Check out these videos to learn more about the Safe to Touch Consensus Conference statements and hazardous drug guideline compliance:
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- Overview
- Recognizing the Risks
- Guideline Support
- Assessing Practices
You shouldn’t have to compromise on hazardous drug safety.
From the compounding pharmacist to the nurse who administers treatment to the staff cleaning a facility, an exposure can occur at almost any moment during the hazardous drug journey. The risk of hazardous drug exposure to healthcare workers is real and significant.
There’s no room for compromise.
With evidence-based insights on your current safe handling practices, rapid hazardous drug detection and closed-system drug transfer device (CSTD) solutions, the BD Hazardous Drug Solutions portfolio is designed to protect you—and the team you count on.
The BD Hazardous Drug Solutions team collaborates with you to understand the real risks of hazardous drug exposure and surface contamination in your facility—and then tailor the solution that’s right for your safety, economic and clinical needs.
A unique end-to-end program designed to help you understand, develop and implement hazardous drug surface contamination monitoring in four steps: assess, develop, test, track.
BD® HD Check System
The first rapid hazardous drug detection* system that provides easy-to-read binary results in less than 10 minutes to help facilitate routine monitoring and evaluate your institution’s safe handling practices.
*The BD® HD Check System tests for select hazardous drugs— cyclophosphamide, doxorubicin and methotrexate. Surfaces with contamination at or above the limits of detection have 95% specificity and sensitivity.
More than 8 million healthcare workers are potentially exposed to hazardous drugs each year.
This includes personnel throughout the entire hazardous drug journey—from pharmacists, nurses and technicians to those in housekeeping and environmental services and shipping and receiving roles.1
The risks of hazardous drug exposure are real and significant.
The Risks
Detrimental effect on DNA
Increased cancer rates
Internal organ damage
Reproductive issues
Exposure may occur anywhere hazardous drugs are present in your facility—from pharmacy receiving and preparation to administration and disposal.
A study of six hospitals found that frequently contacted surfaces at every stage of the hospital medication system had measurable levels of hazardous drug contamination.11
- Centers for Disease Control and Prevention (CDC). Hazardous drug exposures in health care. The National Institute for Occupational Safety and Health (NIOSH) Web site. http://www.cdc.gov/niosh/topics/hazdrug. Accessed April 11, 2023.
- Cavallo D, Ursini CL, Perniconi B, et al. Evaluation of genotoxic effects induced by exposure to antineoplastic drugs in lymphocytes and exfoliated buccal cells of oncology nurses and pharmacy employees. Mutat Res. 2005;587(1-2):45–51. doi:10.1016/j.mrgentox.2005.07.008.
- McDiarmid MA, Oliver MS, Roth TS, Rogers B, Escalante C. Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. J Occup Environ Med. 2010;52(10):1028–34. doi:10.1097/JOM.0b013e3181f73ae6.
- Roussel C, Witt KL, Shaw PB, Connor TH. Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs. Mutat Res. 2019;781:207-217
- Hansen J, Olsen JH. Cancer morbidity among Danish female pharmacy technicians. Scand J Work Environ Health. 1994;20(1):22–26. doi:10.5271/sjweh.1433.
- Skov T, Maarup B, Olsen J, et al. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med. 1992;49(12):855–861. doi:10.1136/oem.49.12.855.
- Sotaniemi EA, Sutinen S, Arranto AJ, et al. Liver damage in nurses handling cytostatic agents. Acta Med Scand. 1983;214(3):181–189. doi:10.1111/j.0954-6820.1983.tb08593.x.
- Lawson CC, Rocheleau CM, Whelan EA, et al. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol. 2012;206(4):327.e1-8.
- Hemminki K, Kyronen P, Lindbohm ML. Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J Epidemiol Community Health. 1985;39(2):141–147. doi:10.1136/jech.39.2.141.
National Institute for Occupational Safety and Health (NIOSH). Current intelligence bulletin 68: NIOSH chemical carcinogen policy. By Whittaker C, Rice F, McKernan L, Dankovic D, Lentz - TJ, MacMahon K, Kuempel E, Zumwalde R, Schulte P, on behalf of the NIOSH Carcinogen and RELs Policy Update Committee. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2017‐100. https://www.cdc.gov/niosh/docs/2017‐100/pdf/2017‐100.pdf. Accessed March 20, 2020.
- Hon CY, Teschke K, Chu W, Demers P, Venners S. Antineoplastic drug contamination of surfaces throughout the hospital medication system in Canadian hospitals. J Occup Environ Hyg. 2013;10(7):374–383. doi:10.1080/15459624.2013.789743.
For decades, clinical organizations have provided evidence-based recommendations to help protect healthcare workers from the risks of hazardous drug exposure. As protective technology and knowledge advance, these guidelines evolve. Staying current is a critical part of keeping your team safe.
The use of CSTDs has been widely recommended by different organizations, including the United States Pharmacopeial Convention (USP),1 American Society of Health-System Pharmacists (ASHP),2 and the National Institute for Occupational Safety and Health (NIOSH).3
“CSTDs should be used when compounding HDs when dosage form allows.”
— USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings
“HDs must be administered safely using protective medical devices and techniques. Examples of protective medical devices include needleless and closed systems.”
— USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings
“For these reasons, USP chapter 800 has determined that CSTDs should be used when compounding HDs and that CSTDs must be used when administering antineoplastic HDs when the dosage form allows and the device is physically or chemically compatible with the HD to be used.”
— ASHP Guidelines on Handling Hazardous Drugs2
“Consider using devices such as closed-system transfer devices, glove bags, and needleless systems when transferring hazardous drugs from primary packaging (such as vials) to dosing equipment (such as infusion bags, bottles, or pumps).”
— NIOSH alert 2004: Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings.3
Organizations, health agencies and conferences around the world, such as the USP,1 Spanish Society of Hospital Pharmacists (SEFH)4 and the 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination,5 recommend routine monitoring as part of a comprehensive safe handling program.
“Environmental wipe sampling for hazardous drug surface residue should be performed routinely (e.g., initially as a benchmark and at least every six months, or more often as needed, to verify containment). […] Repeat the wipe sampling to validate that the deactivation/decontamination and cleaning steps have been effective.”
— USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings1
“To be efficient, any surface contamination monitoring plan should include an assessment of the contamination risk present in the different sections of the HPD’s compounding area. This is essential to determine where to sample and establish a suitable monitoring frequency. [...]”
— 2021 SEFH practice guidelines4
Standards and guidelines have identified several locations in pharmacy and patient administration areas where routine wipe sampling for HD surface contamination might be beneficial.
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Comprehensive safe handling programs include comprehensive training and routine reassessments. Both the USP1 and Oncology Nursing Society7 provide specific recommendations for annual HD education.
“All personnel who handle HDs must be trained based on job functions… Personal competency must be reassessed every 12 months.”
— USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings1
“Comprehensive didactic education and documentation of clinical competence is required for all HCW and must be reassessed at least every 12 months.”
— Oncology Nursing Society—Safe Handling of Hazardous Drugs7
Ample evidence exists to support the prevalence of hazardous drug exposure and associated health risks to healthcare workers. Implementing a comprehensive safe handling program can pose multiple challenges. It’s a step worth taking.
- United States Pharmacopeial Convention. USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings. https://www.usp.org/compounding/general-chapter-hazardous-drugs-handling-healthcare. Published February 1, 2016. Updated June 26, 2020. Accessed April 11, 2023.
- Power LA, Coyne JW. ASHP Guidelines on Handling Hazardous Drugs. Am J Health Syst Pharm. 2018;75(24):1996-2031. doi:10.2146/ajhp180564.
- National Institute for Occupational Safety and Health (NIOSH). NIOSH alert 2004: Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings. http://www.cdc.gov/niosh/docs/2004-165/pdfs/2004-165.pdf. Accessed August April 11, 2023.
- Valero-García S, González-Haba E, Gorgas-Torner MQ, et al. Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments. A consensus Statement. Practice guidelines of the Spanish Society of Hospital Pharmacists (SEFH). Farm Hosp. 2021;45(2):96–107. doi:10.7399/fh.11655.
- Gabay M, Johnson P, Fanikos J, et al. Report on 2020 Safe to Touch Consensus Conference on Hazardous Drug Surface Contamination. Am J Health Syst Pharm. 2021;zxab134. doi:10.1093/ajhp/zxab134.
- Domingo T, Fontán G, Enríquez M, et al. Guía monitorización de superficies de medicamentos peligrosos. 1. ed. Instituto Español de Investigación Enfermera; Consejo General de Enfermería; 2021.
- Polovich M, Olsen, M eds. Safe Handling of Hazardous Drugs. 3rd ed. Pittsburgh, PA: Oncology Nursing Society; 2018.
Your facility likely already has safety measures that help prevent hazardous drug exposure. How well is your program protecting your staff? Are you up to date with evolving standards and guidelines? Is your staff in compliance? Are there opportunities to optimize your approach?
BD can help uncover the answers.
Developed by the JCR and sponsored by BD, the Self-Assessment of Safe Handling Practices for Hazardous Drugs is a confidential online survey used to identify existing USP <800> compliance gaps. For help on closing those gaps, the Improving Safe Handling Practices for Hazardous Drugs Toolkit provides detailed guidance on standards, guidelines and best practices.
The BD® HD Surface Contamination Monitoring Program is a unique end-to-end program designed to help your facility set up, customize and sustain surface contamination monitoring in just four steps: assess, develop, test and track. The program, along with the BD® HD Check System, puts the power of providing data-driven continuous quality improvements for a safe work environment directly in your hands.
BD® Hazardous Drug Surface Contamination Monitoring Program Brochure
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The BD® HD Check system reliably* detects surface contamination on multiple surfaces.
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The BD PhaSeal™ system is airtight and leakproof to protect your staff from hazardous drug exposure during drug preparation, administration and disposal.
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