How can we better protect hospital workers from hazardous drugs?

Hospital Safety Insider, July 25, 2019

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By Ronak Kadakia, PSQH

There are pros and cons to most things in life, and chemotherapy is no different. While it can be extremely effective for patients battling cancer, it can also be damaging to healthy people, such as pharmacists, nurses, doctors, and other hospital staff.

By way of example, the National Institute for Occupational Safety and Health (NIOSH) has shown that these drugs can produce several negative health outcomes, such as abdominal pain, nausea, vomiting, diarrhea, coughing, facial flushing, hair thinning, hair loss, dermatitis, irritation of skin and eyes, irritation of mucous membranes, menstrual cycle disruption, fetal loss, and even some forms of cancer (Centers for Disease Control and Prevention, 2017; Centers for Disease Control and Prevention, 2019).

These effects are not surprising, given that cytotoxic drugs can trace their origins back to mustard gas used in World War I. Autopsies performed on victims of mustard gas during the war exposed decreased white blood cell counts, leading researchers to test nitrogen mustard as a treatment for various types of lymphomas and leukemia.

NIOSH recognizes that hazardous drugs are of major concern, estimating that about 8 million U.S. healthcare workers are potentially exposed to them. This figure includes pharmacy and nursing personnel, physicians, operating room personnel, environmental services workers, workers in research laboratories, veterinary care workers, and shipping and receiving personnel.

The issue of exposure will only be compounded in future years. The National Cancer Institute reports that the number of new cancer cases per year is expected to rise to 23.6 million by 2030. That is a massive increase compared to the Institute’s estimated 1,735,350 new cancer cases in the U.S. for 2018. Simply put, with more cancer patients, staff will come into contact with these medications much more regularly, raising the likelihood that they will experience negative health outcomes.

The U.S. Pharmacopeia (USP) has guidelines to protect hospital workers who handle hazardous drugs. USP 800, the newest chapter outlining safe drug-handling regulations, requires that the drugs be compounded in clean rooms, which are designed to maintain extremely low levels of particulates. Additionally, healthcare workers are instructed to wear personal protective equipment such as gowns, gloves, and face masks. These measures undoubtedly help; however, with the upcoming implementation date of USP 800, healthcare facilities need to invest in safety procedures and equipment to ensure they are protecting their workers to the highest degree possible.

A further recommendation of USP 800 is the implementation of Closed System Transfer Devices (CSTD). But despite growing adoption rates, driven by stricter USP requirements and greater awareness of hazardous drug risks, not all CSTDs are equally effective—which can leave healthcare workers exposed to harm.

How can healthcare workers and decision-makers foster a culture of safety to ensure that hospital staff and patients are best protected?

One of the first things that should be done is to ask the opinions of those who regularly handle hazardous drugs about the current safeguards. They will have an in-depth knowledge of the current processes and can provide suggestions for process improvements. Their expertise should be valued, and their feedback should be listened to and acted upon as quickly as possible.

It is also vital that facilities identify and implement the correct equipment because a facility’s requirements may vary depending on its size, space, and budget. The best way to get this right is to research the various options for each safety measure and ensure that they have been independently tested to the highest standards. The benefits of assessing each product thoroughly and scientifically will become self-evident. These devices will keep contamination to an absolute minimum and will give hospital staff peace of mind while attending to patients.

Robotics will also become vital to the compounding of hazardous drugs. An automated compounding system, enabled with CSTDs, can work efficiently and enhance the safety of hospital pharmacies. In addition to protecting pharmacists from exposure, automated systems can prevent dosage and medication mistakes. This improves patient safety and protects oncology teams from human error.

In an era when technology is thriving and providing answers to questions we have had for decades, more needs to be done to ensure that technology is properly harnessed in healthcare for workers’ protection and well-being. We know the dangers, so let us now work on properly implementing the solutions.

Ronak Kadakia is the director of marketing and business development for Equashield, which provides award-winning CSTDs for the safe compounding and administration of hazardous drugs in oncology settings.


  1. Centers for Disease Control and Prevention. (2017, September 13). Hazardous drug exposures in healthcare: Antineoplastic agents. Retrieved from
  2. Centers for Disease Control and Prevention. (2019, January 30). Hazardous drug exposure in healthcare: Effects of occupational exposure. Retrieved from

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