CDC logoSafer Healthier People  CDC HomeCDC SearchCDC Health Topics A-Z
NIOSH - National Institute for Occupational Safety and Health

Skip navigation links Search NIOSH  |  NIOSH Home  |  NIOSH Topics  |  Site Index  |  Databases and Information Resources  |  NIOSH Products  |  Contact Us

NIOSH Publication No. 2004-165:

Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings

September 2004

ADDITIONAL INFORMATION

Additional information about exposure to hazardous drugs is available at 1–800–35–NIOSH (1–800–356–4674), fax: 1–513–533–8573, E-mail: pubstaft@cdc.gov, or Web site: www.cdc.gov/NIOSH.

Additional information about hazardous drug safety is available at www.osha.gov.

ACKNOWLEDGMENTS

This Alert was written by G. Edward Burroughs, Ph.D., C.I.H.1; Thomas H. Connor, Ph.D.1; Melissa A. McDiarmid, M.D., M.P.H. 4; Kenneth R. Mead, M.S., P.E. 1; Luci A. Power, M.S., R.Ph. 6; and Lawrence D. Reed, M.S.1

Major contributors to this Alert were Barbara J. Coyle, B.S.N., R.N. C.O.H.N.-S.2; Duane R. Hammond, B.S.M.E.1; Melissa M. Leone, R.N., B.S.N.3; Marty Polovich, M.N., R.N., A.O.C.N.5; and Douglas D. Sharpnack, D.V.M.1

Contributions to this Alert were also made by members of the NIOSH Hazardous Drug Safe Handling Working Group. A complete listing of the agencies and organizations who contributed to this Alert is listed in Appendix C. Anne C. Hamilton, Vanessa Becks, Susan Afanuh, Jane Weber, Andre Allen, Anne Votaw, and Teresa Lewis provided editorial and production services.

1NIOSH; 2State of Wisconsin; 3Apria Healthcare; 4University of Maryland; 5Oncology Nursing Society; 6University of California Medical Center

Support for the development of this Alert was provided by the National Occupational Research Agenda (NORA) Control Technology and Personal Protective Equipment Team and the NORA Reproductive Health Research Team.

Please direct comments, questions, or requests for additional information to the following:

Director, Division of Applied Research and Technology
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Cincinnati, OH 45226–1998

Telephone: 1–513–533–8462 or 1–800–35–NIOSH

REFERENCES

Abel EA [2000]. Immunosuppressant and cytotoxic drugs: unapproved uses or indications. Clin Dermatol 18:95–101.

ACGIH [2004]. TLVs ® and BEIs ® based on the documentation of the threshold limit values for chemical substances and physical agents & biological exposure indices. Cincinnati, OH: American Conference of Government Industrial Hygienists.

ACOEM ( American College of Occupational and Environmental Medicine) [1996]. Committee report: ACOEM reproductive hazard management guidelines. J Occup Environ Med 38(1):83–90.

AGS [1998]. Guidelines for gloveboxes. 2nd ed. Santa Rosa, CA: American Glovebox Society, AGS–G001–1998.

AIHA [2002]. Workplace environmental exposure level guides: 2002 WEELs complete set. Fairfax, VA: American Industrial Hygiene Association, Stock# 547-EA-02.

Anderson RW, Puckett WH Jr., Dana WJ, Nguyen TV, Theiss JC, Matney TS [1982]. Risk of handling injectable antineoplastic agents. Am J Hosp Pharm 39:1881–1887.

Arrington DM, McDiarmid MA [1993]. Comprehensive program for handling hazardous drugs. Am J Hosp Pharm 50:1170–1174.

ASHP (American Society of Hospital Pharmacists) [1990]. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm 47:1033–1049.

ASHP/AHFS DI ( American Hospital Formulary Service Drug Information) [2003]. AHFS drug informationonline updates [www.ashp.org./ahfs/index.cfm].

ASTM [in press]. Draft standard practice for assessment of resistance of chemotherapy gloves to permeation by chemotherapy drugs. West Conshohocken, PA: American Society for Testing and Materials.

