Page 11 - 21 Summer Newsletter

Misconceptions About USP <800> Hazardous

Drugs‐Handling in Healthcare Settings

Over recent months, we have received many questions and be adopted to protect themselves and their employees after
comments surrounding the safe handling of hazardous drugs. Assessments of Risks (AORs) are drafted. Some suggestions:
In the Spring 2020 edition of the North Carolina Veterinarian, Personal protective equipment (PPE) should be accessible
Dr. Young published an introduction to this topic. We hope the for the handling of hazardous drugs (face shields, gowns,
information below expands upon that article to clear up any and head covers)
remaining confusion. Closed system transfer devices (like PhaSeal, Equashield,

To start, a hazardous drug (HD) is defined as a drug found on and Mila) should be used to limit flashback, aerosolization,
the latest version of the NIOSH “List of Antineoplastic and and splashing when handling hazardous drugs
Other Hazardous Drugs in Healthcare Settings” or additions Facilities should have a dedicated preparation area for
included by an entity based on an assessment of risk. (NIOSH, reconstituting and administering hazardous drugs to
the National Institute for Occupational Safety and Health, is a patients
federal agency responsible for conducting research and Cage cards can be used to identify patients that have
making recommendations for the prevention of work‐related received hazardous drugs
injury and illness.) Importantly to our veterinary community, All entities should have a descriptive standard operating
no veterinary‐exclusive drugs appear on the currently procedure (SOP) on how to handle hazardous drugs from
published (2016) NIOSH list, but are expected to be included the minute they arrive at the facility to the minute the
in the forthcoming revised version. This means that the medication is administered and then disposed of
current NIOSH list cannot be used as our individual entity’s Employers should provide comprehensive training programs
hazardous drug list. We must each create a list unique to our on how to handle hazardous drugs that inform staff of
workplace after evaluation of each drug in our inventory and hazardous drugs, how to handle them, and by their
the potential danger it poses to our workers if handled signature acknowledge that they understand the risks
inappropriately.
Should you have any further questions, please do not hesitate
The catalyst for USP <800> is also an important consideration to reach out to the authors below.
for our community. It did not arise from the U.S. Food and
Drug Administration (FDA), the Occupational Safety and Gigi Davidson, BSPharm, DICVP, is the former Director of Clinical
Health Administration (OSHA), or the Environmental Pharmacy Services at the NC State University College of
Protection Agency (EPA). It was conceptualized by Dr. Brett Veterinary Medicine where she practiced veterinary pharmacy for
Cordes, a veterinarian who battled cancer (twice) from what 35 years. Among her many accolades, she is the past President of
he believes was years of handling hazardous substances the Society of Veterinary Hospital Pharmacists and the American
without an understanding of the dangers. He consequently College of Veterinary Pharmacists. Ms. Davidson is the American
did not follow the precautions (namely wearing personal Pharmacists Association House of Delegates representative for
ACVP. She was the Chair of the United States Pharmacopeia
protective equipment) that USP <800> recommends.
Compounding Expert Committee from 2010‐2020 and continues
We would like to emphasize that this leads to the purpose of to serve on that Expert Committee. Ms. Davidson was awarded
USP <800>, which is to protect healthcare workers, not the U.S. Pharmacopeial (USP) Convention’s 2015 Beal Award for
patients. Veterinary drugs are not exempt from employee Distinguished Volunteer Service—the organization’s highest
protective measures. There is always a human involved with award, given every 5 years.
administration of any drug. Furthermore, CFR 29 1910.1200
(The OSHA Hazards Communication) federally mandates Natalie Young, PharmD, FACVP, is the current Director of Realo
employers to provide information about the hazards of each Veterinary Pharmacy, an accredited sterile compounding
pharmacy. She is the current President of the American College of
chemical in the workplace. The OSHA General Duty Clause
Veterinary Pharmacists, the Coordinator‐Elect for the American
stipulates that each employer furnish to each of its employees
a workplace that is free from recognized hazards that are Pharmacists Association’s Compounding SIG, serves in the APhA
House of Delegates, and is an Assistant Professor of Clinical
causing or likely to cause death or serious physical harm. Education at the UNC Chapel Hill Eshelman School of Pharmacy.

As our veterinary community strives to become compliant Dr. Young is also an ACHC Certified Hazardous Drug Designated
with USP <800>, we understand that it is unreasonable to ask Person.
veterinarians to have the engineering controls described in
this chapter (e.g., negative pressure rooms and chemo hoods).
(We would like to note that some do.) Simpler measures can

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