A list is the starting point
A hazardous drug handling program identifies relevant drugs, evaluates how workers could be exposed, and establishes controls for the actual tasks performed. It should connect pharmacy, nursing, occupational health, environmental services, and other affected roles.
NIOSH describes potential exposures involving some cancer therapies, antivirals, hormone therapies, and bioengineered agents. Workers who prepare or administer drugs are not the only people who may be exposed; receiving, cleaning, and related activities also deserve attention.
The program therefore needs to follow a drug through the workplace, rather than stop at the moment of administration.
Keep identification current
The NIOSH List of Hazardous Drugs in Healthcare Settings, 2024 supersedes its 2016 list. The publication's webpage also contains later notices. A facility should check those updates and relevant manufacturer information when maintaining its own list.
NIOSH recommends a continuing process that assesses new drugs and new hazard information. An old printed list should not become the only decision tool simply because staff recognize it.
List membership identifies a hazard. It does not mean that every formulation, route, and handling task creates the same exposure.
Assess the work that actually occurs
NIOSH's 2023 risk-management guidance considers dosage form, exposure routes, frequency, duration and magnitude of exposure, work practices, and existing controls. It recommends a facility-specific assessment.
A practical review can follow questions such as:
- How does the drug arrive, and what happens if its packaging is damaged?
- Which preparation, administration, transport, cleaning, and waste tasks occur?
- Who performs those tasks, including staff outside the nursing unit?
- Which engineering controls, procedures, and protective equipment apply?
- How are changes in formulation, equipment, or workflow evaluated?
These are program questions, not instructions for compounding or administering a medication. Staff need the approved procedure and training for the particular task.
Plan for an interruption
NIOSH recommends written spill procedures that identify employee responsibilities, readily available spill kits, training, and consideration of drills. Discovering a spill does not automatically make the person who found it the qualified cleanup responder.
For example, a unit might find that its spill kit is accessible but no one on the night shift knows whom to call. A useful corrective action would address response coverage and communication, rather than merely adding another kit.
The program should also connect an exposure event to prompt occupational-health evaluation and its reporting process.
Review controls as conditions change
NIOSH recommends reassessment when procedures or controls change, new drugs enter the workplace, activity increases, or incidents and departures from planned practices reveal a problem.
Keep the program specific enough that a nurse can find the instructions for the drug and task in question. Safety data sheets and product labeling can support that process, but they do not replace a complete handling program.
NIOSH recommendations are guidance. The employer must separately determine the regulatory and professional requirements applicable to its setting.
Sources
- NIOSH: Hazardous Drugs Exposures in Healthcare (accessed 2026-09-17).
- NIOSH: List of Hazardous Drugs in Healthcare Settings, 2024 and updates (accessed 2026-09-17).
- NIOSH: Managing Hazardous Drug Exposures, 2023 (accessed 2026-09-17) — Relevant sections 1–7 reviewed.