Baker ES, Connor TH [1996]. Monitoring occupational exposure to cancer chemotherapy drugs. Am J Health Syst Pharm 53:2713–2723.

Baker GL, Kahl LE, Zee BC, Stolzer BL, Agarwal AK, Medsger TA Jr. [1987]. Malignancy following treatment of rheumatoid arthritis with cyclophosphamide. Long-term case-control follow-up study. Am J Med 83(1):1–9.

Black LA, Presson AC [1997]. Hazardous drugs. Occup Med: State of the Art Rev 12(4):669–685.

BLS [1998]. 1998 national industry-occupational employment matrix. Excludes hospital-based and public agencies. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics [http://stats.bls.gov].

BLS [1999]. 1999 national occupational employment and wage estimates. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics [http://stats.bls.gov].

Bos RP, Sessink PJM [1997]. Biomonitoring of occupational exposure to cytostatic anticancer drugs. Rev Environ Health 12(1):43–58.

Brown KA, Esper P, Kelleher LO, O’Neill JEB, Polovich M, White JM [2001]. Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.

Burgaz S, Özdamar YN, Karakaya AE [1988]. A signal assay for the detection of genotoxic compounds: application on the urines of cancer patients on chemotherapy and of nurses handling cytotoxic drugs. Human Toxicol 7:557–560.

Cass Y, Musgrave CF [1992] Guidelines for the safe handling of excreta contaminated by cytotoxic agents. Am J Hosp Pharm 49(8):1957–1958.

CDC (Centers for Disease Control) [1987]. Recommendations for prevention of HIV transmission in health-care settings. MMWR 36(Suppl No. 2S).

CDC (Centers for Disease Control) [1988]. Perspectives in disease prevention and health promotion update: universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens in health-care settings. MMWR 37(24):377–388.

CDC/NIH [1999]. Biosafety in microbiological and biomedical laboratories (BMBL). 4th ed. Washington, DC: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Institutes of Health [ www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4toc.htm].

CDC/NIH [2000]. Primary containment for biohazards: selection, installation and use of biological safety cabinets. 2nd ed. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention and National Institutes of Health [ www.cdc.gov/od/ohs/biosfty/bsc/bsc.htm].

CFR. Code of Federal regulations. Washington, DC: U.S. Government Printing Office, Office of the Federal Register.

Chabner BA, Allegra CJ, Curt GA, Calabresi P [1996]. Antineoplastic agents. In: Hardman JG, Limbird LE, eds. Goodman and Gilman’s the pharmacological basis of therapeutics. 9th ed. New York: McGraw-Hill, pp. 1233–1287.

Connor TH [1993]. An evaluation of the permeability of disposable polypropylene-based protective gowns to a battery of cancer chemotherapy drugs. Appl Occup Environ Hyg 8(9):785–789.

Connor TH [1999]. Permeability of nitrile rubber, latex, polyurethane, and neoprene gloves to 18 antineoplastic drugs. Am J Health Syst Pharm 56:2450–2453.

Connor TH, Anderson RW, Sessink PJ, Broadfield L, Power LA [1999]. Surface contamination with antineoplastic agents in six cancer treatment centers in Canada and the United States. Am J Health Syst Pharm 56:1427–1432.

Connor TH, Shults M, Fraser MP [2000]. Determination of the vaporization of solutions of mutagenic antineoplastic agents at 23 and 37º C using a desiccator technique. Mutat Res 470:85–92.

Connor TH, Anderson RW, Sessink PJ, Spivey SM [2002]. Effectiveness of a closed-system device in containing surface contamination with cyclophosphamide and ifosfamide in an i.v. admixture area. Am J Health Syst Pharm 59:68–72.

Delporte JP, Chenoix P, Hubert Ph [1999]. Chemical contamination of the primary packaging of 5-fluorouracil RTU solutions commercially available on the Belgian market. Eur Hosp Pharm 5(3):119–121.

Donner AL [1978]. Possible risk of working with antineoplastic drugs in horizontal laminar flow hoods [letter to the editor]. Am J Hosp Pharm 35:900.

