Think of the NIOSH List of Hazardous Drugs in the Healthcare Setting as a tool to help you identify drugs that are hazardous to your staff; it is not (and likely will never be) a definitive list of all currently approved drugs with hazardous handling risks. However, following the NIOSH criteria will provide solid guidance as you endeavor to identify safety protocols for your staff who handle HDs.

For example, the new Table 1 includes drugs with manufacturer’s special handling information (MSHI) in the product insert (PI) that are also classified by the National Toxicology Program (NTP) and/or the International Agency for Research on Cancer (IARC) as a known carcinogen/probably carcinogenic. Notably, any HDs in Table 1 that require manipulation are no longer eligible for an Assessment of Risk and rather must follow all USP <800> handling requirements.

Those same criteria can be applied to any of the 473 drugs approved since 2016 that are also on your formulary—or as a best practice, apply the criteria to all 473 drugs regardless of formulary status to accommodate patients’ own drugs that may come into your facility.

When reviewing the PIs of recently approved products, look for indications of special handling requirements. Unfortunately, there is no standard statement for MSHI within PIs. As such, start by searching for key terms such as handle as cytotoxic and handle as genotoxic.

While all handling information within a PI must be followed, it may not be identified as an employee safety initiative; rather, there may be language such as “handle in a BSC,” which should prompt further review of any risks. Consider assigning this PI review process of newly approved drugs as a student project or as an opportunity to undertake an AI-driven initiative.

As always, when navigating this list to develop policies and procedures for safe handling within your facility, consider PP&P as a valuable aid. Let our resources (including our webinars, articles, and special supplements) and best practices from peers across the industry be your guide as you protect your team and patients alike.

All the best,

R. Mitchell Halvorsen
Publisher