HAZARDOUS DRUG EXPOSURES IN HEALTHCARE

This section includes articles published on this topic during the past three years.

• Anastasi M, Rudaz S, Lamerie TQ, Odou P, Bonnabry P and Fleury-Souverain S. Efficacy of two cleaning solutions for the decontamination of 10 antineoplastic agents in the biosafety cabinets of a hospital pharmacy. Ann Occup Hyg. 2015; 59:895-908.
• Aguero D and Marge K. Developing a USP <800> compliance gap analysis. Pharm Purch Prod. January 2017; 14 (1):10-12.
• Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4): 249-257.
• AIHA Healthcare Working Group Hazardous Drugs Project Team. Chemotherapy hood decommissioning for disposal or recycling. Fact sheet. Approved by AIHA Board: October 17, 2016. Falls Church, VA: American Industrial Hygiene Association (AIHA).
• Al-Azzam SI, Awawdeh BT, Alzoubi KH, Khader YS and Alkafajei AM. Compliance with safer handling guidelines of antineoplastic drugs in Jordanian hospitals. J Oncol Pharm Pract. 2015; 21(1):3-9.
• Alexander M, King J, Lingaratnam S, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A survey of manufacturing and handling practices for monoclonal antibodies by pharmacy, nursing and medical personnel. J Oncol Pharm Pract. 2016; 22(2):219-227.
• Anastasi M, Rudaz S, Queruau Lamerie T, Odou P, Bonnabry P and Fleury-Souverain S. Efficacy of two cleaning solutions for the decontamination of 10 antineoplastic agents in the biosafety cabinets of a hospital pharmacy. Ann Occup Hyg. 2015; 59:895–908.
• Barle EL, Winkler GC, Glowienke S, Elhajouji A, Nunic J and Martus HJ. Setting occupational exposure limits for genotoxic substance in the pharmaceutical industry. Toxicol Sci. 2016; 151:2-9.
• Beaver CC and Magnan MA. Minimizing staff exposure to antineoplastic agents during intravesical therapy. Clin J Oncol Nurs. 2015; 19:393-395.
• Berdi F, Powell MF, Sanz C, Gonzalez R and Massoomi F. Assessing the efficiency of CSTDs for compounding. Pharm Purch Products. 2015; 12:4-7.
• Berdi F, Powell M, Sanz C, Gonzalez R and Massoomi F. Assessing the efficiency of CSTDs for compounding. Pharm Purch Prod. July 2015; 12 (7) Supp.
• Berruyer M, Tanguay C, Caron NJ, Lefebvre M, Bussières. Multicenter study of environmental contamination with antineoplastic drugs in 36 Canadian hospitals: A 2013 follow-up study. J Occup Environ Hyg. 2015; 12:87-94.
• Bohlandt A, Groeneveld S, Fischer E and Schierl R. Cleaning Efficiencies of three cleaning agents on four different surfaces after contamination by Gemcitabine and 5-fluorouracile. J Occup Environ Hyg. 2015; 12:384-392.
• Boiano JM, Steege AL and Sweeney MH. Adherence to precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. J Occup Environ Hyg. 2015. (epub. DOI: 10.1080/15459624.2015.1029610).
• Canal-Raffin M, Khennoufa K, Martinez B, et al. Highly sensitive LC-MS/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide, ifosfamide, and methotrexate antineoplastic drugs and routine application. J Chromatogr B. 2016; 1038:109–117.
• Cass Y, Connor TH and Tabachnik A. Safe handling of oral antineoplastic medications: focus on targeted therapeutics in the home setting. J Oncol Pharm Practice. 2017; 23:350–378.
• Connor TH, Douglass K, Eisenberg S, Kastango ES, Kienle PC, Massoomi F and Parsad SD. Improving safe handling practices for hazardous drugs: toolkit. Mansur J, contributing editor. 2016. Joint Commission Resources (www.jcrinc.com).
• Connor TH, Celano P, Frame JN and Zan RT. Summary of the Workshop on the Safe Handling of Hazardous Drugs Cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical Oncology. J Oncol Pract 2017; 13:199-205.
• Connor, TH, Power LA, Massoomi F and Polovich M. White glove test for safety. ECNews. 2015; 18: 6-7, 11.
• Connor TH, Power LA, Massoomi F and Polovich M. Are gloves and gowns safe for handling chemotherapy? Pharm Purchasing and Products. 2015; 12:2,4.
• Connor TH and Smith JP. New approaches to wipe sampling methods for antineoplastic and other hazardous drugs in healthcare settings. Pharm Technol Hosp Pharm. 2016; (Epub ahead of printing) DOI: 10.1515/pthp-2016-0009.
• Connor TH, Zock MD and Snow AH. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: methodology and recommendations. J Occup Environ Hyg. 2016; 13:658–667.
• Cox J, Speed V, O’Neal S, Hasselwander T, Sherwood C, Eckel SF and Zamboni WC. Development and evaluation of a novel product to remove surface contamination of hazardous drugs. J Oncol Pharm Pract 2015 (epub ahead of print) DOI:10.1177/1078155215621151.
• Cox J, Speed V, O’Neal S, Hasselwander T, Sherwood C, Eckel SF and Zamboni WC. Development and evaluation of a novel product to remove surface contamination of hazardous drugs. J Oncol Pharm Pract. 2016; (Epub ahead of printing) DOI 10.1177/1078155215621151.
• Cytotoxic Drugs and Related Waste: A Risk Management Guide for South Australian Health Services.
• Dal Bello F, Santoro V, Scarpino V, Martano C, Aigotti R, Chiappa A, Davoli E and Medana C. Antineoplastic drugs determination by HPLC-HRMSn to monitor occupational exposure. Drug Test Anal. 2015. (Epub ahead of print). DOI: 10.1002/dta.1827
• DeJoy DM, Smith TD, Woldu H, Dyal M-A, Steege AL and Boiano JM. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. J Occup Environ Hyg. 2017; 14:485-493.
• Dekyndt B, Decaudin B, Lannoy D and Odou P. Economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries. J Oncol Pharm Practice. 2015; 21:102-110.
• Douglas K, Richter A, Dorey M and Rizvi I. Refining PPE usage for HD compounding: Part 1. Pharm Pract Prod. 2017; February 2017 14 (2):18-21.
• Easty AC, Coakley N, Cheng A, Cividino M, Savage P, Tozer R and White RE. Safe handling of cytotoxics: guideline recommendations. Curr Oncol. 2015; 22:e27-e37.
• Eberwein SM and Amerine LB. Comparison of USP <800> gap analysis tools. Pharm Purch Prod. April 2017; 14 (4) 12-13.
• Eisenberg S. Hazardous drug handling in light of USP <800>. Pharm Purchasing and Products. 2015; 12(2):18-19.
• Eisenberg S. Hazardous drugs and USP <800>: implications for nurses. Clin J Oncol Nurs. 2017; 21:179–187.
• Eisenberg S. A call to action for hazardous drug safety: Where we have been and where we are going. Clin J Onc Nurs. 2016; 20: A1-A8.
• Eisenberg S. A call to action for hazardous drug safety: where we have been and where we are now. Clin J Oncol Nurs. 2016; 20:20-4AP.
• Fabrizi G, Fioretti M and Rocca LM. Dispersive solid-phase extraction procedure coupled to UPLC-ESI-MS/MS analysis for the simultaneous determination of thirteen cytotoxic drugs in human urine. Biomed Chromatogr. 2016; 30:1297-1308.
• Federica DB, Santoro V, Scarpino V, Martano C, Aigotti R, Chiappa A, Davoli E and Medana C. Antineoplastic drugs determination by HPLC-HRMSn to monitor occupational exposure. Drug Test Anal. 2016; 8:730-737.
• Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F and Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): a French multicentric survey. Eur J Surg Oncol. 2015; 41:1361-1367.
• Fleury-Souverain S, Mattiuzzo M, Mehl F, Nussbaumer S, Bouchoud L, Falaschi L, Gex-Fabry M, Rudaz S, Sadeghipour F and Bonnabry P. Evaluation of chemical contamination of surfaces during the preparation of chemotherapies in 24 hospital pharmacies. Eur J Hosp Pharm. 2015; 22:333-341.
• Friese CR, McArdle C, Zhao T, Sun D, Spasojevic I, Polovich M and McCullagh MC. Antineoplastic drug exposure in an ambulatory setting. Cancer Nurs. 2015; 38(2):111-117.
• Garrigue P, Montana M, Ventre C, Gauthier-Villano L, Pisano P and Pourroy B. Safe cytotoxic drug preparation using closed-system transfer device: technical and practical evaluation of a new device (Vialshield/Texium) comparatively to a reference one (Phaseal). Int J Pharm Compounding. 2016; 20:148-154.
• Gomez-Alvarez S, Porta-Oltra B, Hernandez-Griso M, Perez-Labana F and Climente-Marti M. Evaluacion de dos sistemas cerrados en el proceso de elaboracion de quimioterapia parenteral. Farm Hosp. 2016; 40:36-43.
