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HAZARDOUS DRUG EXPOSURES IN HEALTHCARE

Recent Publications, Guidelines, Review Articles and Surveys

Recent Publications

This section includes articles published on this topic during the past three years.

  • Anastasi M, Rudaz S, Lamerie TQ, Odou P, Bonnabry P and Fleury-Souverain S. Efficacy of two cleaning solutions for the decontamination of 10 antineoplastic agents in the biosafety cabinets of a hospital pharmacy. Ann Occup Hyg. 2015; 59:895-908.
  • Aguero D and Marge K. Developing a USP <800> compliance gap analysis. Pharm Purch Prod. January 2017; 14 (1):10-12.
  • Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4): 249-257.
  • AIHA Healthcare Working Group Hazardous Drugs Project Team. Chemotherapy hood decommissioning for disposal or recycling. Fact sheet. Approved by AIHA Board: October 17, 2016. Falls Church, VA: American Industrial Hygiene Association (AIHA).
  • Al-Azzam SI, Awawdeh BT, Alzoubi KH, Khader YS and Alkafajei AM. Compliance with safer handling guidelines of antineoplastic drugs in Jordanian hospitals. J Oncol Pharm Pract. 2015; 21(1):3-9.
  • Alexander M, King J, Lingaratnam S, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A survey of manufacturing and handling practices for monoclonal antibodies by pharmacy, nursing and medical personnel. J Oncol Pharm Pract. 2016; 22(2):219-227.
  • Anastasi M, Rudaz S, Queruau Lamerie T, Odou P, Bonnabry P and Fleury-Souverain S. Efficacy of two cleaning solutions for the decontamination of 10 antineoplastic agents in the biosafety cabinets of a hospital pharmacy. Ann Occup Hyg. 2015; 59:895–908.
  • Barle EL, Winkler GC, Glowienke S, Elhajouji A, Nunic J and Martus HJ. Setting occupational exposure limits for genotoxic substance in the pharmaceutical industry. Toxicol Sci. 2016; 151:2-9.
  • Beaver CC and Magnan MA. Minimizing staff exposure to antineoplastic agents during intravesical therapy. Clin J Oncol Nurs. 2015; 19:393-395.
  • Berdi F, Powell MF, Sanz C, Gonzalez R and Massoomi F. Assessing the efficiency of CSTDs for compounding. Pharm Purch Products. 2015; 12:4-7.
  • Berdi F, Powell M, Sanz C, Gonzalez R and Massoomi F. Assessing the efficiency of CSTDs for compounding. Pharm Purch Prod. July 2015; 12 (7) Supp.
  • Berruyer M, Tanguay C, Caron NJ, Lefebvre M, Bussières. Multicenter study of environmental contamination with antineoplastic drugs in 36 Canadian hospitals: A 2013 follow-up study. J Occup Environ Hyg. 2015; 12:87-94.
  • Bohlandt A, Groeneveld S, Fischer E and Schierl R. Cleaning Efficiencies of three cleaning agents on four different surfaces after contamination by Gemcitabine and 5-fluorouracile. J Occup Environ Hyg. 2015; 12:384-392.
  • Boiano JM, Steege AL and Sweeney MH. Adherence to precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. J Occup Environ Hyg. 2015. (epub. DOI: 10.1080/15459624.2015.1029610).
  • Canal-Raffin M, Khennoufa K, Martinez B, et al. Highly sensitive LC-MS/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide, ifosfamide, and methotrexate antineoplastic drugs and routine application. J Chromatogr B. 2016; 1038:109–117.
  • Cass Y, Connor TH and Tabachnik A. Safe handling of oral antineoplastic medications: focus on targeted therapeutics in the home setting. J Oncol Pharm Practice. 2017; 23:350–378.
  • Connor TH, Douglass K, Eisenberg S, Kastango ES, Kienle PC, Massoomi F and Parsad SD. Improving safe handling practices for hazardous drugs: toolkit. Mansur J, contributing editor. 2016. Joint Commission Resources (www.jcrinc.com).
  • Connor TH, Celano P, Frame JN and Zan RT. Summary of the Workshop on the Safe Handling of Hazardous Drugs Cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical Oncology. J Oncol Pract 2017; 13:199-205.
  • Connor, TH, Power LA, Massoomi F and Polovich M. White glove test for safety. ECNews. 2015; 18: 6-7, 11.
  • Connor TH, Power LA, Massoomi F and Polovich M. Are gloves and gowns safe for handling chemotherapy? Pharm Purchasing and Products. 2015; 12:2,4.
