How to work safely with hazardous drugs

Introduction: Numerous published scientific articles in the 1970s and 1980s on the effects of cytotoxics on the personnel who work with them led to the introduction of the term “hazardous drug.” It was first used by ASHP (American Society of Health-System Pharmacists) in 1990. The term was revised by the US National Institute for Occupational Safety and Health (NIOSH) in 2004. It is used for drugs that are known or suspected to have adverse health effects as a result of employee exposure during work. Aim: Systematized presentation of the basic rules for safe handling of hazardous medicinal products, according to established American, European, and national standards. Materials and Methods: A documentary method was applied. The guidelines and recommendations of ASHP (American Society of Health-System Pharmacists), NIOSH (National Institute for Occupational Safety and Health), EU-OSHA (European Agency for Safety and Health at Work), and the Bulgarian legislation through the Health and Safety at Work Act and Ordinance No. 10 of 26.09.2003 on the protection of workers from risks associated with exposure to carcinogens, mutagens, or substances toxic to reproduction during work were studied and analyzed. The basic rules and good practices for safe work with hazardous medicinal products were derived. Results: There are established international standards for safe work with hazardous medicinal products, as well as regulatory documents of the European Union. Gradually, changes are being made to the Bulgarian legislation in this direction, and the foundations have been laid, but there are still many detailed guidelines and competent control measures that would guarantee the protection of employees who come into contact with mutagenic, carcinogenic, and reproductively damaging medicines. Conclusion: The presence of hazardous drugs in the workplace requires a series of measures on the part of employers, workers, and control authorities, to ensure safe working conditions. The creation of standard operating procedures in medical institutions, which cover all actions related to carcinogenic drugs—receipt, storage, protection, transport, preparation, administration, waste management—is part of the processes of prevention and protection of employees. However, even the best written procedures have no effect if they are not applied and followed.