• Graeve CU, McGovern PM, Alexander B, Church T, Ryan A and Polovich M. Occupational exposure to antineoplastic agents: an analysis of health care workers and their environments. Workplace Health and Safety. 2016 (e-pub; doi: 10.117712.165079916662660).
• Graeve C, McGovern PM, Arnold S and Polovich M. Testing an intervention to decrease healthcare workers’ exposure to antineoplastic agents. ONF April 2017; 44:E10–E19.
• Grases F, Costa-Bauzά A, Bonarriba CR, Pieras EC, Fernάndez RA and Rodrίguez A. On the origin of calcium monohydrate papillary renal stones. Urolithiasis. 2015; 43 (Supp 1):S33-S39.
• Health and Safety Executive. Safe handling of cytotoxic drugs in the workplace.
• He BY, Mendelsohn-Victor K, Mccullagh MC and Friese CR. Personal protective equipment use and hazardous drug spills among ambulatory oncology nurses. ONF 2017; 44: 60–65.
• Ho KV, Edwards MS, Solimando DA Jr, Johnson AD. Determination of extended sterility for single-use vials using the Phaseal closed-system transfer device. J Hematol Oncol Pharm. 2016; 6:46-50.
• Hon CY and Abusitta D. Causes of health care workers’ exposure to antineoplastic drugs: an exploratory study. Can J Hosp Pharm. 2016; 69:216-223.
• Hon CY, Teschke K and Shen H. Healthcare workers’ knowledge, perceptions and behaviors regarding antineoplastic drugs: survey from British Columbia, Canada. J Occup Environ Hyg. 2015; 12:669-677.
• Hon CY, Teschke K, Shen H, Demers PA and Venners S. Antineoplastic drug contamination in the urine of Canadian healthcare workers. Int Arch Occup Environ Health. 2015. DOI 10.1007/s00420-015-1026-1.
• Jeong KW, Lee BY, Kwon MS and Jang JH. Safety management status among nurses handling anticancer drugs: nurse awareness and performance following safety regulations. Asian Pac J Cancer Prev. 2015; 16:3203-3211.
• Jeonimo M, Colombo M, Astrakianakis G and Hon CY. A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers. Anal Bioanal Chem. 2015; 407 (23):7083-92.
• Jorgenson JA and Stevenson JG. Special Report: Closed-system drug-transfer devices: ONB classification and the draft NIOSH protocol. Pharm Pract News. June 2017; Supp:1-4.
• Karpinski J. 2016 Updates to the NIOSH hazardous drug list. Pharm Purch Prod. July 2017; 14 (7):36,38.
• Kibby T. A review of surface wipe sampling compared to biologic monitoring for occupational exposure to antineoplastic drugs. J Occup Environ Hyg. 2017; 14:159–174.
• Kicenuik K, Northrup N, Dawson A, Locke J, Villamil JA, Chretin J, Sfiligoi G, Clifford C, Rosenberg M, Hamilton T, Regan R, Parsons-Doherty M, Mallett C, Philibert J, Imperllizeri J and Hofmeister E. Treatment time, ease of use and cost associated with use of Equashield™, PhaSeal®, or no closed system transfer device for administration of cancer chemotherapy to a dog model. Vet Comp Oncol. 2015 (Epub ahead of print). DOI: 10.1111/vco.12148.
• Kieffer C, Verhaeghe P, Lagrassa S, Gregoire R, Moussaoui Z, Casteras-Ducros C, Clark JE, Vanelle P and Rathelot P. Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units. Eur J Cancer Care. 2015; 24:404-410.
• Kienle PC. Update on proposed USP Chapter <800>. Pharm Purchasing and Products. 2015; 12 (2):2,4.
• King J, Alexander M, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A review of the evidence for occupational exposure risks to novel anticancer agents – A focus on monoclonal antibodies. 2016;22:121-134.
• King J, Alexander M, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A review of the evidence for occupational exposure risks to novel anticancer agents – A focus on monoclonal antibodies. 2016;22:121-134.
• Klahn S. Chemotherapy safety in clinical veterinary oncology. Bet Clin Small Anim. 2014; 44:941-963.
• Krämer I, Federici M. Kaiser V and Thiesen J. Media-fill simulation tests in manual and robotic aseptic preparation of injection solutions in syringes. J Oncol Pharm Pract. 2016; 22:195-204.
• Kunneva L. Closed system drug transfer devices for chemotherapy. Nursing. 2016; 46:67-68.
• Ladeira C, Viega S, Padua M, Carolino E, Gomes MC and Brito M. Genotoxic assessment in different exposure groups working with antineoplastic agents. Occupational Safety and Hygiene III. Arezes PM, Baptista JS, Barroso MP, Carneiro P, Cordeiro P, Nelson C, Melo RB, Miguel AS and Perestrelo G. London: Taylor and Francis Group. 2015. ISBN 978-1-138-02765-7.
• Landeck L, Gonzalez E and Koch OM. Handling chemotherapy drugs – do medical gloves really protect? Int J Cancer. 2015; 137(8): 1800-1805.
• Ledford A and Wetzel B. Constructing an oncology pharmacy. Pharm Purch Prod. May 2017; 14 (5):10-15.
• Le LMM, Reitter D, He S, Bonle FT, Launois A, Martinez D, Prognon P and Caudron E. Safety analysis of occupational exposure of healthcare workers to residual contaminations of cytotoxic drugs using FMECA security approach. Sci Total Environ. 2017 (e-pub; doi: 10.1016/j.scitotenv.2017.05.066).
• Lucas MA and Connor TH. Hazardous drugs: the silent stalker of healthcare workers? Training, education are key to preventing exposures. The Synergist. 2015; January:22-26.
• Massoomi F and Eisenberg S. Pharmacy and nursing collaborate on CSTD training. Pharm Purchasing Prod. 2015; May:12-16.
• Massoomi F. The evolution of the CSTD. Pharm Purchasing and Products. 2015; 12 (2): S1-S12.
• McGowan D. Safe handling and administration of MABS: the guidance. Brit J Nurs. 2015; 24:S14-20.
• Moretti M, Bonfiglioli R, Feretti D, Pavanello S, Mussi F, Grollino MG, Villarini M, Barbieri A, Ceretti E, Carrieri M, Buschini A, Appolloni M, Dominici L, Sabatini L, Gelatti U, Bartolucci GB, Poli P, Stronati L, Mastrangelo G and Monarca S. A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project. BMC Public Health. 2011; 11:195 (http:/Nrww.biomedcentral.com/1471-2458/11/195).
• Moretti M, Grollino MG, Pavanello S, Bonfiglioli R, Villarini M, Appolloni M, Carrieri M, Savatini L, Dominici L, Stronati L, Mastrangelo G, Barbieri A, Fatigoni C, Bartolucci GB, Ceretti E, Mussi F and Monarca S. Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach. Int Arch Occup Environ Health. 2015; 88:683-695.
• Moretti M, Villarini M, Dominici L, Fatigoni C, dell’Omo M, Elisei E, Muzi G and Monarca S. Evaluation of genotoxic effects in subjects occupationally exposed to antineoplastic drugs [in Italian]. Igiene e Sanita Pubblica 2013; 69:55–77.
• Müller-Ramírez C, Squibb K and McDiarmid M. Accessible analytical methodology for assessing workplace contamination of antineoplastic drugs in limited-resource oncology health-care settings. J Anal Sci and Technol. 2016; (Epub ahead of printing) DOI: 10.1186/s40543-016-0091-8.
• Müller-Ramírez C, Squibb K and McDiarmid M. Measuring extent of surface contamination produced by the handling of antineoplastic drugs in low-to-middle-income country oncology health care settings. Arch Occup Environ Health. 2016; (Epub ahead of printing) DOI: 10.1080/19338244.2016.1222346.
• Murashov V and Howard J. Risks to health care workers from nano-enabled medical products. J Occup Environ Hyg. 2015; 12:D75-D85.
• Nurgat Z, Faris D, Mminah M, Vibar A, AL-Jazairi A, Ewing S, Ashour M, Qaisi SK, Balhareth S and AL-Jedai A. A three-year study of a first-generation chemotherapy-compounding robot. Am J Health-Syst Pharm. 2015; 72:1036-1045.
• Page E, Couch JR and de Perio MA. Evaluation of a multiple sclerosis cluster among nurses in an inpatient oncology ward. J Occup Environ Hyg. 2015; 12:D54-59.
• Palma E and Bufarini C. Robotized compounding of oncology drugs in a hospital pharmacy. Int J Pharm Compd. 2014; 18:358-364.
• Panahi D, Azari M, Akbari ME, Zendehdel R, Mirzaei HR, Hatami H and Mehrabi Y. Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug. Environ Monit Assess. 2016; 188:238-243.
• Panahi D, Azari M, Akbari E, Zendehdel R, Mirzaei HR, Itatami H and Mehrnbi Y. Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug. Environ Monit Assess. 2016; 188:238(e-pub; doi: 10.1007/s10661-016-5255-x).
• Polovich M. Minimizing occupational exposure to antineoplastic agents. J Infus Nurs. 2016; 39:307–313.