  • Connor TH and Smith JP. New approaches to wipe sampling methods for antineoplastic and other hazardous drugs in healthcare settings. Pharm Technol Hosp Pharm. 2016; (Epub ahead of printing) DOI: 10.1515/pthp-2016-0009.
  • Connor TH, Zock MD and Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: methodology and recommendations. J Occup Environ Hyg. 2016; 13:658–667.
  • Cox J, Speed V, O’Neal S, Hasselwander T, Sherwood C, Eckel SF and Zamboni WC. Development and evaluation of a novel product to remove surface contamination of hazardous drugs. J Oncol Pharm Pract 2015 (epub ahead of print) DOI:10.1177/1078155215621151.
  • Cox J, Speed V, O’Neal S, Hasselwander T, Sherwood C, Eckel SF and Zamboni WC. Development and evaluation of a novel product to remove surface contamination of hazardous drugs. J Oncol Pharm Pract. 2016; (Epub ahead of printing) DOI 10.1177/1078155215621151.
  • Cytotoxic Drugs and Related Waste: A Risk Management Guide for South Australian Health Services.
  • Dal Bello F, Santoro V, Scarpino V, Martano C, Aigotti R, Chiappa A, Davoli E and Medana C. Antineoplastic drugs determination by HPLC-HRMSn to monitor occupational exposure. Drug Test Anal. 2015. (Epub ahead of print). DOI: 10.1002/dta.1827
  • DeJoy DM, Smith TD, Woldu H, Dyal M-A, Steege AL and Boiano JM. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. J Occup Environ Hyg. 2017; 14:485-493.
  • Dekyndt B, Decaudin B, Lannoy D and Odou P. Economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries. J Oncol Pharm Practice. 2015; 21:102-110.
  • Douglas K, Richter A, Dorey M and Rizvi I. Refining PPE usage for HD compounding: Part 1. Pharm Pract Prod. 2017; February 2017 14 (2):18-21.
  • Easty AC, Coakley N, Cheng A, Cividino M, Savage P, Tozer R and White RE. Safe handling of cytotoxics: guideline recommendations. Curr Oncol. 2015; 22:e27-e37.
  • Eberwein SM and Amerine LB. Comparison of USP <800> gap analysis tools. Pharm Purch Prod. April 2017; 14 (4) 12-13.
  • Eisenberg S. Hazardous drug handling in light of USP <800>. Pharm Purchasing and Products. 2015; 12(2):18-19.
  • Eisenberg S. Hazardous drugs and USP <800>: implications for nurses. Clin J Oncol Nurs. 2017; 21:179–187.
  • Eisenberg S. A call to action for hazardous drug safety: Where we have been and where we are going. Clin J Onc Nurs. 2016; 20: A1-A8.
  • Eisenberg S. A call to action for hazardous drug safety: where we have been and where we are now. Clin J Oncol Nurs. 2016; 20:20-4AP.
  • Fabrizi G, Fioretti M and Rocca LM. Dispersive solid-phase extraction procedure coupled to UPLC-ESI-MS/MS analysis for the simultaneous determination of thirteen cytotoxic drugs in human urine. Biomed Chromatogr. 2016; 30:1297-1308.
  • Federica DB, Santoro V, Scarpino V, Martano C, Aigotti R, Chiappa A, Davoli E and Medana C. Antineoplastic drugs determination by HPLC-HRMSn to monitor occupational exposure. Drug Test Anal. 2016; 8:730-737.
  • Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F and Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): a French multicentric survey. Eur J Surg Oncol. 2015; 41:1361-1367.
  • Fleury-Souverain S, Mattiuzzo M, Mehl F, Nussbaumer S, Bouchoud L, Falaschi L, Gex-Fabry M, Rudaz S, Sadeghipour F and Bonnabry P. Evaluation of chemical contamination of surfaces during the preparation of chemotherapies in 24 hospital pharmacies. Eur J Hosp Pharm. 2015; 22:333-341.
  • Friese CR, McArdle C, Zhao T, Sun D, Spasojevic I, Polovich M and McCullagh MC. Antineoplastic drug exposure in an ambulatory setting. Cancer Nurs. 2015; 38(2):111-117.
  • Garrigue P, Montana M, Ventre C, Gauthier-Villano L, Pisano P and Pourroy B. Safe cytotoxic drug preparation using closed-system transfer device: technical and practical evaluation of a new device (Vialshield/Texium) comparatively to a reference one (Phaseal). Int J Pharm Compounding. 2016; 20:148-154.
  • Gomez-Alvarez S, Porta-Oltra B, Hernandez-Griso M, Perez-Labana F and Climente-Marti M. Evaluacion de dos sistemas cerrados en el proceso de elaboracion de quimioterapia parenteral. Farm Hosp. 2016; 40:36-43.
