An antineoplastic agent is a chemotherapeutic agent that controls or kills cancer cells. Antineoplastic drugs are cytotoxic (inhibit or prevent cell function) but generally more damaging to dividing cells than resting cells. Antineoplastic drugs are a subset of hazardous drugs.
A hazardous drug is identified by one of the following criteria: carcinogenicity; teratogenicity or developmental toxicity; reproductive toxicity in humans; organ toxicity at low doses in humans or animals; genotoxicity; or new drugs that mimic existing hazardous drugs in structure or toxicity.
Occupational exposure to antineoplastic agents in healthcare settings can occur to several groups of workers ranging from the pharmacists and pharmacy technicians who prepare and measure the doses of medication that are to be administered to the patient and the physicians and nursing personnel who administer the drugs to patients, to housekeeping personnel who must dispose of drug contaminated waste, included discarded personal protective clothing. Exposure to antineoplastic drugs can also occur to personnel responsible for maintaining and certifying biological safety cabinets used in the preparation and handling of these drugs.
Another group of occupationally exposed workers can be found in the field of veterinary medicine. Increasingly, domestic animals are developing cancers for which treatment with antineoplastic agents is often used.
What are the hazards associated with antineoplastic drugs?
Occupational exposure to antineoplastic drugs can occur by inhalation, dermal contact or ingestion. In addition to acute or short-term effects related to treatment with antineoplastic agents, there are a number of long-term or chronic effects that include liver and kidney damage, damage to the bone marrow, damage to the lungs and heart, infertility (temporary and permanent), effects on reproduction and the developing fetus in pregnant women, hearing impairment and cancer.
What can I do to protect myself?
Only individuals trained in the safe handling of antineoplastic drugs should be involved in their use. Annual retraining in the hazards of antineoplastic drugs is recommended, including the procedures to follow in the event of a spill. Proper personal protective clothing and equipment must always be used when working with antineoplastic drugs. Pharmacists and others who prepare antineoplastic drugs for administration to patients should use a Class II or Class III biological safety cabinet (BSC) that has been certified to maintain the correct air flow rate.
What resources are available to assist employers?
Safety and Health Programs
Training and Outreach Services
Presentations on personal protective equipment (PPE), respiratory protection and hazard communication are available to assist employers in training their employees and should be modified to address site-specific hazards and conditions.
In addition, the education, training and technical assistance bureau provides free online safety and health training and outreach services (i.e., speaker's bureau requests, safety booths) upon request.
Lastly, the NCDOL Library offers free safety and health videos (including streaming video services) and related research assistance on consensus standards (i.e., ANSI, NFPA, NEC).
A-Z Safety and Health Topics
The consultative services bureau provides free and confidential onsite consultation regarding worksite safety and health hazards.
Which standards apply?
OSH has adopted the following standards which are applicable to antineoplastic agents in North Carolina. Note: Please also check the standards information and activity webpage to see if there has been any recent or upcoming regulatory activity on this topic.
North Carolina General Statute
NCGS 95-156 - handling of dangerous antineoplastic agents
North Carolina Administrative Code
13 NCAC 07G .0101 - handling of antineoplastic agents
In addition, OSH has adopted the following general industry standards relevant to antineoplastic drugs in North Carolina:
29 CFR 1910.132 - personal protective equipment, general requirements
29 CFR 1910.134 - respiratory protection
29 CFR 1910.1000 - air contaminants
29 CFR 1910.1200 - hazard communication
Other Applicable Standards
In addition, the Which OSHA Standards Apply webpage can help identify other standards that may be applicable to your worksite.
Where can I learn more?
- National Institute for Occupational Safety and Health (NIOSH) Alert:Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings, published in September 2004 is incorporated by reference in 13 NCAC 07G.0101.
- Industry Guide 49 - OSHA General Industry Standards Requiring Programs, Inspections, Procedures, Records and/or Training provides requirements for standards related to antineoplastic agents in general industry.
If you would like to receive interpretive guidance on this or any other OSH standard or topic, you can submit your questions using the Ask OSH web form, by e-mail to email@example.com or by calling 919-707-7876.