• Poupeau C, Tanguay C, Plante C, Gagne S, Caron N and Bussieres JF. Pilot study of biological monitoring of four antineoplastic drugs among Canadian healthcare workers. J Oncol Pharm Pract. 2017; 23:323–332.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Pract News (special edition). 2016; 23-36.
• Ramphal R, Bains T, Goulet G and Vaillancourt R. Occupational exposure to chemotherapy of pharmacy personnel at a single centre. Can J Hosp Pharm. 2015; 68:104-112.
• Redic KA, Fang K, Christen C and Chaffee BW. Surface contamination of hazardous drug pharmacy storage bins and pharmacy distributor shipping containers. J Oncol Pharm Pract. 2016 (e-pub; doi: 10.1177/1078155216679027).
• Ricci MS, Fazier M, Moore J, Cromwell M, Galush WJ, Patel AR, Adler M, Altenburger U, Grauschopf U, Goldbach P, Fast JL, Kramer I and Mahler HC. In-use physicochemical and microbiological stability of biological parenteral products. Am J Health-Syst Pharm. 2015; 72:396-407.
• Rinehart JR and Jorgenson JA. Considerations for handling monoclonal antibodies. Pharm Purchasing and Products. 2015; May:S6-10.
• Rosenthal M. CSTD buyers need advocacy help. Pharm Prac News. 2016; April 4.
• Rosenthal M. CSTD test protocol stirs debate (Part 1) Pharm Pract News. February 2017; 44 (2):20-21.
• Rosenthal M. Establishing procedures for testing CSTDs (Part 2). Pharm Pract News. March 2017; 44 (3):32-33.
• Rudnitzki T and McMahon D. Oral agents for cancer: safety challenges and recommendations. Clin J Oncol Nurs. 2015; 19 (Suppl):41-46.
• Sakhvidi MJZ, Hajaghazadeh M, Mostaghaci M, Mehrparvar AH, Sakhvidi FZ and Naghshineh E. Applicability of the comet assay in evaluation of DNA damage in healthcare providers’ working with antineoplastic drugs: a systematic review and meta-analysis. Int J Occup Environ Health. 2016; 22:52-67.
• Schierl R, Masini C, Groeneveld S, Fischer E, Bohlandt A, Rosini V and Paolucci D. Environmental contamination by cyclophosphamide preparation: comparison of conventional manual production in biological safety cabinet and robot-assisted production by APOTECAchemo. J Oncol Pharm Pract. 2016; 22(1):37-45.
• Sessink PJM, Leclercq GM, Wouters DM, Halbardier L, Hammad C and Kassoul N. Environmental contamination, product contamination and workers exposure using a robotic system for antineoplastic drug preparation. J Oncol Pharm Pract. 2015: 21(2):118-127.
• Sidikou O, Simon N, Sergent G, Vasseur M, Pinturaud M, Richeval C, Allorge D, Decaudin B and Odou P. In vitro assessment of a new extension set intended to reduce occupational exposure to antineoplastic drugs during hepatic chemoembolisation. Cardiovasc Intervent Radiol. 2016; 39(1):141-3.
• Silver SR, Steege AL and Boiano JM. Predictors of adherence to safe handling practices for antineoplastic drugs: a survey of hospital nurses. J Occup Environ Hyg. 2016; 13:203-212.
• Simons A and Toland S. Closed systems for drug delivery: a necessity, not an option. Brit J Nurs. 2015; 24:S20,S22.
• Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, Connor TH and Snawder JE. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2016; 22:396-408.
• Smith JP, Sammons DL, Robertson SA, Pretty JR, DeBord DG, Connor TH and Snawder JE. Detection and measurement of surface contamination by multiple antineoplastic drugs using multiplex bead assay. J Oncol Pharm Pract. 2016; 22 (1): 60-67.
• Smith JP, Sammons DL, Pretty JR, Kurtz KS, Robertson SA, DeBord DG, Connor TH and Snawder JE. Detection of 5-fluorouracil surface contamination in near real time. J Oncol Pharm Pract. 2015 (Epub ahead of print). DOI: 10.1177/1078155215585187.
• Tomas ME, Kundrapu S, Thota P, Sunkesula VCK, Cadnum JL, Mana TSC, Jencson A, O’Donnell M, Zabarsky TF, Hecker MT, Ray AJ, Wilson BM and Donskey CJ. Contamination of health care personnel during removal of personal protective equipment. JAMA Intern Med. 2015; 175(12):1904-1910
• Tomkins J. Ensuring health care worker safety when handling hazardous drugs: the joint position statement from the Oncology Nursing Society, the American Society of Clinical Oncology and the Hematology/Oncology Pharmacy Association. Eur J Oncol Pharm. 2015; 11:278-279.
• Vazquez R, Boubet K, Guerrault-Moro MN and Crauste-Manciet S. Impact of handling errors for chemical cross-contamination risk for the preparation of parenteral cytotoxic drugs. Pharm Technol Hosp Pharm. 2016; (Epub ahead of printing) DOI: 10.1515/pthp-2015-0009.
• Villa AF, El Balkhi S, Aboura R, Sageot H, Hasni-Pichard H, Pocard M, Elias D, Joly N, Payen D, Blot F, Poupon J and Garnier R. Evaluation of oxaliplatin exposures of healthcare workers during heated intraperitoneal perioperative chemotherapy (HIPEC). Ind Health. 2015; 53:28-37.
• Villarinia M, Gianfredia V, Levoratoa S, Vannini S, Salvatori T and Moretti M. Occupational exposure to cytostatic/antineoplastic drugs and cytogenetic damage measured using the lymphocyte cytokinesis-block micronucleus assay: a systematic review of the literature and meta-analysis. Mutat Res. 2016; 770(Pt A):35–45.
• Vyas N, Turner A, Clark JM and Sewell GJ. Evaluation of a closed-system cytotoxic transfer device in a pharmaceutical isolator. J Oncol Pharm Pract. 2016; 22(1):10-19.
• Wagner JT. Ensure safe use of CAIs and CACIs. Pharm Purchasing and Products. 2014; 11(12):12-14.
• Zhang J, Bao J, Wang R, Geng Z, Chen Y, Xie XY, Jiang L, Deng Y, Liu G, Xu R and Miao L. A multicenter study of biological effects assessment of pharmacy workers occupationally exposed to antineoplastic drugs in pharmacy intravenous admixture services. J Haz Mat. 2016; 315: 86–92.
• Zhang X, Zheng Q, Lv Y, An M, Zhang Y, Wei Y and Feng W. Evaluation of adverse health risks associated with antineoplastic drug exposure in nurses at two Chinese hospitals: the effects of implementing a pharmacy intravenous admixture service. Am J Ind Med. 2016; 59:264–273.

Since it was first recognized that occupational exposure to antineoplastic agents posed a potential health risk to workers exposed to these agents, various groups, institutions and agencies around the world have developed and published guidelines or recommendations for handling antineoplastic agents. The most often referred to guidelines in the United States are the OSHA Technical manual: Controlling Occupational Exposure to Hazardous Drugs revised in 1995 and the NIOSH Alert: Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs, published in 2004. Others include handling guidelines by the American Society of Hospital-System Pharmacists, the Oncology Nursing Society and the International Society of Oncology Pharmacy Practitioners.

• Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4): 249-257.
• Albin K. Administering chemotherapy: Is it safe for pregnant or breast-feeding veterinary technicians? Vet Tech. Oct 2010; E1-E5.
• Alessio L, Apostoli P, Draicchio F, Forni A, Lucchini R, Merler E, Palazzo S, Scarselli R and Sossai D. Prevention of risks from occupational exposures to antineoplastic drugs: Consensus document. Med Lav. 1996; 87:194-206.
• Alessio L, Apostoli P, Draicchio F, Forni A, Lucchini R, Merler E, Palazzo S, Scarselli R and Sossai D. Prevention of risks from occupational exposures to antineoplastic drugs: Consensus document. Int J Occup Environ Health. 1997; 3:84-87.
• Alexander M, King J, Bajel C, Doecke C, Fox P, Lingaratnam S, Mellor JD, Nicholson L, Roos I, Saunders T, Wilkes J, Zielinski R, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel. Intern Med J. 2014; (Epub ahead of print) DOI: 10.111/imj.12564.
• Alexander M, King J, Bajel A, Doecke C, Fox P, Lingaratnam S, Mellor JD, Nicholson L, Roos I, Saunders T, Wilkes J, Zielinski R, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. Australian consensus guidelines for the safe handling of monoclonal antibodies for cancer treatment by healthcare personnel. Intern Med J. 2014; 44:1018-1026.
• American Society of Hospital Pharmacists. Technical assistance bulletin on handling cytotoxic drugs in hospitals. Am J Hosp Pharm. 1985; 42:131-137.
• American Society of Hospital Pharmacists. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm. 1990; 47:1033-1049.
• American Society of Health-System Pharmacists. ASHP Guidelines on Handling Hazardous Drugs: Am J Health-Syst Pharm. 2006; 63:1172-1193.
• Anon. Practice fined for health and safety record. Vet Rec. 2014; 175:418.