  • Graeve CU, McGovern PM, Alexander B, Church T, Ryan A and Polovich M. Occupational exposure to antineoplastic agents: an analysis of health care workers and their environments. Workplace Health and Safety. 2016 (e-pub; doi: 10.117712.165079916662660).
  • Graeve C, McGovern PM, Arnold S and Polovich M. Testing an intervention to decrease healthcare workers’ exposure to antineoplastic agents. ONF April 2017; 44:E10–E19.
  • Grases F, Costa-Bauzά A, Bonarriba CR, Pieras EC, Fernάndez RA and Rodrίguez A. On the origin of calcium monohydrate papillary renal stones. Urolithiasis. 2015; 43 (Supp 1):S33-S39.
  • Health and Safety Executive. Safe handling of cytotoxic drugs in the workplace.
  • He BY, Mendelsohn-Victor K, Mccullagh MC and Friese CR. Personal protective equipment use and hazardous drug spills among ambulatory oncology nurses. ONF 2017; 44: 60–65.
  • Ho KV, Edwards MS, Solimando DA Jr, Johnson AD. Determination of extended sterility for single-use vials using the Phaseal closed-system transfer device. J Hematol Oncol Pharm. 2016; 6:46-50.
  • Hon CY and Abusitta D. Causes of health care workers’ exposure to antineoplastic drugs: an exploratory study. Can J Hosp Pharm. 2016; 69:216-223.
  • Hon CY, Teschke K and Shen H. Healthcare workers’ knowledge, perceptions and behaviors regarding antineoplastic drugs: survey from British Columbia, Canada. J Occup Environ Hyg. 2015; 12:669-677.
  • Hon CY, Teschke K, Shen H, Demers PA and Venners S. Antineoplastic drug contamination in the urine of Canadian healthcare workers. Int Arch Occup Environ Health. 2015. DOI 10.1007/s00420-015-1026-1.
  • Jeong KW, Lee BY, Kwon MS and Jang JH. Safety management status among nurses handling anticancer drugs: nurse awareness and performance following safety regulations. Asian Pac J Cancer Prev. 2015; 16:3203-3211.
  • Jeonimo M, Colombo M, Astrakianakis G and Hon CY. A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers. Anal Bioanal Chem. 2015; 407 (23):7083-92.
  • Jorgenson JA and Stevenson JG. Special Report: Closed-system drug-transfer devices: ONB classification and the draft NIOSH protocol. Pharm Pract News. June 2017; Supp:1-4.
  • Karpinski J. 2016 Updates to the NIOSH hazardous drug list. Pharm Purch Prod. July 2017; 14 (7):36,38.
  • Kibby T. A review of surface wipe sampling compared to biologic monitoring for occupational exposure to antineoplastic drugs. J Occup Environ Hyg. 2017; 14:159–174.
  • Kicenuik K, Northrup N, Dawson A, Locke J, Villamil JA, Chretin J, Sfiligoi G, Clifford C, Rosenberg M, Hamilton T, Regan R, Parsons-Doherty M, Mallett C, Philibert J, Imperllizeri J and Hofmeister E. Treatment time, ease of use and cost associated with use of Equashield™, PhaSeal®, or no closed system transfer device for administration of cancer chemotherapy to a dog model. Vet Comp Oncol. 2015 (Epub ahead of print). DOI: 10.1111/vco.12148.
  • Kieffer C, Verhaeghe P, Lagrassa S, Gregoire R, Moussaoui Z, Casteras-Ducros C, Clark JE, Vanelle P and Rathelot P. Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units. Eur J Cancer Care. 2015; 24:404-410.
  • Kienle PC. Update on proposed USP Chapter <800>. Pharm Purchasing and Products. 2015; 12 (2):2,4.
  • King J, Alexander M, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A review of the evidence for occupational exposure risks to novel anticancer agents – A focus on monoclonal antibodies. 2016;22:121-134.
  • King J, Alexander M, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A review of the evidence for occupational exposure risks to novel anticancer agents – A focus on monoclonal antibodies. 2016;22:121-134.
  • Klahn S. Chemotherapy safety in clinical veterinary oncology. Bet Clin Small Anim. 2014; 44:941-963.
  • Krämer I, Federici M. Kaiser V and Thiesen J. Media-fill simulation tests in manual and robotic aseptic preparation of injection solutions in syringes. J Oncol Pharm Pract. 2016; 22:195-204.
  • Kunneva L. Closed system drug transfer devices for chemotherapy. Nursing. 2016; 46:67-68.
