The HCS also applies to hazardous drugs, when the drug manufacturer has determined to be hazardous and that are known to be present in the workplace in such a manner that employees are exposed under normal conditions of use or in a foreseeable emergency. This does not include drugs that are in solid, final form for direct administration to the patient, such as pills or tablets.
According to OSHA, risks to personnel working with hazardous drugs are a function of the drugs' inherent toxicity and the extent of exposure. The main routes of exposure are: inhalation of dusts or aerosols, dermal absorption, and ingestion. Contact with contaminated food or cigarettes represents the primary means of ingestion. Opportunity for exposure to hazardous drugs may occur at many points in the handling of these drugs.
- Hazardous drugs that must be reconstituted, transferred from one container to another, or manipulated before administration to patients can be a potential exposure point. Even if care is taken, opportunity for absorption through inhalation or direct skin contact can occur.
Manipulations that can cause splattering, spraying, and aerosolization of hazardous drugs. Such examples include:
- withdrawal of needles from drug vials;
- drug transfer using syringes and needles or filter straws;
- breaking open of ampules; and
- expulsion of air from a drug-filled syringe.
Evaluation of these preparation techniques, using fluorescent dye solutions, has shown contamination of gloves and the sleeves and chest of gowns.
- Horizontal airflow work benches which provide an aseptic environment for the preparation of injectable drugs. However, these units provide a flow of filtered air originating at the back of the work space and exiting toward the employee using the unit. Thus, they increase the likelihood of drug exposure to both the preparer and other personnel in the room.