• Association partitaire pour la santé et la sécurité du travail du secteur affaires sociaux (ASSTSAS) Prevention Guide. Safe Handling of Hazardous Drugs. 2008.
• ASTM D666-01 “Standard Practice for Field Collection of Organic Compounds from Surface Using Wipe Sampling,” ASTM International.
• Barle EL, Winkler GC, Glowienke S, Elhajouji A, Nunic J and Martus HJ. Setting occupational exposure limits for genotoxic substance in the pharmaceutical industry. Toxicol Sci. 2016; 151:2-9.
• Barry LK and Booher RB. Promoting the responsible handling of antineoplastic agents in the community. Oncol Nurs Forum. 1985; 12:41-46.
• Beaver CC and Magnan MA. Minimizing staff exposure to antineoplastic agents during intravesical therapy. Clin J Oncol Nurs. 2015; 19:393-395.
• BCCA [2008]. Module 1: Safe handling of hazardous drugs. In: BC cancer agency pharmacy practice standards for hazardous drugs. www.bccancer.bc.ca/HPI/Pharmacy/GuidesManuals/safehandling.htm Date accessed: January 2013.
• Bonnabry P, Cingria L, Ackermann M, Sadeghipour F, Bilger L and Mach N. Use of a prospective risk analysis method to improve the safety of the cancer chemotherapy process. Int J Qual Health Care. 2006; 18:9-16.
• Brown KA, Esper P, Kelleher LO, O’Neill JEB, Polovich M and White JM (eds.) 2001. Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.
• Buchanan EC and Schneider PJ. Compounding Sterile Preparations 3rd Ed., 2009.
• Canadian Society of Hospital Pharmacists. Guidlines for handling of hazardous pharmaceuticals. Can J Hosp Pharm. 1981; 34:126-128.
• Canadian Society of Hospital Pharmacists, Guidelines for the handling and disposal of hazardous pharmaceuticals (Including cytotoxic drugs), Ottawa, 1993.
• Canadian Occupational Health and Safety Division. Cytotoxic Drugs. Canada. 1999.
• Cass Y and Musgrave CF. Guidelines for the safe handling of excreta contaminated by cytotoxic drugs. Am J Hosp Pharm. 1992; 49:1957-1958.
• Cass Y. Reducing chemotherapy associated risks. Clin Pharm Eur. Sept-Dec, 2005: 1-2.
• Chaffee BW, Armistead JA, Benjamin BE, Cotugno MC, Forrey RA, Hintzen BL, Pfeiffenberger T and Stevenson JG. Guidelines for the safe handling of hazardous drugs: consensus recommendations. Am J Health-Syst Pharm. 2010; 67:1545-1546.
• Clinical Oncology Society of Australia. Guidelines for safe handling of antineoplastic agents. Med J Australia. 1983; 1:426-428.
• Crul, M, Franki AS and Simons K. Preparation of monoclonal antibodies: practice across Europe. 2011; 5:6-8.
• Colls BM. Cytotoxic chemotherapy: A potential hazard to patients and hospital personnel? The New Zealand Med J. 1987; 100:149-150.
• Connor TH, Douglass K, Eisenberg S, Kastango ES, Kienle PC, Massoomi F and Parsad SD. Improving safe handling practices for hazardous drugs: toolkit. Mansur J, contributing editor. 2016. Joint Commission Resources (www.jcrinc.com).
• Connor TH and MacKenzie BM. Should monoclonal antibodies and their conjugates be considered occupational hazards. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• Coyle B and Polovich M. Handling hazardous drugs: How safe are you? Am J Nurs. 2004; 104:104.
• Council on Scientific Affairs. Guidelines for handling parenteral antineoplastics. JAMA. 1985; 253:1590-1592.
• Cytotoxic Drugs and Related Waste: A Risk Management Guide for South Australian Health Services
• Davis MR. Handling and preparation of cytotoxic drugs-Minimizing the risk. Aust J Hosp Pharm. 1980; 10:127-30.
• Davis MR. Guidelines for Safe handling of cytotoxic drugs in pharmacy departments and hosptal wards. Hosp Pharm. 1981; 16:17-20.
• Davis J, McLauchlan R, Kirsa, S, Jackson J, Morey K, Ng L, Passuello F, Siderov J and Tonietto A. SHPA Standards of practice for the safe handling of cytotoxic drugs in pharmacy departments. Aust J Hosp Pharm. 1999; 29:108-116.
• Deffenbaugh JH. Risks of using technicians and not pharmacists to handle antineoplastic drugs. Am J Health-Syst Pharm. 2000; 57:1750-1753.
• Del Gaudio D and Menonna-Quinn D. Chemotherapy. Potential occupational hazards. Amer J Nurs, 1998; 98:59-65.
• DesRoches P. Cytotoxic drug handling-Monitoring in the occupational health setting. AAOHN J. 2003; 51:106-108.
• Dolan SA, Felizardo G, Barnes S, Cox TR, Patrick M, Ward KS and Arias KM. APIC position paper: safe injection, infusion, and medication vial practices in health care. Am J Infect Control. 2010; 38:167-172.
• Easty AC, Coakley N, Cheng A, Cividino M, Savage P, Tozer R and White RE. Safe handling of cytotoxics: guideline recommendations. Curr Oncol. 2015; 22:e27-e37.
• Eisenberg S. Hazardous drug handling in light of USP <800>. Pharm Purchasing and Products. 2015; 12(2):18-19.
• Eisenberg, S. Safe handling and administration of antineoplastic chemotherapy. J Infus Nurs. 2009; 32:23-32.
• Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F and Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): a French multicentric survey. Eur J Surg Oncol. 2015; 41:1361-1367.
• Fishman M and Mrozek-Orlowski M. Cancer chemotherapy guidelines and recommendations for practice (2nd ed.) 1999, Oncology Nursing Press, Pittsburgh.
• Fortenbaugh C and Rummel M. Chemotherapy safety. Clin J Oncol Nurs. 2004; 8:424-425.
• Gambrell J and Moore S. Assessing workplace compliance with handling of antineoplastic agents. Clin J Oncol Nurs. 2006; 10:473-477.
• Georgiad A, Ramme E, Wretman C and Eksborg S. How to create acceptable working conditions for hospital pharmacy staff when preparing cytotoxic drugs. Euro J Hosp Pharm. 2004;3: 40-42.
• Gibbs J. Handling cytotoxic drugs. Nurs Times. 1991; 87:54-55.
• González-Bayó, L, González-Moreno S and Ortega-Pérez G. Safety considerations for operating room personnel during hyperthermic intraoperative intraperitoneal chemotherapy perfusion. Eur J Surg Oncol. 2006; 32:619-624.
• Goodin S. Advancing the safe and appropriate use of oral chemotherapy agents. Am J Health-Syst Pharm. 2007; 64:S1-40.
• Goodin S, editor. Advancing the safe and appropriate use of oral chemotherapy agents. Articles based on the proceedings of an interdisciplinary educational program. Am J Health-Syst Pharm. 2007; 64(Suppl 5): S1–S36.
• Goodin S, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, Patel RA, Schwartz R, Tames MJ, Terkola R, Vadnais B, Wright D and Meier K. Safe handling of oral chemotherapeutic agents in clinical practice: recommendations from an international pharmacy panel. J Oncol Pract. 2011; 7:7-12.
• Grajny AE, Christie D, Tichy AM and Talashek ML. Chemotherapy: How safe the caregiver? Home Healthcare Nurse. 1993; 11:51-58.
• Green E, Johnston M, Trudeau M, Schwartz L, Poirier S, Macartney G and Milliken D. Safe handling of parenteral cytotoxics: Recommendations for Ontario. J Oncol Pract. 2009; 5:1-5.
• Gregoire RE, Segal R and Hale KM. Handling antineoplastic-drug admixtures at cancer centers: practices and pharmacist attitudes. Am J Hosp Pharm. 1987; 44:1090-1095.
• Griffin E. Safety considerations and safe handling of oral chemotherapy agents. Clin J Oncol Nurs. 2003; S7:25-29.
• Gullo SM. Safe handling of antineoplastic drugs: Translating the recommendations into practice. Oncol Nurs Forum. 1988; 15:595-601.
• Gurwell A. Protect yourself from the hazards of anticancer drugs. RN. 1983; 46:66-67.
• Harrison BR. Developing guidelines for working with antineoplastic drugs. Am J Hosp Pharm. 1981; 38:1686-1693.
• Health and Safety Executive. Safe handling of cytotoxic drugs in the workplace
• Hoppe-Tichy T. Current challenges in European oncology pharmacy practice. J Oncol Pharm Pract. 2010; 16:9-18.
• Italian Society of Preventive Medicine for Health Care Workers. Summary of recommendations for a rational implementation of the ministery of heath guidlines on the prevention of occupational risks in handling antineoplastic agents. Med Lav. 2001; 92:137-148. (English abstract)
• International Society of Oncology Pharmacy Practitioners. Standards of Practice: Safe Handling of Cytotoxics. J Oncol Pharm Pract. 2007; 13:1-81.