  • Ladeira C, Viega S, Padua M, Carolino E, Gomes MC and Brito M. Genotoxic assessment in different exposure groups working with antineoplastic agents. Occupational Safety and Hygiene III. Arezes PM, Baptista JS, Barroso MP, Carneiro P, Cordeiro P, Nelson C, Melo RB, Miguel AS and Perestrelo G. London: Taylor and Francis Group. 2015. ISBN 978-1-138-02765-7.
  • Landeck L, Gonzalez E and Koch OM. Handling chemotherapy drugs – do medical gloves really protect? Int J Cancer. 2015; 137(8): 1800-1805.
  • Ledford A and Wetzel B. Constructing an oncology pharmacy. Pharm Purch Prod. May 2017; 14 (5):10-15.
  • Le LMM, Reitter D, He S, Bonle FT, Launois A, Martinez D, Prognon P and Caudron E. Safety analysis of occupational exposure of healthcare workers to residual contaminations of cytotoxic drugs using FMECA security approach. Sci Total Environ. 2017 (e-pub; doi: 10.1016/j.scitotenv.2017.05.066).
  • Lucas MA and Connor TH. Hazardous drugs: the silent stalker of healthcare workers? Training, education are key to preventing exposures. The Synergist. 2015; January:22-26.
  • Massoomi F and Eisenberg S. Pharmacy and nursing collaborate on CSTD training. Pharm Purchasing Prod. 2015; May:12-16.
  • Massoomi F. The evolution of the CSTD. Pharm Purchasing and Products. 2015; 12 (2): S1-S12.
  • McGowan D. Safe handling and administration of MABS: the guidance. Brit J Nurs. 2015; 24:S14-20.
  • Moretti M, Bonfiglioli R, Feretti D, Pavanello S, Mussi F, Grollino MG, Villarini M, Barbieri A, Ceretti E, Carrieri M, Buschini A, Appolloni M, Dominici L, Sabatini L, Gelatti U, Bartolucci GB, Poli P, Stronati L, Mastrangelo G and Monarca S. A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project. BMC Public Health. 2011; 11:195 (http:/Nrww.biomedcentral.com/1471-2458/11/195).
  • Moretti M, Grollino MG, Pavanello S, Bonfiglioli R, Villarini M, Appolloni M, Carrieri M, Savatini L, Dominici L, Stronati L, Mastrangelo G, Barbieri A, Fatigoni C, Bartolucci GB, Ceretti E, Mussi F and Monarca S. Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach. Int Arch Occup Environ Health. 2015; 88:683-695.
  • Moretti M, Villarini M, Dominici L, Fatigoni C, dell’Omo M, Elisei E, Muzi G and Monarca S. Evaluation of genotoxic effects in subjects occupationally exposed to antineoplastic drugs [in Italian]. Igiene e Sanita Pubblica 2013; 69:55–77.
  • Müller-Ramírez C, Squibb K and McDiarmid M. Accessible analytical methodology for assessing workplace contamination of antineoplastic drugs in limited-resource oncology health-care settings. J Anal Sci and Technol. 2016; (Epub ahead of printing) DOI: 10.1186/s40543-016-0091-8.
  • Müller-Ramírez C, Squibb K and McDiarmid M. Measuring extent of surface contamination produced by the handling of antineoplastic drugs in low-to-middle-income country oncology health care settings. Arch Occup Environ Health. 2016; (Epub ahead of printing) DOI: 10.1080/19338244.2016.1222346.
  • Murashov V and Howard J. Risks to health care workers from nano-enabled medical products. J Occup Environ Hyg. 2015; 12:D75-D85.
  • Nurgat Z, Faris D, Mminah M, Vibar A, AL-Jazairi A, Ewing S, Ashour M, Qaisi SK, Balhareth S and AL-Jedai A. A three-year study of a first-generation chemotherapy-compounding robot. Am J Health-Syst Pharm. 2015; 72:1036-1045.
  • Page E, Couch JR and de Perio MA. Evaluation of a multiple sclerosis cluster among nurses in an inpatient oncology ward. J Occup Environ Hyg. 2015; 12:D54-59.
  • Palma E and Bufarini C. Robotized compounding of oncology drugs in a hospital pharmacy. Int J Pharm Compd. 2014; 18:358-364.
  • Panahi D, Azari M, Akbari ME, Zendehdel R, Mirzaei HR, Hatami H and Mehrabi Y. Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug. Environ Monit Assess. 2016; 188:238-243.
  • Panahi D, Azari M, Akbari E, Zendehdel R, Mirzaei HR, Itatami H and Mehrnbi Y. Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug. Environ Monit Assess. 2016; 188:238(e-pub; doi: 10.1007/s10661-016-5255-x).
