Safe Handling of Hazardous Drugs in Long-Term Care Communities 

Hazardous drugs (HD) can be found in many medical facilities, including long-term care (LTC) and residential care communities. Due to the potentially dangerous nature of these drugs, they must be monitored and properly handled. The United States Pharmacopeia (USP) Section 800 outlines strict requirements and regulations to help facilities manage hazardous drugs.  

What is USP 800 

USP is an independent, worldwide organization that sets quality, purity, strength, and identity standards for medicines, food ingredients, and dietary supplements. Section 800 is specific to hazardous drugs in healthcare settings. USP 800 establishes standards for safe handling of HDs to minimize exposure risk to healthcare personnel, patients, and the environment.  

Section 800, which went into effect in 2019, outlines standards that apply to all healthcare personnel who receive, prepare, administer, transport, or come in contact with HDs and all environments where HDs are handled.  According to the Centers for Disease Control and Prevention (CDC), more than eight million U.S. healthcare workers are exposed to HDs each year. Safe handling of HDs can minimize the acute and long-term effects of exposure on the environment, patients, and healthcare personnel.  

What are Hazardous Drugs  

The National Institute for Occupational Safety and Health (NIOSH) defines hazardous drugs as anything that exhibits one or more toxic characteristics such as carcinogenicity, reproductive toxicity, and genotoxicity. Hazardous drugs commonly found in long-term care facilities include Methotrexate, Azathioprine, Warfarin, Clonazepam, and Valganciclovir. NIOSH maintains a list of HDs used in healthcare settings and separates them into three categories. Table 1 identifies the most hazardous drugs and provides information about handling that must be followed. Tables 2 and 3 are less hazardous and handling discretion is up to each facility based on an assessment of risk.  

How to Perform an Assessment of Risk (AoR) 

When table 2 and 3 HDs are used in a LTC community, an AoR is required for each drug. Remember, an AoR is not necessary for table 1 HDs because all requirements for containment are explained and must be followed. An AoR identifies exposure risk and routes for each HDs by type and dosage. The assessment also determines types of exposure based on staff responsibilities and activity. A thorough AoR should account for:  

• Receiving, storing, and packaging  
• Manipulations such as crushing or mixing 
• Spills, transport, and waste  

Performing risk assessments and preparing for compliance with USP 800 is a lengthy and tedious process—but it does not have to be painful and confusing. Learn more about hazardous drugs, compliance, assessments of risk, and appropriate policies and procedures for LTC communities, with the help of Forum Extended Care experts.  

Join Executive Vice President Pamela Kramer, Vice President of Pharmacy Operations, Karen Smith, and Director of Clinical Services, Johnson Abraham, for our June Webinar to learn more about managing HDs in your LTC community.