• Jacobson JO, Polovich M, McNiff KK, LeFebvre KB, Cummings C, Galioto M, Bonelli KR and McCorkle MR. American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards. J Clin Oncol. 2009; 27:5469-5475.
• Jacobson JO, Polovich M, McNiff KK, LeFebvre KB, Cummings C, Galioto M, Bonelli KR and McCorkle MR. American Society of Clinical Oncology/Oncology Nursing Society Chemotherapy Administration safety standards. J Clin Oncol. 2009; 27:5469-5475.
• Jones RB, Frank R and Mass T. Safe handling of chemotherapeutic agents: A report from the Mount Sinai Medical Center. Ca-A Cancer Journal for Clinicians. American Cancer Society. 1983; 33:257-263.
• Karpinski J. 2016 Updates to the NIOSH hazardous drug list. Pharm Purch Prod. July 2017; 14 (7):36,38.
• Kienle PC. Update on proposed USP Chapter <800>. Pharm Purchasing and Products. 2015; 12 (2):2,4.
• Klahn S. Chemotherapy safety in clinical veterinary oncology. Bet Clin Small Anim. 2014; 44:941-963.
• Klancher JW, Vorndran M and Weiss W. Hazardous drugs: Controlling the risks in healthcare facilities. Professional Safety. Nov 2008: 24-29.
• Knowles RS and Virden JE. Handling of injectable antineoplastic agents. Br J Med. 1980; 281:589-591.
• Ladik CF, Stoehr GP and Maurer MA. Precautionary measures in the preparation of antineoplastics. Am J Hosp Pharm. 1980; 37:1184-1185.
• Le Garlantezec P, Rizzo-Padoin N, Lamand V, Aupee O, Broto H and Almeras D. Manipulation des medicaments anticancereux a l’hopital: le point sur l’exposition et sur les mesures de prevention. Archives des Maladies Professionnelles et de l’Environment. 2011; 72:24-35.
• Leone M, McDiarmid M, Polovich M, Coyle B, Power L, Connor TH and Reed LD. Medical surveillance for health care workers exposed to hazardous drugs. DHHS (NIOSH) Publication No. 2007-117.
• LeRoy ML, Roberts MJ and Theisen JA. Procedures for handling antineoplastic injections in comprehensive cancer centers. Am J Hosp Pharm. 1983; 40:601-603.
• Lester J. Safe handling and administration considerations of oral anticancer agents in the clinical and home setting. Clin J Oncol Nurs. 2012; 16:E192-E197.
• Massoomi F, Neff B, Pick A and Danekas P. Implementation of a safety program for handling hazardous drugs in a community hospital. Am J Health-Syst Pharm. 2008; 65:861–865.
• Macek C. Hospital personnel who handle anticancer drugs may face risks. JAMA. 1982; 247:11-12.
• Mahmoud S, Leonard D and Jacklin A. Cytotoxics preparation: reduction of medication errors and enhancing capacity. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• Massoomi F, Neff B, Rick A and Denekas P. Implementation of a safety program for handling hazardous drugs in a community hospital. Am J Heath-Syst Pharm. 2008; 65:861-865.
• Mayer DK. Hazards of chemotherapy: Implementing safe handling practices. Cancer Suppl. 1992; 70:988-992.
• McAllister JC and Davis SM. State regulations for home i.v. therapy. Am J Hosp Pharm. 1989; 46:1545-1546.
• McDiarmid MA. Pharmaceuticals as hospital hazards: managing the risks. J Occup Med. 1991; 33:155-158.
• McDiarmid MA. Public health policy activity on the safe handling of hazardous anti-cancer drugs in the healthecare workplace. Eur J Oncol. 2004; 9:81-86.
• McDiarmid MA, Condon M. Organizational safety culture/climate and worker compliance with hazardous drug guidelines: lessons from the blood-borne pathogen experience. J Occup Environ Med. 2005; 47:740-749.
• McGowan D. Safe handling and administration of MABS: the guidance. Brit J Nurs. 2015; 24:S14-20.
• McLauchlan R. Safe dispensing of oral chemotherapy. Saf Considerations Oncol Pharm (Special edition, Fall 2011) www.ppme.eu.
• Mellinger E, Skinker L, Sears D, Gardner D and Shult P. Safe handling of chemotherapy in the perioperative setting. AORN J. 2010; 91:435-453.
• Moody DG. Veterans Administration medical center policies and procedures for handling injectable antineoplastic drugs. 1984; 41:916-919.
• Moore TD, Hale KM, Cortese LM, Fillmore AD, Jozefczy KF, Scala SM and Wellman GS. Managing employee apprehension toward handling cytotoxic drugs. Am J Hosp Pharm. 1985; 42:826-831.
• Murphy CP, Goldspiel BR and Koeller J. Cost of implementing Veterans Administration directives for handling antineoplastic agents. Am J Hosp Pharm. 1987; 44:788-791.
• Myers CE. Pharmacy implications of the revised OSHA Hazard Communication Standard. Am J Hosp Pharm. 1989; 46:990-991.
• National Study Commission on Cytotoxic Exposure. Recommendations for handling cytotoxic agents. Sept, 1987.
• National Institutes of Health Publication. Recommendations for the Safe Handling of Cytotoxic Drugs. US DHHS PHS, NIH Pub No. 92-2621.
• NIOSH 2004. Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings www.cdc.gov/niosh/docs/2004-165/.
• NIOSH 2009. Personal Protective Equipment for Health Care Workers Who Work with Hazardous Drugs www.cdc.gov/niosh/docs/wp-solutions/2009-106/.
• NIOSH 2010. Workplace solutions: safe handling of hazardous drugs for veterinary healthcare workers. DHHS (NIOSH) Publication No. 2010-150. www.cdc.gov/niosh/docs/wp-solutions/2010-150/pdfs/2010-150.pdf.
• Nixon S and Schulmeister L. Safe handling of hazardous drugs: Are you protected? Clin J Onc Nurs. 2009; 13:433-439.
• Nygren O. Cytotoxic drugs. Hasselhorn HM, Toomingas A, Lagerström M (Hrsg.): Occupational Health for Health Care Workers – a Practical Guide; Page 115-120. Amsterdam, Lausanne, New York: Elsevier, 1999.
• Official Journal of the European Communities. Council directive of 28 June. 1990 on the protection of workers from the risks related to exposure to carcinogens at work (90/394/EEC). No. L. 196/1-7. 26.7.90.
• Oncology Nursing Society. Cancer chemotherapy guidelines and recommendations for practice. Powel, LL, ed. ONS, 1996.
• Oncology Nursing Society. Standards for Cancer Nursing Practice. 1982.
• OSHA Instruction TED 1.15. Directorate of technical support. Controlling occupational exposure to hazardous drugs. Sept, 1995.
• OSHA [1999]. OSHA technical manual, TED 1-0.15A, Sec VI, Chapt II: Categorization of drugs as hazardous. Date accessed: January 20.
• Parillo, VL. Documentation forms for monitoring occupational surveillance of healthcare workers who handle cytotoxic drugs. Oncol Nurs Forum, 1994; 21:115-120.
• Peak VJ, McDaniel PA and Waite WW. Technician training module for an outpatient antineoplastic admixture program. Am J Hosp Pharm. 1987; 44:354-355.
• Placentino RA, Cesarini L, Sacco A and Magnavita N. Application of the A.S.I.A. model to activities of manipulation of antineoplastic drugs. G Ital Med Lav Erg. 2003; 25S:178-179.
• Polovich M. Minimizing occupational exposure to antineoplastic agents. J Infus Nurs. 2016; 39:307–313.
• Polovich M. Safe handling of hazardous drugs. Online Journal of Issues in Nursing. 2004; 9 (3)Manuscript 5.
• Polovich M, White J M and Kelleher LO (eds.) 2005. Chemotherapy and biotherapy guidelines and recommendations for practice (2nd. ed.) Pittsburgh, PA: Oncology Nursing Society.
• Polovich M, Whitford JM and Olsen M (eds.) 2009. Chemotherapy and biotherapy guidelines and recommendations for practice (3rd. ed.) Pittsburgh, PA: Oncology Nursing Society.
• Polovich M, Bolton DL, Eisenberg S, Glynn-Tucker EM, Howard-Ruben J, McDiarmid MA, Power LA and Smith CA. Safe handling of hazardous drugs. Oncol Nurs Society. Second Edition. February, 2011.
• Polovich M, Olsen M and LeFebvre K (eds.) 2014. Chemotherapy and biotherapy guidelines and recommendations for practice. Pittsburgh, PA: Oncology Nursing Society.
• Power LA, Anderson RW, Cortopasssi R, Gera JR and Lewis RM. Update on safe handling of hazardous drugs: The advice of experts. Am J Hosp Pharm. 1990; 47:1050-1060.
• Power LA and Polovich M. Safe handling of hazardous drugs: Reviewing standards for worker protection. Pharm Practice News. June 2009: 1-8.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Pract News. March 2010; 1-8.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Practice News. March 2011; 1-12.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Practice News. March 2012; 1-12.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Pract News (special edition). 2012; 31-42.
