Safe Handling Awareness

Overview: Risk of Exposure
Increasing Risk of Hazardous Drug Exposure

  • The World Health Organization projects that deaths from cancer worldwide will continue to rise, with an estimated 12 million deaths in 2030. 1
  • Increased number of cancer cases and more potent chemotherapy drugs may elevate risk for exposure
  • Hazardous drugs are also being used to treat non-malignant illnesses
  • Investigational and experimental drugs are considered hazardous until proven otherwise

Potential for Hazardous Effects if Not Handled Properly

Results show that coming into contact with hazardous agents can cause numerous problems.

  • Skin Irritations
  • Cancer 2,3
  • Reproductive Health Issues 4,5

Contaminated healthcare workers experienced higher rates of miscarriage and potential fetal malformations. Workers reported that they were experiencing side effects similar to those of a chemotherapy patient (hair loss, vomiting, mouth sores, and skin rashes). Additionally, the incidence of cancer in these workers was higher, especially for leukemia and bladder cancer.

Daily Exposure May Create Long-Term Consequences

The National Institute for Occupational Safety and Health (NIOSH) and the American Society of Health-System Pharmacists (ASHP) revised their classification of hazardous drugs to include over 195 drugs, including International Agency for Research on Cancer’s (IARC) group of over 29 carcinogens.

Expanded Use of Hazardous Drugs is Occurring Outside of Oncology Departments

Because of ongoing research and emerging evidence, hazardous drugs are now being explored and used for a number of conditions:

Rheumatoid Arthritis (RA)
Systemic Lupus Erythematosus (SLE)
Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS)

Additionally, these drugs are being used in areas where they have not traditionally been used:

  • Rheumatology/immunology
  • Infectious disease
  • Obstetrics/gynecology
  • Emergency room
  • Radiology
  • Operating room

Commonly Documented Contaminated Surfaces 7

Contamination is commonly reported on the following surfaces:

  • BSC work surface, BSC airfoil, preparation room floor
  • Gloves, gowns, shoes
  • Pharmacy floor, pharmacy office chair
  • Syringes, carts, trash cans
  • Patient room floor, patient table, patient chair
  • Checking counters in the pharmacy.

This fact demonstrates that contamination can spread out and into the environment anywhere that hazardous drugs have been used.

Potential Routes of Exposure  7

Inhalation: breathing contaminated air (aerosols and vapors)

Dermal contact: touching contaminated surfaces, direct contact with drugs

Ingestion: chewing gum, hand-to-mouth (eating and drinking)

Who is at Risk?

All hospital workers have the potential to be exposed, especially:

  • Nurses
  • Pharmacists and Pharmacy Technicians
  • Physicians
  • Paraprofessionals
  • Janitorial and maintenance staff

There are also reported cases of human uptake of chemotherapeutic agents in staff who work in areas where hazardous drugs are handled but are not involved in handling the drugs themselves.

Learn about hazardous drug classes


1. World Health Organization. The WHO Cancer Home page. Available at: Accessed Oct. 26, 2011.

2. Environmental Working Group. The Nurses’ Health page. Available at: Accessed Oct. 26, 2011.

3. Anderson RW, Puckett WH Jr, Dana WJ et al. Risk of handling injectable antineoplastic agents. American Journal of Health-System Pharmacy. 1982; 39(11): 1881-1887.

4. Valanis B, Vollmer W, Steele P. Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists. Journal of Occupational and Environmental Medicine. 1999; 41(8): 632-638.

5. Peelen S, Roeleveld N, Heederik D et al. Toxic effects on reproduction in hospital personnel. ISBN 90 5749 255 5.

6. NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2010

7. Sessink P, Bos R. Drugs hazardous to healthcare workers – a review article. Drug Safety. 1999; 20(4): 347-359.