Dorr RT [1983]. Practical techniques for preparation and administration of cytotoxic agents. Presented at Practical Approaches to Safe Handling of Anticancer Products, Mayaguez, Puerto Rico, Nov. 2–5.

Dorr RT, Alberts DS [1992]. Topical absorption and inactivation of cytotoxic anticancer agents in vitro. Cancer 70(4)(Suppl):983–987.

Duvall E, Baumann B [1980]. An unusual accident during the administration of chemotherapy. Cancer Nurs 3(4):305–306.

Ensslin AS, Stoll Y, Pethran A, Pfaller A, Römmelt H, Fruhmann G [1994]. Biological monitoring of cyclophosphamide and ifosfamide in urine of hospital personnel occupationally exposed to cytostatic drugs. Occup Environ Med 51:229–233.

Ensslin AS, Huber R, Pethran A, Römmelt H, Schierl R, Kulka U, Fruhmann G [1997]. Biological monitoring of hospital pharmacy personnel occupationally exposed to cytostatic drugs: urinary excretion and cytogenetics studies. Int Arch Occup Environ Health 70:205–208.

EPA [2001]. Managing hazardous waste: a guide for small businesses. Washington, DC: U.S. Environmental Protection Agency, Report No. EPA530–K–01–005.

Erlichman C, Moore MJ [1996]. Carcinogenesis: a late complication of cancer chemotherapy. In: Chabner BA, Longo DL, eds. Cancer chemotherapy and biotherapy: principles and practice. 2nd ed. Philadelphia, PA: Lippincott-Raven, pp. 45–58.

Falck K, Gröhn P, Sorsa M, Vainio H, Heinonen E, Holsti LR [1979]. Mutagenicity in urine of nurses handling cytostatic drugs. Lancet 1(8128):1250–1251.

Favier B, Gilles L, Ardiet C, Latour JF [2003]. External contamination of vials containing cytotoxic agents supplied by pharmaceutical manufacturers. J Oncol Pharm Pract 9:15–20.

51 Fed. Reg. 34006–34012 [1986]. USEPA (Environmental Protection Agency): Guidelines for mutagenicity risk assessment.

56 Fed. Reg. 63798–63826 [1991]. USEPA (Environmental Protection Agency): Guidelines for developmental toxicity risk assessment.

61 Fed. Reg. 56274–56322 [1996a]. USEPA (Environmental Protection Agency): Guidelines for reproductive toxicity risk assessment.

61 Fed. Reg. 17960–18011 [1996b]. USEPA (Environmental Protection Agency): Proposed guidelines for carcinogen risk assessment.

Fransman W, Vermeulen R, Kromhout H [2004]. Occupational dermal exposure to cyclophosphamide in Dutch hospitals: a pilot study. Ann Occup Hyg 48(3):237–244.

Fuchs J, Hengstler JG, Jung D, Hiltl G, Konietzko J, Oesch F [1995]. DNA damage in nurses handling antineoplastic agents. Mutat Res 342:17–23.

Galassi A, Hubbard SM, Alexander HR, Steinhaus E [1996]. Chemotherapy administration: practical guidelines. In: Chabner BA, Longo DL, eds. Cancer chemotherapy and biotherapy: principles and practice. 2nd ed. Philadelphia, PA: Lippincott-Raven, pp. 529–551.

Harris CC [1975]. Immunosuppressive anticancer drugs in man: their oncogenic potential. Radiol 114(1):163–166.

Harris CC [1976]. The carcinogenicity of anticancer drugs: a hazard to man. Cancer 37(2)(Suppl):1014–1023.

Harrison BR [2001]. Risks of handling cytotoxic drugs. In: Perry MC ed., The chemotherapy source book. 3rd ed. Philadelphia, PA: Lippincott, Williams and Wilkins, pp. 566–582.

Harrison BR, Kloos MD [1999]. Penetration and splash protection of six disposable gown materials against fifteen antineoplastic drugs. J Oncol Pharm Pract 5(2):61–66.

Harrison BR, Schultz CD [2000]. Determination of tablet trituration dust in work zone air. J Oncol Pharm Pract 6(1):23.

