Resources Tools

ASHP Guidelines for Handling Hazardous Drugs
The ASHP Guidelines on Handling Hazardous Drugs provide a framework for healthcare teams to develop policies and procedures to minimize the risks that hazardous drugs pose to healthcare workers.

ASHP USP <800> Quick Assessment Tool
ASHP's free USP <800> Quick Assessment Tool provides a topline evaluation of your facility's compliance readiness. Determine your organizations readiness for compliance by completing ASHP Consulting’s Quick Assessment Tool. 

A pharmacy-led United States Pharmacopeia (USP) Chapter <800> compliance collaborative at an academic medical center
One academic medical center’s efforts to move toward compliance with requirements of United States Pharmacopeia (USP) chapter 800 through a multidepartmental collaborative initiative are described.

USP General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings
USP General Chapter <800> provides standards for safe handling of hazardous drugs to minimize the risk of exposure to healthcare personnel, patients and the environment. General Chapter <800> describes requirements including responsibilities of personnel handling hazardous drugs; facility and engineering controls; procedures for deactivating, decontaminating and cleaning; spill control; and documentation. These standards apply to all healthcare personnel who receive, prepare, administer, transport or otherwise come in contact with hazardous drugs and all the environments in which they are handled.

FAQs: <800> Hazardous Drugs—Handling in Healthcare Settings
A page of frequently asked questions with responses and guidance provided by members of the USP Compounding Expert Committee.

The National Institute for Occupational Safety and Health (NIOSH)- Hazardous Drug Exposure in Healthcare

All listed drugs are considered hazardous, but safe-handling precautions can vary with the activity and the formulation of the drug. The current NIOSH approach involves three groups of drugs:

  • Table 1: Antineoplastic drugs (AHFS Classification 10:00) [ASHP/AHFS DI 2016]. Note that many of these drugs may also pose a reproductive risk for susceptible populations (Table 1).
  • Table 2: Non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous drug. Note that some of these drugs may also pose a reproductive risk for susceptible populations (Table 2).
  • Table 3: Drugs that primarily pose a reproductive risk to men and women who are actively trying to conceive and women who are pregnant or breast feeding, because some of these drugs may be present in breast milk (Table 3)

No single approach can cover the diverse potential occupational exposures to the listed drugs.

NIOSH List of Hazardous Drugs in Healthcare Settings 2019

NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016

NIOSH Federal Register Landing Page
Notices for additions and removals outside of scheduled document updates are posted here.

CDC- Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings
The current update (2016) adds 34 drugs and includes a review of the 2004 list. The National Institute for Occupational Safety and Health (NIOSH) of the Centers for Disease Control and Prevention (CDC) has updated its list of hazardous drugs for 2016.

Controlling Occupational Exposure to Hazardous Drugs
Work-practice guidelines for personnel dealing with cytotoxic drugs (CDs) are presented. Current practices in the preparation, storage, administration, and disposal of CDs may expose pharmacists, nurses, physicians, and other health-care workers to high environmental levels of these drugs. OSHA has developed these guidelines to protect health-care workers from unnecessary exposure to CDs. A brief summary of the short-term and long-term hazards known to be associated with these drugs is presented. The risks to workers handling CDs are a combined result of the drugs' inherent toxicity and the extent to which workers are directly exposed to CDs via inhalation, absorption, and ingestion. Work-practice guidelines that can limit the exposure of workers to CDs and the equipment necessary to carry out these practices properly are described.

The Chapter <800> Answer Book By Patricia C. Kienle
A comprehensive guide to every area of compounding, administering, storing, and disposing of hazardous drugs, written in a question-and-answer format.  Organized in a format like Chapter <800>, each section begins with an overview of the key issues and requirements of that section, followed by questions and answers covering the specifics of compliance. A glossary of terms, acronyms, and abbreviations, plus extensive reference to the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, adds to the ease of use.

Oncology Nursing Society - Safe Handling of Hazardous Drugs Third Edition (ONS) 
Safe Handling of Hazardous Drugs is based on the recommendations of NIOSH, OSHA, ONS, the American Society of Health-System Pharmacists (ASHP), and USP. This resource provides oncology nurses with the latest details and procedures needed to keep safe in the workplace.

Perform an Assessment of Risk to Comply with USP <800>
In the pursuit of USP Chapter <800> compliance, the first step is to identify all hazardous drugs (HD) available in your entity, as well as their dosage forms and the specific handling practices for those products. Sample Hazardous Drug Assessment of Risk Template

It Takes a Team to Build Better Hazardous Drug Lists
A system wide approach can facilitate a smooth process to help entities within health systems create hazardous drug (HD) lists and procedures


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