Occupational and environmental impact of hazardous drugs


  • Carlo Sala Editor in Chief


hazardous drugs


The term hazardous drugs was first used in 1990 by ASHP (American Society of Hospital Pharmacists) and taken up by OSHA (Occupational Safety and Health Administration) and NIOSH (National Institute for Occupational Safety and Health) in 2004 .
Hazardous medicinal products (HMPs) are mainly used for the treatment of cancer and for the treatment of other diseases and are a source of occupational exposure and environmental impact.
In a recent study published by the European Commission in March 2021, the number of workers definitely exposed at European level is estimated at at least 1.8 million. Also taking into account the potential exposure throughout the health sector, the number rises to 12.7 million of which 7.3 million are nurses [European Commission, 2021; ETUI, 2020; Musu & Lindsley,


ASHP Guidelines on Handling Hazardous Drugs (2018). Am J Health-Syst Pharm. 2018; 75:1996- 2031

Chaturved P.et al. 2021. Prevalence and hazardous impact of pharmaceutical and personal care products and antibiotics in environment: A review on emerging contaminants, Environmental Research, Volume 194,2021,110664, ISSN 0013-9351,https://doi.org/10.1016/j.envres.2020.110664

COMMUNICATION FROM THE COMMISSION TO THE EUROPEAN PARLIAMENT, THE COUNCIL AND THE EUROPEAN ECONOMIC AND SOCIAL COMMITTEE- European Union Strategic Approach to Pharmaceuticals in the Environment. Brussels, 11.3.2019 COM(2019) 128 final

Comunidad de Madrid. 2018. Resolution From the Regional Deputy Minister for Health Which Dictates Instructions for Safe Manipulation Of Hazardous Medicines n 51/2018 - General Directorate of Health Care Coordination and General Directorate of Human Resources and Industrial Relationships.

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [CDC–2020–0046; NIOSH–233–C] Hazardous Drugs: Draft NIOSH List of Hazardous Drugs in Healthcare Settings, 2020; Procedures; and Risk Management Information. Federal Register / Vol. 85, No. 85 / Friday, May 1, 2020 / Notices

De Plato F .Hazardous drugs and occupational risk: the unknown siblings of antineoplastic drugs 2021 (SIFO document)

ETUI (2020) Inclusion of hazardous medicinal products within the scope of the carcinogens and mutagens directive, Briefing note. https://www.etui.org/news/inclusionhazardous-medicinal-products-within-scope-carcinogens-and-mutagens-directive

European Biosafety Network. 2015. Preventing occupational exposure to cytotoxic and other hazardous drugs. https://www.europeanbiosafetynetwork.eu/wpcontent/uploads/2016/05/Exposure-to-CytotoxicDru

European Biosafety Network (EBN). Observatory on current biosafety practice in European Oncology. February 2019. https://www.europeanbiosafetynetwork.eu/wp-content/uploads/2019/03/Observatory-on-current-biosafety-practice-in-European-Oncology-1.pdf)

European Commission (2021) Study supporting the assessment of different options concerning the protection of workers from exposure to hazardous medicinal products, including cytotoxic medicinal products: final report, Publications Office. Publications Office. https://data.europa.eu/doi/10.2767/17127

Fu, Y.;et al. (2019). Degradation of Three Nonsteroidal Anti-Inflammatory Drugs by UV/Persulfate: Degradation Mechanisms, Efficiency in Effluents Disposal. Chem. Eng. J. 2019, 356, 1032–1041

Hejna M.et al. 2022 Pharmaceuticals in the Aquatic Environment: A Review on Eco-Toxicology and the Remediation Potential of Algae. Int. J. Environ. Res. Public Health, 19, 7717. https://doi.org/10.3390/ijerph19137717

HSE Guideline on the Safe Handling of Cytotoxic Drugs 2022

Korczowska, E.,et al. 2020. Environmental contamination with cytotoxic drugs in 15 hospitals from 11 European countries—results of the MASHA project: European Journal of Oncology Pharmacy. 3(2):e24.

Leso V.,et al. (2022) Exposure to antineoplastic drugs in occupational settings: a systematic review of biological monitoring data, International Journal of Environmental Research and Public Health, 19 (6), 3737. https://doi.org/10.3390/ijerph19063737

Lombardi R, et al.; Documento Italiano di Consenso SIFO (Società Italiana di Farmacia Ospedaliera e dei Servizi Farmaceutici delle Aziende Sanitarie). Gestione del rischio di esposizione del personale sanitario nella manipolazione dei farmaci antineoplastici iniettabili: gli aspetti di prevenzione e la caratterizzazione delle misure di sicurezza. Aprile 2017.https://www.sifoweb.it/images/pdf/attivita/attivita-scientifica/ aree_scientifiche/area_oncologica/CONSENSUS_DOCUMENT_FINALE.pdf

Ma, D.; et al.l2021. Critical Review of Advanced Oxidation Processes in Organic Wastewater Treatment. Chemosphere, 275, 130104.

Musu, T. & Vogel, L. 2018. Cancer and work: understanding occupational cancers and taking action to eliminate them. ETUI. https://www.etui.org/sites/default/files/cancer-ENWEB.pdf

Musu, T., Lindsley I. 2022. The ETUI’s list of hazardous medicinal products (HMPs) including cytotoxics and based on the EU CLP classification system of Carcinogenic, Mutagenic and Reprotoxic (CMR) substances. Report 2022.05. ISBN : 978-2-87452-641-1 European Trade Union Institute Bd du Roi Albert II, 5 1210 Brussels

National Toxicology Program (2019) NTP monograph on the systematic review of occupational exposure to cancer chemotherapy agents and adverse health outcomes. https://doi.org/10.22427/NTP-MGRAPH-5

NIOSH List of Hazardous Drugs in Healthcare Settings, 2020

Occupational Safety and Health Administration (OSHA) 2016. Controlling Occupational Exposure to Hazardous Drugs. https://www.osha.gov/ SLTC/hazardousdrugs/controlling_occex_hazardousdrugs.html

SESCAM. 2018. Guidelines for Action on the Risk of Exposure to Hazardous Drugs For Health Service Workers in Castile-La Mancha - SESCAM Occupational Risks Prevention Service.