Harrison BR, Godefroid RJ, Kavanaugh EA [1996]. Quality-assurance testing of staff pharmacists handling cytotoxic agents. Am J Health Syst Pharm 53:402–407.

Hemminki K, Kyyrönen P, Lindbohm M-L [1985]. Spontaneous abortions and malformations in the offspring of nurses exposed to anesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J Epidemiol Commun Health 39:141–147.

Hepp R, Gentschew G [1998]. External contamination of commercially available cytotoxic drugs (in German). Krankenhauspharmazie 19(1):22–27.

Hewitt JB [1997]. Health effects of occupational exposure to antineoplastic drugs: an integrative research approach. Ontario, Canada: Ministry of Labour, Industrial Disease Panel.

IARC [1979]. IARC monographs: chemicals and industrial processes associated with cancer in humans: 20 Vols. Lyons, France: World Health Organization, International Agency for Research on Cancer, pp. 1–70.

IARC [2004]. IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Lyons, France: World Health Organization, International Agency for Research on Cancer. [www.iarc.fr]. Date accessed: March 2004.

Johansson H [1979]. How hazardous are cytotoxic agents to personnel? (in Swedish). Vardfacket 3(1):10–16.

Kevekordes S, Gebel TW, Hellwig M, Dames W, Dunkelberg H [1998]. Human effect monitoring in cases of occupational exposure to antineoplastic drugs: a method comparison. Occup Environ Med 55:145–149.

Kiffmeyer TK, Kube C, Opiolka S, Schmidt KG, Schöppe G, Sessink PJM [2002]. Vapor pressures, evaporation behaviour and airborne concentrations of hazardous drugs: implications for occupational safety. Pharmeaceut J 268:331–337.

Klein M, Lambov N, Samev N, Carstens G [2003]. Permeation of cytotoxic formulations through swatches from selected medical gloves. Am J Health Syst Pharm 60:1006–1011.

Kleinberg ML, Quinn MJ [1981]. Airborne drug levels in a laminar-flow hood. Am J Hosp Pharm 38:1301–1303.

Kromhout H, Hoek F, Uitterhoeve R, Huijbers R, Overmars RF, Anzion R, Vermeulen R [2000]. Postulating a dermal pathway for exposure to antineoplastic drugs among hospital workers. Applying a conceptual model to the results of three workplace surveys. Ann Occup Hyg 44(7):551–560.

Krstev S, Peruničić B, Vidakovic A [2003]. Work practice and some adverse health effects in nurses handling antineoplastic drugs. Med Lav 94(5):432–439.

Kusnetz E, Condon M [2003]. Acute effects from occupational exposure to antineoplastic drugs in a para-professional health care worker. Am J Ind Med 44:107–109.

Larson RR, Khazaeli MB, Dillon HK [2003]. A new monitoring method using solid sorbent media for evaluation of airborne cyclophosphamide and other antineoplastic agents. Appl Occup Environ Hyg 18(2):120–131.

Levin LI, Holly EA, Seward JP [1993]. Bladder cancer in a 39-year-old female pharmacist. J Natl Cancer Inst 85(13):1089–1091.

Mader RM, Rizovski B, Steger GG, Wachter A, Kotz R, Rainer H [1996]. Exposure of oncologic nurses to methotrexate in the treatment of osteosarcoma. Arch Environ Health 51(4):310–314.

Mahon SM, Casperson DS, Yackzan S, Goodner S, Hasse B, Hawkins J, Parham J, Rimkus C, Schlomer M, Witcher V [1994]. Safe handling practices of cytotoxic drugs: the results of a chapter survey. Oncol Nurs Forum 21(7):1157–1165.

Mason HJ, Morton J, Garfitt SJ, Iqbal S, Jones K [2003]. Cytotoxic drug contamination on the outside of vials delivered to a hospital pharmacy. Ann Occup Hyg 47(8):681–685.

McDevitt JJ, Lees PSJ, McDiarmid MA [1993]. Exposure of hospital pharmacists and nurses to antineoplastic agents. J Occup Med 35(1):57–60.

McDiarmid M, Egan T [1988]. Acute occupational exposure to antineoplastic agents. J Occup Med 30(12):984–987.