• Power LA and Polovich M. Safe handling of hazardous drugs: reviewing standards for worker protection. Pharm Pract News (special edition). 2016; 23-36.
• Randolph SA. Hazardous drugs in health care settings—recognition and control. Workplace Health Saf. 2012; 60:412.
• Reich SD. Antineoplastic agents as potential carcinogens: Are nurses and pharmacists at risk? Cancer Nurs. 1981; 7:500-502.
• Ricci MS, Fazier M, Moore J, Cromwell M, Galush WJ, Patel AR, Adler M, Altenburger U, Grauschopf U, Goldbach P, Fast JL, Kramer I and Mahler HC. In-use physicochemical and microbiological stability of biological parenteral products. Am J Health-Sys Pharm. 2015; 72:396-407.
• Rinehart JR and Jorgenson JA. Considerations for handling monoclonal antibodies. Pharm Purchasing Products. 2015; May:S6-10.
• Roberts S and Sewell G. Safe handling of cytotoxics. Hosp Pharm Eur. July/August 2007: 17-19.
• Rudnitzki T and McMahon D. Oral agents for cancer: safety challenges and recommendations. Clin J Oncol Nurs. 2015; 19 (Suppl):41-46.
• Salman D, Barton S and Gebara SN. Improving the stability of anticancer drugs. J Oncol Pharm Practice. 2014; 20:236.
• Siden R, Kem R, Ostrenga A, Nicksy D, Bernhardt B and Bartholomew J. Templates of patient brochures for the preparation, administration and safe-handling of oral chemotherapy. J Oncol Pharm Practice. 2014; 20:217-224.
• Schierl R, Bohlandt A and Nowak D. Gudiance values for surface monitoring of antineoplastic drugs in German pharmacies. Ann Occup Hyg. 2009; 1-9.
• Scott SA, Schrott DB and Loesch GA. Pharmacy program for improved handling of antineoplastic agents. Am J Hosp Pharm. 1983; 40:1179-1182.
• Scott SA. Antineoplastic drug information and handling guidelines for office-based physicians. Am J Hosp Pharm. 1984; 41:2402-2403.
• Sessink PJM. Environmental contamination with cytostatic drugs: past, present, future. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• Si P and Chan A. Common toxicities of oral anticancer agents: an overview. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• Simmons CC. Oral chemotherapeutic drugs: handle with care. Nursing. 2010; 40:44-47.
• Skov T, Lynge E, Maarup B, Olsen J, Rorth M and Winthereik H. Risks for physicians handling antineoplastic drugs. Lancet. 1990; 336:1446.
• Skov T, Olsen J, Rorth M, Maarup B, Winthereik H and Lynge E. Cytostatics–work environment. Reassuring studies–but need for more. Sygeplejersken. 1991; 91:4-7.
• Skov T. Handling antineoplastic drugs in the European Community countries. Eur J Cancer Prev. 1993; 2:43-46.
• Slimowitz R and Mitrik LJ. Studies on long-term, not short-term, effects of antineoplastic drug handling are needed. Am J Hosp Pharm. 1993; 50:1862-1863.
• Solimando DA. Preparation of antineoplastic drugs: A review. Am J Intraven Ther Clin Nut. 1983; September: 16-27.
• Sproll B, Milan H, Caligiuri C, Dyck S, Rosenthal B and Raymond CB. Development and implementation of a regional program for the safe handling of hazardous drugs by hospital pharmacies. Can J Hosp Pharm. 2012; 65:223-228.
• Stevens KR. Safe handling of cytotoxic drugs in home chemotherapy. Sem Oncol Nurs. 1989; 5:15-20.
• Stolar MH, Power LA and Viele CS. Recommendations for handling cytotoxic drugs in hospitals. Am J Hosp Pharm. 1983; 40:1163-1171.
• Sugiura S-i, Asano M, Gohma H, Nakanishi H, Hashida T and Okuda M. Obtaining insurance coverage for the use of closed systems in Japan. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• Süle A. Safety assessment and revision of a central cytostatic unit base on ESOP guidelines. Eur J Oncol Pharm. 2014; 8:19-23.
• Takada S. Principles of chemotherapy safety procedures. Clin Tech Small Anim Pract. 2003; 18:73-74.
• The Joint Commission. Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation. Oakbrook Terrace, IL: The Joint Commission, November 2012. www.jointcommission.org/.
• Theiss JC. Hospital personnel who handle anticancer drugs may face risks. JAMA. 1982; 247:11-12.
• Tomkins J. Ensuring health care worker safety when handling hazardous drugs: the joint position statement from the Oncology Nursing Society, the American Society of Clinical Oncology and the Hematology/Oncology Pharmacy Association. Eur J Oncol Pharm. 2015; 11:278-279.
• Umemura, M., Itoh, A., Ando, Y., Yamada, K., Wakiya, Y, and Nabeshima, T. Effects of outside air temperature on the preparation of antineoplastic drug solutions in biological safety cabinets. Journal of Oncology Pharmacy Pract. 2015; 21(4): 243-248.
• U.S. Department of Labor. 1986. Guidelines for cytotoxic (antineoplastic) drugs. OSHA, Office of Occupational Medicine. Pub 8-1.1, January 1986.
• U.S. Pharmacopeia (USP) Revised Chapter (797) Pharmaceutical Compounding-Sterile Preparations.
• USP 797: guidebook to pharmaceutical compounding: sterile preparations. 2008. Rockville, Md: United States Pharmacopeia.
• Wagner JT, Considerations for Choosing a Primary engeneering control for compounding sterile products. Int J Pharm Comp. 2005; 9:284-290.
• Walton AM, Mason S, Busshart M, Spruill AD, Cheek S, Lane A, Sabo K and Taylor A. Safe handling: implementing hazardous drug precautions. Clin J Oncol Nurs. 2012; 16:251-254
• Widströ m J and Edling C. Antineoplastic Agents. In DK Brune and Edling C (Eds.) Occupational Hazards in Health Professions. 1989. Boca Raton, FL: CRC Press, Inc.
• White RE and Easty AC. Human factors: safery lessons for oncology pharmacy practice. Saf Considerations Oncol Pharm (Special edition) Fall 2011) www.ppme.eu.
• White SK, Stephens AD, Dowjat B and Sugarbaker PH. Safety constiderations [sic] in the use of interoperative intraperitoneal chemotherapy. Cancer Treatment and Research, PH Sugarbaker (ed.) Kluwer Academic Publichers, Boston, 1996; 311-316.
• Willemson-McBride TL and Gehan K. Safe handling of cytotoxic agents: A team approach. AORN J. 2009; 90:731-740.
• Williamson KM, Turner JG, Brown KC, Newman KD, Sirles AT and Selleck CS. Occupational health hazards for nurses–Part II. Image: J Nurs Schol. 1988; 20:162-168.
• Wilson JP and Solimando DA. Aseptic technique as a safety precaution in the preparation of antineoplastic agents. Hosp Pharm. 1981; 16:575-581.
• Young RL and DuVall EM. Chemotherapy exposure file. Am J Hosp Pharm. 1985; 42:1990-1991.
• Zellmer WA. Fear of anticancer drugs. Am J of Hosp Pharm. 1984; 42:665.
• Zimmerman PF, Laresen RK, Barkley EW and Gallelli JF. Recommendations for the safe handling of injectable antineoplastic drug products. Am J Hosp Pharm. 1981; 38:1693-1695.

Several authors have published articles reviewing the topic of occupational exposure to antineoplastic agents. These articles provide a good starting place for individuals not familiar with this area to learn more of what some of the issues are and what type of studies have been performed in this area.

• Aguero D and Marge K. Developing a USP <800> compliance gap analysis. Pharm Purch Prod. January 2017; 14 (1):10-12.
• Baker ES and Connor TH. Monitoring occupational exposure to cancer chemotherapy drugs. Am J Health-Syst Pharm. 1996; 53:2713-2723.
• Bos RP and Sessink PJM. Biomonitoring of occupational exposure to cytostatic anticancer drugs. Rev Environ Health. 1997; 12:43-58.
• Bussières JF, Touzin K and Lefebvre M. Monitoring of hazardous drugs in hospital practice. Hosp Pharm Eur. 2007; July/August: 21-24.
• Cass Y, Connor TH and Tabachnik A. Safe handling of oral antineoplastic medications: focus on targeted therapeutics in the home setting. J Oncol Pharm Practice. 2017; 23:350–378.
• Cass Y. Hospital pharmacy in Israel. Hosp Pharm Eur. 2005; Sept/Oct:86-87.
• Cass Y. Reducing chemotherapy-associated risks. Clin Pharm Eur. 2006; Sept-Dec :1-2.
• Cass Y and Setton I. 25 years of safe handling of cytotoxics (antineoplastics) in Israel. J Oncol Pharm Pract. 2006; 12:83-90.
• Connor TH, Celano P, Frame JN and Zan RT. Summary of the Workshop on the Safe Handling of Hazardous Drugs Cohosted by the National Institute for Occupational Safety and Health and the American Society of Clinical Oncology. J Oncol Pract 2017; 13:199-205.