  • Polovich M. Minimizing occupational exposure to antineoplastic agents. J Infus Nurs. 2016; 39:307–313.
  • Poupeau C, Tanguay C, Plante C, Gagne S, Caron N and Bussieres JF. Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers. J Oncol Pharm Pract. 2017; 23:323–332.
  • Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Pract News (special edition). 2016; 23-36.
  • Ramphal R, Bains T, Goulet G and Vaillancourt R. Occupational exposure to chemotherapy of pharmacy personnel at a single centre. Can J Hosp Pharm. 2015; 68:104-112.
  • Redic KA, Fang K, Christen C and Chaffee BW. Surface contamination of hazardous drug pharmacy storage bins and pharmacy distributor shipping containers. J Oncol Pharm Pract. 2016 (e-pub; doi: 10.1177/1078155216679027).
  • Ricci MS, Fazier M, Moore J, Cromwell M, Galush WJ, Patel AR, Adler M, Altenburger U, Grauschopf U, Goldbach P, Fast JL, Kramer I and Mahler HC. In-use physicochemical and microbiological stability of biological parenteral products. Am J Health-Syst Pharm. 2015; 72:396-407.
  • Rinehart JR and Jorgenson JA. Considerations for handling monoclonal antibodies. Pharm Purchasing and Products. 2015; May:S6-10.
  • Rosenthal M. CSTD buyers need advocacy help. Pharm Prac News. 2016; April 4.
  • Rosenthal M. CSTD test protocol stirs debate (Part 1) Pharm Pract News. February 2017; 44 (2):20-21.
  • Rosenthal M. Establishing procedures for testing CSTDs (Part 2). Pharm Pract News. March 2017; 44 (3):32-33.
  • Rudnitzki T and McMahon D. Oral agents for cancer: safety challenges and recommendations. Clin J Oncol Nurs. 2015; 19 (Suppl):41-46.
  • Sakhvidi MJZ, Hajaghazadeh M, Mostaghaci M, Mehrparvar AH, Sakhvidi FZ and Naghshineh E. Applicability of the comet assay in evaluation of DNA damage in healthcare providers’ working with antineoplastic drugs: a systematic review and meta-analysis. Int J Occup Environ Health. 2016; 22:52-67.
  • Schierl R, Masini C, Groeneveld S, Fischer E, Bohlandt A, Rosini V and Paolucci D. Environmental contamination by cyclophosphamide preparation: comparison of conventional manual production in biological safety cabinet and robot-assisted production by APOTECAchemo. J Oncol Pharm Pract. 2016; 22(1):37-45.
  • Sessink PJM, Leclercq GM, Wouters DM, Halbardier L, Hammad C and Kassoul N. Environmental contamination, product contamination and workers exposure using a robotic system for antineoplastic drug preparation. J Oncol Pharm Pract. 2015: 21(2):118-127.
  • Sidikou O, Simon N, Sergent G, Vasseur M, Pinturaud M, Richeval C, Allorge D, Decaudin B and Odou P. In vitro assessment of a new extension set intended to reduce occupational exposure to antineoplastic drugs during hepatic chemoembolisation. Cardiovasc Intervent Radiol. 2016; 39(1):141-3.
  • Silver SR, Steege AL and Boiano JM. Predictors of adherence to safe handling practices for antineoplastic drugs: a survey of hospital nurses. J Occup Environ Hyg. 2016; 13:203-212.
  • Simons A and Toland S. Closed systems for drug delivery: a necessity, not an option. Brit J Nurs. 2015; 24:S20,S22.
  • Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, Connor TH and Snawder JE. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2016; 22:396-408.
  • Smith JP, Sammons DL, Robertson SA, Pretty JR, DeBord DG, Connor TH and Snawder JE. Detection and measurement of surface contamination by multiple antineoplastic drugs using multiplex bead assay. J Oncol Pharm Pract. 2016; 22 (1): 60-67.
  • Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, Connor TH and Snawder JE. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2015 (Epub ahead of print). DOI: 10.1177/1078155215585187.
  • Tomas ME, Kundrapu S, Thota P, Sunkesula VCK, Cadnum JL, Mana TSC, Jencson A, O’Donnell M, Zabarsky TF, Hecker MT, Ray AJ, Wilson BM and Donskey CJ. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med. 2015; 175(12):1904-1910
  • Tomkins J. Ensuring health care worker safety when handling hazardous drugs: the joint position statement from the Oncology Nursing Society, the American Society of Clinical Oncology and the Hematology/Oncology Pharmacy Association. Eur J Oncol Pharm. 2015; 11:278-279.