McDiarmid MA, Egan T, Furio M, Bonacci M, Watts SR [1986]. Sampling for airborne fluorouracil in a hospital drug preparation area. Am J Hosp Pharmacy 43:1942–1945.

McDiarmid MA, Gurley HT, Arrington D [1991]. Pharmaceuticals as hospital hazards: managing the risks. J Occup Med 33(2):155–158.

McDiarmid MA, Kolodner K, Humphrey F, Putman D, Jacobson-Kram D [1992]. Baseline and phosphoramide mustard-induced sister-chromatid exchanges in pharmacists handling anti-cancer drugs. Mutat Res 279:199–204.

McInnes S, Schilsky RL [1996]. Infertility following cancer chemotherapy. In: Chabner BA, Longo DL, eds. Cancer chemotherapy and biotherapy: principles and practice. 2nd ed. Philadelphia, PA: Lippincott-Raven, pp. 31–44.

Micoli G, Turci R, Arpellini M, Minoia C [2001]. Determination of 5-fluorouracil in environmental samples by solid-phase extraction and high-performance liquid chromatography with untraviolet detection. J Chromatogr B 750:25–32.

Minoia C, Turci R, Sottani C, Schiavi A, Perbellini L, Angeleri S, Draicchio F, Apostoli P [1998]. Application of high performance liquid chromatography/tandem mass spectrometry in the environmental and biological monitoring of healthcare personnel occupationally exposed to cyclophosphamide and ifosfamide. Rapid Commun Mass Spectrom 12:1485–1493.

Moody DJ, Kagan J, Liao D, Ellison GW, Myers LW [1987]. Administration of monthly-pulse cyclophosphamide in multiple sclerosis patients. Effects of long-term treatment on immunologic parameters. J Neuroimmunol 14(2):161–173.

Naumann BD, Sargent EV [1997]. Setting occupational exposure limits for pharmaceuticals. Occup Med: State of the Art Rev 12(1):67–80.

NCHS ( National Center for Health Statistics) [1996]. Vital and health statistics: the national home and hospice care survey, 1996 summary. Series 13: data from the National Health Care Survey No. 141 [www.cdc.gov/nchs/fastats/homehosp.htm]. Date accessed: 2001.

Neal AdW, Wadden RA, Chlou WL [1983]. Exposure of hospital workers to airborne antineoplastic agents. Am J Hosp Pharm 40:597–601.

Ng LM, Jaffe N [1970]. Possible hazards of handling antineoplastic drugs [letters to the editor]. Pediatrics 46(4):648–649.

Nguyen TV, Theiss JC, Matney TS [1982]. Exposure of pharmacy personnel to mutagenic antineoplastic drugs. Cancer Res 42:4792–4796.

Nieweg RMB, de Boer M, Dubbleman RC, Gall HE, Hesselman GM, Lenssen PCHP, van Maanen LWGM, Majoor PWFM, Ouwerkerk J, Slegt JH. [1994]. Safe handling of antineoplastic drugs. Cancer Nurs 17:501–511.

NIH [2002]. 1999 recommendations for the safe handling of cytotoxic drugs. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, NIH Publication No. 92–2621. [www.nih.gov/od/ors/ds/pubs/cyto]. Date accessed: March 28.

Nikula E, Kiviniitty K, Leisti J, Taskinen PJ [1984]. Chromosomal aberrations in lymphocytes of nurses handling cytostatic agents. Scand J Work Environ Health 10:71–74.

NIOSH [1997]. NIOSH alert: preventing allergic reactions to natural rubber latex in the workplace. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 97–135.

NIOSH [2004]. Arsenic. In: NIOSH pocket guide to chemical hazards. Washington, DC: 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. 97–140.

Norppa H, Sorsa M, Vainio H, Gröhn P, Heinonen E, Holsti L, Nordman E [1980]. Increased sister chromatid exchange frequencies in lymphocytes of nurses handling cytostatic drugs. Scand J Work Environ Health 6:299–301.