• Connor TH. Hazardous anticancer drugs in health care. Ann NY Acad Sci. 2006; 1076:615-623.
• Connor TH and McDiarmid MA. Preventing occupational exposures to antineoplastic drugs in health care settings. CA Cancer J Clin. 2006; 56:354-365.
• Connor TH. Hazardous anticancer drugs in health care: Environmental Exposure Assessment. Ann NY Acad Sci. 2006; 1076:615-623.
• Connor TH and McDiarmid MA. Preventing occupational exposures to antineoplastic drugs in health care settings. CA Cancer J Clin. 2006; 56:354-365.
• Connor TH and MacKenzie BA. 2014 updates to the NIOSH hazardous drug list. Pharm Purchasing Products. 2014; 92-99.
• Davis J, McLauchlan R and Connor TH. Exposure to hazardous drugs in healthcare: an issue that will not go away. J Oncol Pharm Pract. 2011; 17:9-13.
• Del Gaudio D and Menonna-Quinn D. Chemotherapy: Potential Occupational Hazards. AJN. 1998; 98: 59-65.
• DesRoches P. Cytotoxic drug handling-Monitoring in the occupational health setting. AAOHN J. 2003; 51:106-108.
• Eberwein SM and Amerine LB. Comparison of USP <800> gap analysis tools. Pharm Purch Prod. April 2017; 14 (4) 12-13.
• Eisenberg S. A call to action for hazardous drug safety: Where we have been and where we are going. Clin J Onc Nurs. 2016; 20: A1-A8.
• Eisenberg S. Hazardous drugs and USP <800>: implications for nurses. Clin J Oncol Nurs. 2017; 21:179–187.
• Forni A, Bonatti S and Merler E. Cytogenetic indicators of genotoxicity in subjects occupationally exposed to antineoplastic drugs. Med Lav. 1996; 87:222-229. [English abstract]
• Fransman W, Occupational exposure to cytotoxic drugs. Hospital Pharmacy Eur. 2007; 35:85-86.
• Fransman W, Peelen S, Hilhorst S, Roeleveld N, Heederik D and Kromhout H. A pooled analysis to study trends in exposure to antineoplastic drugs among nurses. Ann Occup Hyg. 2007; 51:231-239.
• Furlow B. How to improve the safety of chemotherapy administration. Oncol Nurse Advisor. 2010; 21-25.
• Gilani S and Giridharan S. Is it safe for pregnant health-care professionals to handle cytotoxic drugs? A review of the literature and recommendations. Ecancermedicalscience. 2014; 8:418.
• Halsen G and Kramer I. Assessing the risk to health care staff from long-term exposure to anticancer drugs – the case of monoclonal antibodies. J Oncol Pharm Pract. 2011; 17:68-80.
• King J, Alexander M, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A review of the evidence for occupational exposure risks to novel anticancer agents – A focus on monoclonal antibodies. J Oncol Pharm Pract. 2016;22(2):121-134.
• Le Garlantezec P, Rizzo-Padoin N, Lamand V, Aupee O, Broto H and Almeras D. Handling of antineoplastic drugs in the hospital: focus on exposure and on protective measures (in French and English). Arch de Maladies Prof Environ. 2011; 72:24–35.
• Lucas MA and Connor TH. Hazardous drugs: the silent stalker of healthcare workers? Training, education are key to preventing exposures. The Synergist. 2015; January:22-26.
• McDiarmid MA. Medical surveillance for antineoplastic-drug handlers. Am J Hosp Pharm. 1990; 47: 1061-1066.
• McDiarmid MA, Gurley HT and Arrington D. Pharmaceuticals as hospital hazards: Managing the risks. JOEM. 1991; 33: 155-158.
• McDiarmid MA, Condon M. Organizational safety culture/climate and worker compliance with hazardous drug guidelines: lessons from the blood-borne pathogen experience. J Occup Environ Med. 2005; 47:740-749.
• Meade E. Avoiding accidental exposure to intravenous cytotoxic drugs. Br J Nurs. 2014; 23:S34, S36-39.
• Meier K, Griffith N, Chen B, Chuk K, Daouphars M, Doreau C, Patel RA, Schwartz R, Tames MJ, Terkola R, Vadnais, B, Wright D and Goodin S. Safe handling of oral chemotherapeutic agents: a European perspective. Eur J Oncol Pharm. 2011/2; 5:4-10.
• Moore RM, Davis YM and Kaczmarek RG. An overview of occupational hazards among veterinarians, with particular reference to pregnant women. Am Ind Hyg Assoc J. 1993; 54:113-120.
• Moretti M, Bonfiglioli R, Feretti D, Pavanello S, Mussi F, Grollino MG, Villarini M, Barbieri A, Ceretti E, Carrieri M, Buschini A, Appolloni M, Dominici L, Sabatini L, Gelatti U, Bartolucci GB, Poli P, Stronati L, Mastrangelo G and Monarca S. A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project. BMC Public Health. 2011; 11:195 (http:/Nrww.biomedcentral.com/1471-2458/11/195).
• Nussbaumer S, Bonnabry P, Veuthey JL and Fleury-Souverain S. Analysis of anticancer drugs: a review. Talanta. 2011; 85:2265-2289.
• Piekarczyk A, Grzesiuk E, Zimak J and Taljanski W. Are cytostatic drugs and their metabolites, excreted by patients during chemotherapy, hazardous for the family environment? Medycyna Wieku Rozwojowego. 2001; V Suplemtnt I do nr 3.(English abstract)
• Polovich M. Safe handling of hazardous drugs. Online Journal of Issues in Nursing. 2004; 9.
• Polovich M and Giesker KE. Occupational hazardous drug exposure among non-oncology nurses. Medsurg Nurs. 2011; 20:79-85, 97.
• Polovich M and Clark PC. Factors influencing oncology nurses’ use of hazardous drug safe-handling precautions. Oncol Nurs Forum. 2012; 39: E299-309.
• Power LA. Hazardous drugs in oncology: the impact on practices of USP 797 and the NIOSH alert. Community Oncol. 2008; 5:343-346.
• Rogers B. Investigations of work-related exposures to antineoplastic agents: An overview of the literature. Sem Occup Med. 1987; 2:83-89.
• Roller M, Eickmann U and Nies E. Krebsrisiko durch beruflichen Umgang mit Zytostatika- quantitative Betrachtungen. Hauptverband der gewerblichen Berufsgenossenschaften; BIA-Report 5/2001.(English Abstract)
• Roussel C and Connor TH. Chemotherapy: Biomarkers of exposure, effect, reproductive hazards, and cancer. The Oncology Pharmacist. 2014; 7:1, 10-13, 18.
• Roussel C and Connor TH. Chemotherapy: current and emerging issues in safe handling of antineoplastic and other hazardous drugs. The Oncology Pharmacist. 2014; 7:1, 8-11. (Reprinted in The Oncology Nurse. 2014; 7:1, 14-17.)
• Sessink PJM and Bos RP. Drugs hazardous to healthcare workers:Evaluation of methods for monitoring occupational exposure to cytotoxic drugs. Drug Safety. 1999; Apr 20 (4): 347-359.
• Sorsa M, Hemminki K and Vainio H. Biologic monitoring of exposure to chemical mutagens in the occupational environment. Teratogenesis Carcinog Mutagen. 1982; 2:137-150.
• Sorsa M, Hemminki K and Vainio H. Occupational exposure to anticancer drugs-Potential and real hazards. Mutat Res. 1985; 154:135-149.
• Sorsa M and Anderson D. Monitoring of occupational exposure to cytostatic anticancer agents. Mutat Res. 1996; 355:253-261.
• Sorsa M, Hamelia M and Jarviluoma E. Handling anticancer drugs: from hazard identification to risk management? Ann NY Acad Sci. 2006; 1076:628-634.
• Stellman JM and Zoloth SR. Cancer chemotherapeutic agents as occupational hazards: A literature review. Cancer Invest. 1986; 4:127-135.Suspiro A and Prista J. Biomarkers of occupational exposure do anticancer agents: a minireview. Toxicol Lett. 2011; 207:42-52.
• Tilyou S. Cytotoxic drug residues still lurking in health care facilities: 75% of wipe samples from several hospitals deemed contaminated with at least one chemotherapeutic agent. HEM/ONC Pharm in Focus. 2010; 37 (01).
• Toolaram AP, Kummerer K and Schneider M. Environmental risk assessment of anti-cancer drugs and their transformation products: a focus on their genotoxicity characterization-state of knowledge and short comings. Mutat Res Rev Mutat Res. 2014; 760:18-35.
• Trossman S. Hazardous conditions. Am J Nurs. 2006; 106:75-78.
• Turci R, Sottani C, Spagnoli G and Minoia C. Biological and environmental monitoring of hospital personnel exposed to antineoplastic agent: a review of analytical methods. J Chromatog B. 2003; 789:169-209.
• Vanchieri C. Health hazard to community practice nurses: the ‘big worry’. Community Oncol. 2005; 2:277-279.