  • Vazquez R, Boubet K, Guerrault-Moro MN and Crauste-Manciet S. Impact of handling errors for chemical cross-contamination risk for the preparation of parenteral cytotoxic drugs. Pharm Technol Hosp Pharm. 2016; (Epub ahead of printing) DOI: 10.1515/pthp-2015-0009.
  • Villa AF, El Balkhi S, Aboura R, Sageot H, Hasni-Pichard H, Pocard M, Elias D, Joly N, Payen D, Blot F, Poupon J and Garnier R. Evaluation of oxaliplatin exposures of healthcare workers during heated intraperitoneal perioperative chemotherapy (HIPEC). Ind Health. 2015; 53:28-37.
  • Villarinia M, Gianfredia V, Levoratoa S, Vannini S, Salvatori T and Moretti M. Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: a systematic review of the literature and meta-analysis. Mutat Res. 2016; 770(Pt A):35–45.
  • Vyas N, Turner A, Clark JM and Sewell GJ. Evaluation of a closed-system cytotoxic transfer device in a pharmaceutical isolator. J Oncol Pharm Pract. 2016; 22(1):10-19.
  • Wagner JT. Ensure safe use of CAIs and CACIs. Pharm Purchasing and Products. 2014; 11(12):12-14.
  • Zhang J, Bao J, Wang R, Geng Z, Chen Y, Xie XY, Jiang L, Deng Y, Liu G, Xu R and Miao L. A multicenter study of biological effects assessment of pharmacy workers occupationally exposed to antineoplastic drugs in pharmacy intravenous admixture services. J Haz Mat. 2016; 315: 86–92.
  • Zhang X, Zheng Q, Lv Y, An M, Zhang Y, Wei Y and Feng W. Evaluation of adverse health risks associated with antineoplastic drug exposure in nurses at two Chinese hospitals: the effects of implementing a pharmacy intravenous admixture service. Am J Ind Med. 2016; 59:264–273.

Guidelines, Recommendations and Regulations for Handling Antineoplastic Agents

Since it was first recognized that occupational exposure to antineoplastic agents posed a potential health risk to workers exposed to these agents, various groups, institutions and agencies around the world have developed and published guidelines or recommendations for handling antineoplastic agents. The most often referred to guidelines in the United States are the OSHA Technical manual: Controlling Occupational Exposure to Hazardous Drugs revised in 1995 and the NIOSH Alert: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs, published in 2004. Others include handling guidelines by the American Society of Hospital-System Pharmacists, the Oncology Nursing Society and the International Society of Oncology Pharmacy Practitioners.

  • Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4): 249-257.
  • Albin K. Administering chemotherapy: Is it safe for pregnant or breast-feeding veterinary technicians? Vet Tech. Oct 2010; E1-E5.
  • Alessio L, Apostoli P, Draicchio F, Forni A, Lucchini R, Merler E, Palazzo S, Scarselli R and Sossai D. Prevention of risks from occupational exposures to antineoplastic drugs: Consensus document. Med Lav. 1996; 87:194-206.
  • Alessio L, Apostoli P, Draicchio F, Forni A, Lucchini R, Merler E, Palazzo S, Scarselli R and Sossai D. Prevention of risks from occupational exposures to antineoplastic drugs: Consensus document. Int J Occup Environ Health. 1997; 3:84-87.
  • Alexander M, King J, Bajel C, Doecke C, Fox P, Lingaratnam S, Mellor JD, Nicholson L, Roos I, Saunders T, Wilkes J, Zielinski R, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel. Intern Med J. 2014; (Epub ahead of print) DOI: 10.111/imj.12564.
  • Alexander M, King J, Bajel A, Doecke C, Fox P, Lingaratnam S, Mellor JD, Nicholson L, Roos I, Saunders T, Wilkes J, Zielinski R, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel. Intern Med J. 2014; 44:1018-1026.
  • American Society of Hospital Pharmacists. Technical assistance bulletin on handling cytotoxic drugs in hospitals. Am J Hosp Pharm. 1985; 42:131-137.
  • American Society of Hospital Pharmacists. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm. 1990; 47:1033-1049.
  • American Society of Health-System Pharmacists. ASHP Guidelines on Handling Hazardous Drugs: Am J Health-Syst Pharm. 2006; 63:1172-1193.
  • Anon. Practice fined for health and safety record. Vet Rec. 2014; 175:418.
  • Association partitaire pour la santé et la sécurité du travail du secteur affaires sociaux (ASSTSAS) Prevention Guide. Safe Handling of Hazardous Drugs. 2008.
  • ASTM D666-01 “Standard Practice for Field Collection of Organic Compounds from Surface Using Wipe Sampling,” ASTM International.