NSF/ANSI [2002]. Class II (laminar flow) biosafety cabinetry: NSF International standard/American National standard for biosafety cabinetry. Ann Arbor, MI: National Sanitation Foundation and American National Standards Institute, NSF/ANSI 49–2002. [www.nsf.org/biohazard/bio_standards.htm l]. Date accessed: March 28.

Nygren O, Lundgren C [1997]. Determination of platinum in workroom air and in blood and urine from nursing staff attending patients receiving cisplatin chemotherapy. Int Arch Occup Environ Health 70:209–214.

Nygren O, Gustavsson B, Ström L, Friberg A [2002]. Cisplatin contamination observed on the outside of drug vials. Ann Occup Hyg 46(6):555–557.

OSHA [1986]. Guidelines for cytotoxic (antineoplastic) drugs. Washington, DC: Department of Labor, Occupational Safety and Health Administration, Office of Occupational Medicine Publication No. 8–1.1.

OSHA [1995]. OSHA Instruction TED (training and education directive), 1.15 directorate of technical support: controlling occupational exposure to hazardous drugs. Washington, DC: Occupational Safety and Health Administration.

OSHA [1999]. OSHA technical manual, TED 1–0.15A, Sec VI, Chapt II: Categorization of drugs as hazardous. [www.osha.gov/dts/osta/ otm/otm_vi/otm_vi_2.html#2]. Date accessed: January 20.

PDA [2001]. Technical report no. 34: design and validation of isolator systems for the manufacturing and testing of health care products. PDA J Pharm Sci Technol 55(5)(Suppl TR34).

PDR [2004]. Physician’s desk reference for drug interactions. Montvale, NJ: Thomson Healthcare [www.pdr.net/pdrnet]. Date accessed: March 9.

Peelen S, Roeleveld N, Heederik D, Krombout H, de Kort W [1999]. Toxic effects on reproduction in hospital personnel (in Dutch). Reproductie-toxische effecten bij ziekenhuispersonel. Netherlands: Elsivier.

Pethran A, Hauff K, Hessel H, Grimm C-H [1998]. Biological, cytogenetic, and ambient monitoring of exposure to antineoplastic drugs. J Oncol Pharm Practice 4:57.

Pethran A, Schierl R, Hauff K, Grimm C-H, Boos K-S, Nowak D [2003]. Uptake of antineoplastic agents in pharmacy and hospital personnel. Part 1: monitoring of urinary concentrations. Int Arch Occup Environ Health 76:5–10.

Polovich M, ed. [2003]. Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.

Pyy L, Sorsa M, Hakala E [1988]. Ambient monitoring of cyclophosphamide in manufacture and hospitals. Am Ind Hyg Assoc J 49(6):314–317.

REPROTOX [2003]. An information system on environmental hazards to human reproduction and development. Washington, DC: Columbia Hospital for Women Medical Center, Reproductive Toxicology Center [http://reprotox.org]. Date accessed: February 2004.

Rogers B, Emmett EA [1987]. Handling antineoplastic agents: urine mutagenicity in nurses. IMAGE: J Nurs Scholarsh 19:108–113.

Ros JJW, Simons KA, Verzijl JM, de Bijl GA, Pelders MG [1997]. Practical applications of a validated method of analysis for the detection of traces of cyclophosphamide on injection bottles and at oncological outpatient center (in Dutch). Ziekenhuisfarmacie 13:168–171.

Rosenthal RC [1996]. Multimodality therapy: using the best available treatments together rationally. Vet Clin North Am Small Anim Pract 26(1):1–8.

Rubino FM, Floridia L, Pietropaolo AM, Tavazzani M, Colombi A [1999]. Measurement of surface contamination by certain antineoplastic drugs using high-performance liquid chromatography: applications in occupational hygiene investigations in hospital environments. Med Lav 90(4):572–583.

Sargent EV, Kirk GD [1988]. Establishing airborne exposure control limits in the pharmaceutical industry. Am Ind Hyg Assoc J 49(6):309–313.

Sargent EV, Naumann BD, Dolan DG, Faria EC, Schulman L [2002]. The importance of human data in the establishment of occupational exposure limits. Hum Ecol Risk Assess 8(4):805–822.

Schardein, JL [2000]. Chemically induced birth defects. 3rd ed., rev. New York: Marcel Deckker, Inc.

