Note. The Table of Control Approaches provides general approaches that should be adapted to facility-specific conditions. For more detailed information on safe handling practices, see the reference list for this table [ASHP 2006; NIOSH 2004a, 2008; ONS 2011, 2018; OSHA 2016; Power and Cyne 2018].

^* Abbreviations: BSC = Biological safety cabinet; CACI = compounding aseptic containment isolator; CSTD = closed system drug-transfer device; CVE = containment ventilated enclosure; HIPEC = hyperthermic intraperitoneal chemotherapy; NA = not applicable; NG = nasogastric; PAPR = powered air-purifying respirator; PO = per os (by mouth).

^† Respiratory protection must be selected on the basis of the hazardous drug and its physical form (particulate, vapor, etc.) and other exposure factors. For general activities, a N95 may suffice. Use a surgical N95 respirator if there is potential for splashes of bodily fluids or liquid drugs. When performing activities such as cleaning the BSC or CACI or responding to large spills, a combination particulate/chemical cartridge respirator may be needed.

^‡ Compounding is the process of combining, mixing, or altering ingredients by or under the direct supervision of a licensed pharmacist or physician to create a prescribed medication tailored to the needs of an individual patient. See FDA: https://www.fda.gov/drugs/human-drug-compounding/section-503a-federal-food-drug-and-cosmetic-act and https://www.fda.gov/drugs/human-drug-compounding/compounding-and-fda-questions-and-answers.

^§ For nonsterile preparations, a ventilated engineering control such as a fume hood, Class I BSC or CVE is sufficient if the ventilated engineering control exhaust is either (1) HEPA filtered and appropriately exhausted to the outside of the building (preferred) or (2) filtered with redundant HEPA filters in series and recirculated back into the C-SCA. Although these activities are recommended in ventilated engineering controls, they may not be possible under some treatment scenarios (e.g., time-sensitive activities in the emergency department). If the activity is performed in a ventilated engineering control that is used for sterile intravenous preparations, a thorough cleaning and disinfecting is required following the activity.

^¶ Sterile gloves are required for aseptic drug preparation in a BSC or CACI.

^** Needed if the patient might resist (infant, unruly patient, patient predisposed to spitting, patient with difficulty swallowing, or veterinary patient) or if the formulation is hard to swallow.

^†† Intravenous tubing already attached and primed.

^‡‡ Activities such as cleaning floors may not require eye or respiratory protection but cleaning a BSC or CACI may require it.

View NIOSH [2023]. Managing hazardous drug exposures: information for healthcare settings. By Hodson L, Ovesen J, Couch J, Hirst D, Lawson C, Lentz TJ, MacKenzie B, Mead K. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2023-130, https://doi.org/10.26616/NIOSHPUB2023130.