Download NIOSH Updates

ISOPP 2014 Summary Report
I would like to thank both the Canadian Association of Pharmacy in Oncology and the
International Symposium on Pharmacy Practice for the opportunity to attend ISOPP XIV in
Montreal. This article focuses on hazardous drug safe handling procedure updates presented at
ISOPP.
NIOSH Updates to its Guidance for the Safe Handling of Hazardous Drugs - Dr. Thomas Connor,
National Institute for Occupational Safety and Health (NIOSH), USA
USP Chapter 800: Hazardous Drugs – Handling in the Healthcare Setting
This new USP Chapter is scheduled for publication this year. The proposed content, formerly
included in Chapter 797, is available at www.usp.org > enter “chapter 800” in the search
field.
NIOSH Hazardous Drug List
The 2014 NIOSH Hazardous Drug List will soon be available at
www.cdc.gov/niosh/topics/hazdrug. The list contains 26 new drugs. The reason for
classifying each drug as hazardous is included with each listing. Any drug classified as
hazardous by the manufacturer is also considered hazardous by NIOSH.
The 2014 list divides hazardous drugs into three categories:
1. Antineoplastic drugs
Most monoclonal antibodies (MABs) are not listed because they are large
molecules, so the potential for uptake is small. Two new MABs are included because
they are conjugated with antineoplastic agents.
2. Non-antineoplastic hazardous drugs
Many tablets and capsules are included in this category.
3. Drugs with reproductive effects
Australian consensus guidelines for the safe handling and Administration of Monoclonal
Antibodies for cancer treatment by healthcare personnel – Sue Kirsa
A team of Australian pharmacists, medical oncologists, and nurses surveyed existing Australian
practices and reviewed available evidence for the preparation and safe handling procedures for
monoclonal antibodies (MABs). The resulting guidelines are available at
http://www.wcmics.org/ > select Guidelines from the top menu.
Some key highlights from the consensus guidelines include:
 MABs require greater handling precautions than other non-hazardous injectible
medications, but do not warrant full cytotoxic precautions.
 The risk of MAB exposure is stratified based on the role of the staff member; those involved
in preparation are at the highest risk.
 Without evidence of safety, healthcare workers with relevant health considerations (e.g.,
pregnancy) should avoid preparation of MABs.
 Dispose of MABs using the same procedures used for non-hazardous parenteral agents.
 The waste products and body fluids of patients receiving MAB therapy can be handled using
the same procedures used for non-hazardous parenteral agents.
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Gloves and gowns are not required for handling MABs from a safety point of view due to a
lack of dermal penetration; however, gloves should be used when sterility is required.
Protective eyewear and masks should be worn while preparing MABs.
Protective eyewear and masks are not required for administration of MABs, but may be
considered for dis/connecting lines due to risk of aerosolization.
Isolators or biological safety cabinets are not required for the preparation of MABs.
Closed System Drug Transfer Devices (CSDTDs) are not required for the preparation of
MABs.
MABs conjugated with antineoplastics or radiopharmaceuticals require the safety
procedures recommended for the conjugate.