Schmähl D, Habs M [1978]. Experimental carcinogenesis of antitumor drugs. Cancer Treat Rev 5(4):175–184.

Schmaus G, Schierl R, Funck S [2002]. Monitoring surface contamination by antineoplastic drugs using gas chromatography-mass spectrometry and voltammetry. Am J Health Syst Pharm 59:956–961.

Schreiber C, Radon K, Pethran A, Schierl R, Hauff K, Grimm C-H, Boos K-S, Nowak D. [2003]. Uptake of antineoplastic agents in pharmacy personnel. Part 2: study of work-related risk factors. Int Arch Occup Environ Health 76:11–16.

Selevan SG, Lindbohm M-L, Hornung RW, Hemminki K [1985]. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med 313(19):1173–1178.

Sessink PJM, Bos RP [1999]. Drugs hazardous to healthcare workers: evaluation of methods for monitoring occupational exposure to cytostatic drugs. Drug Saf 20(4):347–359.

Sessink PJM, Anzion RBM, Van der Broek PHH, Bos RP [1992a]. Detection of contamination with antineoplastic agents in a hospital pharmacy department. Pharm Week Sci 14:16–22.

Sessink PJM, Boer KA, Scheefhals APH, Anzion RBM, Bos RP [1992b]. Occupational exposure to antineoplastic agents at several departments in a hospital: environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. Int Arch Occup Environ Health 64:105–112.

Sessink PJM, Cerná M, Rössner P, Pastorková A, Bavarová H, Franková K, Anzion RBM, Bos RP [1994a]. Urinary cyclophosphamide excretion and chromosomal aberrations in peripheral blood lymphocytes after occupational exposure to antineoplastic agents. Mutat Res 309:193–199.

Sessink PJM, Van der Kerkhof MCA, Anzion RBM, Noordhoek J, Bos RP [1994b]. Environmental contamination and assessment of exposure to antineoplastic agents by determination of cyclophosphamide in urine of exposed pharmacy technicians: is skin absorption an important exposure route? Arch Environ Health 49(3):165–169.

Sessink PJM, Rolf M-AE, Ryden NS [1999]. Evaluation of the PhaSeal hazardous drug containment system. Hosp Pharm 34:1311–1317.

Sessink PJM, Wittenhorst BCJ, Anzion RBM, Bos RP [1997]. Exposure of pharmacy technicians to antineoplastic agents: reevaluation after additional protective measures. Arch Environ Health 52(3):240–244.

Shahsavarani S, Godefroid RJ, Harrison BR [1993]. Evaluation of occupational exposure to tablet trituration dust [Abstract]. Presented at the 28th Annual ASHP Midyear Clinical Meeting, Atlanta, GA, December 28.

Shepard TH [2001]. Catalog of teratogenic agents. 10th ed. Baltimore, MD: Johns Hopkins University Press [ www.depts.washington.edu/~terisweb]. Date accessed: Feb. 2004.

Shimkin MB, Weisburger JH, Weisburger EK, Gubareff N, Suntzeff V [1966]. Bioassay of 29 alkylating chemicals by the pulmonary-tumor response in strain A mice. J Natl Cancer Inst 36:915–935.

Singleton LC, Connor TH [1999]. An evaluation of the permeability of chemotherapy gloves to three cancer chemotherapy drugs. Oncol Nurs Forum 26(9):1491–1496.

Skov T, Lynge E, Maarup B, Olsen J, Rørth M, Winthereik H [1990]. Risk for physicians handling antineoplastic drugs [letter to the editor]. The Lancet 336:1446.

Skov T, Maarup B, Olsen J, Rørth M, Winthereik H, Lynge E [1992]. Leukaemia and reproductive outcome among nurses handling antineoplastic drugs. Br J Ind Med 49:855–861.

Smith CA [2002]. Managing pharmaceutical wastewhat pharmacists should know. J Pharm Soc Wis (Nov/Dec):17–22.

Sorsa M, Anderson D [1996]. Monitoring of occupational exposure to cytostatic anticancer agents. Mutat Res 355:253–261.