• Vandenbroucke J. Quality assurance project in a university hospital-2 years of experience. EHP. 2001; 7: 60-68.
• Vaughn MC and Christensen WD. Occupational exposure to cancer chemotherapeutic drugs: A literature review. Am Ind Hyg Assoc J. 1985; 46:B8-B18.
• Vecchio D, Sasco AJ and Cann CI. Occupational risk in health care and research. Am J Ind Med. 2003; 43:36-397.

A number of surveys have examined work practice standards and compliance with guidelines for the proper handling of antineoplastic agents.

• Ahmad N, Simanovski V, Hertz S, Klaric G, Kaizer L and Krzyzanowska MK. Oral chemotherapy practices at Ontario cancer centres. J Oncol Pharm Pract. 2015; 21(4):249-257.
• Alexander M, King J, Lingaratnam S, Byrne J, MacMillan K, Mollo A, Kirsa S and Green M. A survey of manufacturing and handling practices for monoclonal antibodies by pharmacy, nursing and medical personnel. J Oncol Pharm Pract. 2016; 22:219-227.
• Al-Azzam SI, Awawdeh BT, Alzoubi KH, Khader YS and Alkafajei AM. Compliance with safer handling guidelines of antineoplastic drugs in Jordanian hospitals. J Oncol Pharm Pract. 2015; 21 (1):3-9.
• Ben-Ami S, Shaham J, Rabin S, Melzer A and Ribak J. The influence of nurses’ knowledge, attitudes, and health beliefs on their safe behavior with cytotoxic drugs in Israel. Cancer Nurs. 2001; 24:192-200.
• Boiano JM, Steege AL and Sweeney MH. Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. J Occup Environ Hyg. 2014; 11:728-740.
• Boiano JM, Steege AL and Sweeney MH. Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. J Occup Environ Hyg. 2014; 11:728-740.
• Boiano JM, Steege AL and Sweeney MH. Adherence to precautionary Guidelines for Compounding Antineoplastic Drugs: A Survey of Nurses and Pharmacy Practitioners. J Occup Environ Hyg. 2015. (epub. DOI: 10.1080/15459624.2015.1029610).
• Cohen IA, Newland SJ and Kirking DM. Injectable-antineoplastic-drug practices in Michigan hospitals. Am J Hosp Pharm. 1987; 44:1096-1105.
• Constantinidis TC, Vagka E, Dallidou P, Basta P, Drakopoulos V, Kakolyris S and Chatzaki E. Occupational health and safety of personnel handling chemotherapeutic agents in Greek hospitals. Eur J Cancer Care. 2011; 20:123-131.
• DeJoy DM, Smith TD, Woldu H, Dyal M-A, Steege AL and Boiano JM. Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. J Occup Environ Hyg. 2017; 14:485-493.
• Dekyndt B, Decaudin B, Lannoy D and Odou P. Economic assessment of aseptic compounding rooms in hospital pharmacies in five European countries. J Oncol Pharm Pract. 2015; 21:102-110.
• Friese CR, Himes-Ferris L, Fraier MN, McCullagh MC and Griggs JJ. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy. BMJ Qual Saf. 2012; 21(9) 753-759.
• Fuller TP, Bain EI and Sperrazza K. A survey of the status of hazardous drug awareness and control in a sample Massachusetts nursing population. J Occup Environ Hyg. 2007; 4:D113-119.
• Gambrell J and Moore S. Assessing workplace compliance with handling of antineoplastic agents. Clin J Onc Nurs. 2006; 10:473-477.
• Gilbar PJ. External contamination of cytotoxic drug vials. J Pharm Pract Res. 2005; 35:264-265.
• Gregoire RE, Segal R and Hale KM. Handling antineoplastic-drug admixtures at cancer centers: Practices and pharmacist attitudes. Am J Hosp Pharm. 1987; 44:1090-1095.
• Hon C-Y, Teschke K, Chua P, Venners S and Nakashima L. Occupational exposure to antineoplastic drugs: Identification of job categories potentially exposed throughout the hospital medication system. Saf Health Work. 2011; 2:273-281.
• Hon CY, Barzan C and Astrakianakis G. Identification of knowledge gaps regarding healthcare workers’ exposure to antineoplastic drugs: review of literature, North America versus Europe. Saf Health Work. 2014; 5:169-174.
• Hon CY, Teschke K and Shen H. Healthcare workers’ knowledge, perceptions and behaviors regarding antineoplastic drugs: survey from British Columbia, Canada. J Occup Environ Hyg. 2015; 12:669-677.
• Hon CY and Abusitta D. Causes of health care workers’ exposure to antineoplastic drugs: an exploratory study. Can J Hosp Pharm. 2016; 69:216-223.
• Jeong KW, Lee BY, Kwon MS and Jang JH. Safety management status among nurses handling anticancer drugs: nurse awareness and performance following safety regulations. Asian Pac J Cancer Prev. 2015; 16:3203-3211.
• Kieffer C, Verhaeghe P, Lagrassa S, Gregoire R, Moussaoui Z, Casteras-Ducros C, Clark JE, Vanelle P and Rathelot P. Preventing the contamination of hospital personnel by cytotoxic agents: evaluation and training of the para-professional healthcare workers in oncology units. Eur J Cancer Care. 2015; 24:404-410.
• Kyprianou M, Kapsou M, Raftopoulos V and Soteriades ES. Knowledge, attitudes and beliefs of Cypriot nurses on the handling of antineoplastic agents. Eur J Oncol Nurs. 2010; 14:278-282.
• Mahon SM, Casperson DS, Yackzan S, Goodner S, Hasse B, Hawkins J, Parham J, Rimkus C, Schlomer M and Witcher V. Safe handling practices of cytotoxic drugs: The results of a chapter survey. Oncol Nurs Forum. 1994; 21:1157-1165.
• Martin S. Chemotherapy-handling practices of outpatient and office-based oncology nurses. Onc Nurs Forum. 2003; 30:575-581.
• Nieweg RMB, de Boer M, Dubbleman RC, Gall HE, Hesselman GM, Lenssen PCHP, van Maanen LWGM, Majoor PWFM and Slegt JH. Safe handling of antineoplastic drugs. Cancer Nurs. 1994; 17:501-511.
• Pedersen CA, Schneider PJ and Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration – 2014. 2015; 72:1119-1137.
• Polovich M and Martin S. Nurses’ use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncol Nurs Forum. 2011; 38:718-726.
• Roop JC and Wu HS. Current practice patterns for oral chemotherapy: results of a national survey. Oncol Nurs Forum. 2014; 41:185-194.
• Sauer KA, Coons SJ and Berger PK. Survey of training, handling practices, and risk perceptions of Kentucky pharmacists working with antineoplastic agents. Am J Hosp Pharm. 1991; 48:119-120.
• Shahrasbi AA, Afshar M, Shokraneh F, Monji F, Noroozi M, Ebrahimi-Khojin M, Madani SF, Ahadi-Barzoki M and Rajabi M. Risks to health professionals from hazardous drugs in Iran: a pilot study of understanding of healthcare team to occupational exposure to cytotoxics. EXCLI Journal (ISSN 1611-2156). 2014; 13:491-501.
• Silver SR, Steege AL and Boiano JM. Predictors of adherence to safe handling practices for antineoplastic drugs: a survey of hospital nurses. J Occup Environ Hyg. 2016; 13:203-212.
• Steege AL, Boiano JM and Sweeney MH. NIOSH health and safety practices survey of healthcare workers: training and awareness of employer safety procedures. Am J Ind Med. 2014; 57(6):640-652.
• Stellman JM, Aufiero BM and Taub RN. Assessment of potential exposure to antineoplastic agents in the health care setting. Prev Med. 1984; 13:245-255.
• Trovato, JA and Tuttle LA. Oral chemotherapy handling and storage practices among Veterans Affairs oncology patients and caregivers. J Oncol Pharm Pract. 2014; 20:88-92.
• Turk M, Davas A, Ciceklioglu M, Sacaklioglu F and Mercan T. Knowledge, attitude and safe behaviour of nurses handling cytotoxic anticancer drugs in Ege University Hospital. Asian Pac J Cancer Prev. 2004; 5:164-168.
• Valanis B and Shortridge L. Self protective practices of nurses handling antineoplastic drugs. Oncol Nurs Forum. 1987; 14:23-27.
• Valanis B, McNeil V and Driscoll K. Staff members’ compliance with their facility’s antineoplastic drug handling policy. Oncol Nurs Forum. 1991; 18:571-576.
• Valanis B, Vollmer WM, Labuhn K, Glass A and Corelle C. Antineoplastic drug handling protection after OSHA guidelines: Comparison by profession, handling activity and work site. J Occup Med. 1992; 34:149-155.
• Washburn DJ. Intravesical antineoplastic therapy following transurethral resection of bladder tumors: nursing implications from the operating room to discharge. Clin J Oncol Nurs. 2007; 11:553-559.
• Yoshida J, Kosaka H, Nishida S and Kumagai S. Actual conditions of the mixing of antineoplastic drugs for injection in hospitals in Osaka Prefecture, Japan. J Occup Health. 2008; 50:86-91.