double gloves, a protective gown, and protection for eyes and the respiratory system. They are also advised to use a closed-system drug transfer device and use a biological safety cabinet.
Under the law, employers in health care facilities with any level of workplace exposure risks must implement a hazardous drugs control program by this month. The program must be consistent with the NIOSH recommendations.
Some states, such as Washington, allow facilities to take the NIOSH list for what it is, but also allow for additional protocols to be added. Others, such as California and North Carolina require facilities to develop protocol to protect workers, but regulations do not apply to all drugs on the NIOSH list – only the designated antineoplastic drugs.
In the state of Washington, a local hospital says they will use gowns and gloves as needed during highest risk activities, such as administering IV chemotherapy drugs. However, they acknowledge that for many nursing and pharmacy units, using that much PPE may be “excessive,” so policies will be adjusted in those areas to reflect the appropriate PPE.
Typically, there is a lot of room for health care facilities to create their own policies around the use of PPE to protect workers in various settings and situations with varying exposure risks.