Sorsa M, Hemminki K, Vainio H [1985]. Occupational exposure to anticancer drugspotential and real hazards. Mutat Res 154:135–149.

Spivey S, Connor TH [2003]. Determining sources of workplace contamination with antineoplastic drugs and comparing conventional IV drug preparation with a closed system. Hosp Pharm 38(2):135–139.

Stuart OA, Stephens AD, Welch L, Sugerbaker PH [2002]. Safety monitoring of the coliseum technique for heated intraoperative intraperitoneal chemotherapy with mitomycin C. Ann Surg Oncol 9(2):186–191.

Stücker I, Caillard J-F, Collin R, Gout M, Poyen D, Hémon D [1990]. Risk of spontaneous abortion among nurses handling antineoplastic drugs. Scand J Work Environ Health 16:102–107.

Sweetman SC, ed. [2002]. Martindale: the complete drug reference. 33rd ed. London, UK: The Royal Pharmaceutical Society of Great Britain [jmcglashan@rpsgb.org.uk].

Takada S [2003]. Principles of chemotherapy safety procedures. Clin Tech Small Anim Pract 18(2):73–74.

Thompson CA [2003]. USP publishes enforceable chapter on sterile compounding. Am J Health Syst Pharm 60:1814–1817.

Ündeğer Ü, Baþaran N, Kars A, Güç D [1999]. Assessment of DNA damage in nurses handling antineoplastic drugs by the alkaline COMET assay. Mutat Res 439:277–285.

U.S. Census Bureau [1997]. U.S. Census Bureau: 1997 economic census data [www.census.gov]. Date accessed: March 2004.

USC. United States code. Washington, DC: U.S. Government Printing Office.

USP [2004]. Chapter <797> Pharmaceutical compoundings)—sterile preparations. In: United States Pharmacopeia and National Formulary (USP–NF).

Valanis B, McNeil V, Driscoll K [1991]. Staff members’ compliance with their facility’s antineoplastic drug handling policy. Onc Nurs Forum 18(3):571–576.

Valanis BG, Vollmer WM, Labuhn KT, Glass AG [1993a]. Acute symptoms associated with antineoplastic drug handling among nurses. Cancer Nurs 16(4):288–295.

Valanis BG, Vollmer WM, Labuhn KT, Glass AG [1993b]. Association of antineoplastic drug handling with acute adverse effects in pharmacy personnel. Am J Hosp Pharm 50:455–462.

Valanis B, Vollmer W, Labuhn K, Glass A [1997]. Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists. J Occup Environ Med 39(6):574–580.

Valanis B, Vollmer WM, Labuhn K, Glass A, Corelle C [1992]. Antineoplastic drug handling protection after OSHA guidelines: comparison by profession, handling activity, and work site. J Occup Med 34:149–155.

Valanis B, Vollmer WM, Steele P [1999]. Occupational exposure to antineoplastic agents: self-reported miscarriages and stillbirths among nurses and pharmacists. J Occup Environ Med 41(8):632–638.

Vandenbroucke J, Robays H [2001]. How to protect environment and employees against cytotoxic agents, the UZ Ghent experience. J Oncol Pharm Practice 6(4):146–152.

Walusiak J, Wittczak T, Ruta U, Palczynski C [2002]. Occupational asthma due to mitoxantrone. Allergy 57(5):461.

Weisburger JH, Griswold DP, Prejean JD, Casey AE, Wood HB, Weisburger EK [1975]. The carcinogenic properties of some of the principal drugs used in clinical cancer chemotherapy. Recent Results Cancer Res 52:1–17.

White SK, Stephens AD, Dowjat B, Sugarbaker PH [1996]. Safety constiderations [sic] in the use of intraoperative intraperitoneal chemotherapy. Cancer Treat Res 82:311–316.

Wick C, Slawson MH, Jorgenson JA, Tyler LS [2003]. Using a closed-system protective device to reduce personnel exposure to antineoplastic agents. Am J Health Syst Pharm 60:2314–2320.

 
left arrow Previous
Next right arrow

NIOSH Home
 |  NIOSH Search  | Site Index  | Topic List | Contact Us