  • Barle EL, Winkler GC, Glowienke S, Elhajouji A, Nunic J and Martus HJ. Setting occupational exposure limits for genotoxic substance in the pharmaceutical industry. Toxicol Sci. 2016; 151:2-9.
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Review Articles

Several authors have published articles reviewing the topic of occupational exposure to antineoplastic agents. These articles provide a good starting place for individuals not familiar with this area to learn more of what some of the issues are and what type of studies have been performed in this area.

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  • Cass Y, Connor TH and Tabachnik A. Safe handling of oral antineoplastic medications: focus on targeted therapeutics in the home setting. J Oncol Pharm Practice. 2017; 23:350–378.
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  • Connor TH. Hazardous anticancer drugs in health care: Environmental Exposure Assessment. Ann NY Acad Sci. 2006; 1076:615-623.
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  • Lucas MA and Connor TH. Hazardous drugs: the silent stalker of healthcare workers? Training, education are key to preventing exposures. The Synergist. 2015; January:22-26.
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  • Nussbaumer S, Bonnabry P, Veuthey JL and Fleury-Souverain S. Analysis of anticancer drugs: a review. Talanta. 2011; 85:2265-2289.
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  • Sessink PJM and Bos RP. Drugs hazardous to healthcare workers:Evaluation of methods for monitoring occupational exposure to cytotoxic drugs. Drug Safety. 1999; Apr 20 (4): 347-359.
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Surveys

A number of surveys have examined work practice standards and compliance with guidelines for the proper handling of antineoplastic agents.

  • Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4):249-257.
  • Alexander M, King J, Lingaratnam S, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A survey of manufacturing and handling practices for monoclonal antibodies by pharmacy, nursing and medical personnel. J Oncol Pharm Pract. 2016; 22:219-227.
  • Al-Azzam SI, Awawdeh BT, Alzoubi KH, Khader YS and Alkafajei AM. Compliance with safer handling guidelines of antineoplastic drugs in Jordanian hospitals. J Oncol Pharm Pract. 2015; 21 (1):3-9.
  • Ben-Ami S, Shaham J, Rabin S, Melzer A and Ribak J. The influence of nurses’ knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel. Cancer Nurs. 2001; 24:192-200.
  • Boiano JM, Steege AL and Sweeney MH. Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. J Occup Environ Hyg. 2014; 11:728-740.
  • Boiano JM, Steege AL and Sweeney MH. Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. J Occup Environ Hyg. 2014; 11:728-740.
  • Boiano JM, Steege AL and Sweeney MH. Adherence to precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. J Occup Environ Hyg. 2015. (epub. DOI: 10.1080/15459624.2015.1029610).
  • Cohen IA, Newland SJ and Kirking DM. Injectable-antineoplastic-drug practices in Michigan hospitals. Am J Hosp Pharm. 1987; 44:1096-1105.
  • Constantinidis TC, Vagka E, Dallidou P, Basta P, Drakopoulos V, Kakolyris S and Chatzaki E. Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals. Eur J Cancer Care. 2011; 20:123-131.
  • DeJoy DM, Smith TD, Woldu H, Dyal M-A, Steege AL and Boiano JM. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. J Occup Environ Hyg. 2017; 14:485-493.
  • Dekyndt B, Decaudin B, Lannoy D and Odou P. Economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries. J Oncol Pharm Pract. 2015; 21:102-110.
  • Friese CR, Himes-Ferris L, Fraier MN, McCullagh MC and Griggs JJ. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf. 2012; 21(9) 753-759.
  • Fuller TP, Bain EI and Sperrazza K. A survey of the status of hazardous drug awareness and control in a sample Massachusetts nursing population. J Occup Environ Hyg. 2007; 4:D113-119.
  • Gambrell J and Moore S. Assessing workplace compliance with handling of antineoplastic agents. Clin J Onc Nurs. 2006; 10:473-477.
  • Gilbar PJ. External contamination of cytotoxic drug vials. J Pharm Pract Res. 2005; 35:264-265.
  • Gregoire RE, Segal R and Hale KM. Handling antineoplastic-drug admixtures at cancer centers: Practices and pharmacist attitudes. Am J Hosp Pharm. 1987; 44:1090-1095.
  • Hon C-Y, Teschke K, Chua P, Venners S and Nakashima L. Occupational exposure to antineoplastic drugs: Identification of job categories potentially exposed throughout the hospital medication system. Saf Health Work. 2011; 2:273-281.
  • Hon CY, Barzan C and Astrakianakis G. Identification of knowledge gaps regarding healthcare workers’ exposure to antineoplastic drugs: review of literature, North America versus Europe. Saf Health Work. 2014; 5:169-174.
