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November 22, 2013
California takes steps to protect workers from chemotherapy drugs

Chemotherapy can be lifesaving for cancer patients, but for the workers who prepare and administer it, exposure to chemotherapy drugs has been linked to numerous health hazards, ranging from skin rashes and infertility to an increased risk of several forms of cancer. To combat this problem, in 2014, California healthcare employers will be required to implement new measures to protect their employees from exposure to chemotherapy drugs.

The law, which will take effect on January 1, 2014, directs Cal/OSHA to develop standards implementing National Institute for Occupational Safety and Health (NIOSH) recommendations detailed in a 2004 hazard alert titled “Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Healthcare Settings.”

The new requirements would apply not only to workers in hospitals, but also to pharmacists, clinic workers, and others in the healthcare field.

Workers can be exposed to chemotherapy drugs in a wide variety of ways, including initial preparation, administering chemotherapy to a patient, handling contaminated wastes, and cleaning up spills.

According to NIOSH, inhalation and skin contact or absorption are the most likely routes of exposure, but unintentional ingestion resulting from hand-to-mouth contact and accidental injection from a needlestick or sharps injury are also possible.

To prevent worker exposure to chemotherapy drugs, NIOSH recommends the following practices:

  • Require workers to wear appropriate personal protective equipment (PPE), including chemotherapy gloves, gowns, and eye protection. PPE should be worn when opening containers to unpack chemotherapy drugs as well as while administering or preparing them to minimize the risk of exposure if damaged containers are present.
  • During preparation (including mixing, counting, crushing, compounding powders, and pouring liquids), use a ventilated cabinet designed to reduce worker exposures.
  • When administering chemotherapy drugs, use protective medical devices such as needleless systems.
  • Do not permit eating or drinking in areas where chemotherapy drugs are handled.
  • Establish and maintain periodic cleaning routines for all work surfaces and equipment that may become contaminated, and make sure cleanup and decontamination is performed by workers who have been trained on safe procedures.
  • As required by OSHA’s hazard communication standard, train workers on the hazards associated with chemotherapy drugs and safe work practices, including handling, PPE, and disposal. Make sure to provide appropriate training to both clinical and non-clinical (e.g., maintenance staff) personnel who may be exposed.

You can read the full hazard alert at

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