  • Hon CY, Teschke K and Shen H. Healthcare workers’ knowledge, perceptions and behaviors regarding antineoplastic drugs: survey from British Columbia, Canada. J Occup Environ Hyg. 2015; 12:669-677.
  • Hon CY and Abusitta D. Causes of health care workers’ exposure to antineoplastic drugs: an exploratory study. Can J Hosp Pharm. 2016; 69:216-223.
  • Jeong KW, Lee BY, Kwon MS and Jang JH. Safety management status among nurses handling anticancer drugs: nurse awareness and performance following safety regulations. Asian Pac J Cancer Prev. 2015; 16:3203-3211.
  • Kieffer C, Verhaeghe P, Lagrassa S, Gregoire R, Moussaoui Z, Casteras-Ducros C, Clark JE, Vanelle P and Rathelot P. Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units. Eur J Cancer Care. 2015; 24:404-410.
  • Kyprianou M, Kapsou M, Raftopoulos V and Soteriades ES. Knowledge, attitudes and beliefs of Cypriot nurses on the handling of antineoplastic agents. Eur J Oncol Nurs. 2010; 14:278-282.
  • Mahon SM, Casperson DS, Yackzan S, Goodner S, Hasse B, Hawkins J, Parham J, Rimkus C, Schlomer M and Witcher V. Safe handling practices of cytotoxic drugs: The results of a chapter survey. Oncol Nurs Forum. 1994; 21:1157-1165.
  • Martin S. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Onc Nurs Forum. 2003; 30:575-581.
  • Nieweg RMB, de Boer M, Dubbleman RC, Gall HE, Hesselman GM, Lenssen PCHP, van Maanen LWGM, Majoor PWFM and Slegt JH. Safe handling of antineoplastic drugs. Cancer Nurs. 1994; 17:501-511.
  • Pedersen CA, Schneider PJ and Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration – 2014. 2015; 72:1119-1137.
  • Polovich M and Martin S. Nurses’ use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum. 2011; 38:718-726.
  • Roop JC and Wu HS. Current practice patterns for oral chemotherapy: results of a national survey. Oncol Nurs Forum. 2014; 41:185-194.
  • Sauer KA, Coons SJ and Berger PK. Survey of training, handling practices, and risk perceptions of Kentucky pharmacists working with antineoplastic agents. Am J Hosp Pharm. 1991; 48:119-120.
  • Shahrasbi AA, Afshar M, Shokraneh F, Monji F, Noroozi M, Ebrahimi-Khojin M, Madani SF, Ahadi-Barzoki M and Rajabi M. Risks to health professionals from hazardous drugs in Iran: a pilot study of understanding of healthcare team to occupational exposure to cytotoxics. EXCLI Journal (ISSN 1611-2156). 2014; 13:491-501.
  • Silver SR, Steege AL and Boiano JM. Predictors of adherence to safe handling practices for antineoplastic drugs: a survey of hospital nurses. J Occup Environ Hyg. 2016; 13:203-212.
  • Steege AL, Boiano JM and Sweeney MH. NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures. Am J Ind Med. 2014; 57(6):640-652.
  • Stellman JM, Aufiero BM and Taub RN. Assessment of potential exposure to antineoplastic agents in the health care setting. Prev Med. 1984; 13:245-255.
  • Trovato, JA and Tuttle LA. Oral chemotherapy handling and storage practices among Veterans Affairs oncology patients and caregivers. J Oncol Pharm Pract. 2014; 20:88-92.
  • Turk M, Davas A, Ciceklioglu M, Sacaklioglu F and Mercan T. Knowledge, attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital. Asian Pac J Cancer Prev. 2004; 5:164-168.
  • Valanis B and Shortridge L. Self protective practices of nurses handling antineoplastic drugs. Oncol Nurs Forum. 1987; 14:23-27.
  • Valanis B, McNeil V and Driscoll K. Staff members’ compliance with their facility’s antineoplastic drug handling policy. Oncol Nurs Forum. 1991; 18:571-576.
  • Valanis B, Vollmer WM, Labuhn K, Glass A and Corelle C. Antineoplastic drug handling protection after OSHA guidelines: Comparison by profession, handling activity and work site. J Occup Med. 1992; 34:149-155.
  • Washburn DJ. Intravesical antineoplastic therapy following transurethral resection of bladder tumors: nursing implications from the operating room to discharge. Clin J Oncol Nurs. 2007; 11:553-559.
  • Yoshida J, Kosaka H, Nishida S and Kumagai S. Actual conditions of the mixing of antineoplastic drugs for injection in hospitals in Osaka Prefecture, Japan. J Occup Health. 2008; 50:86-91.
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