The Hazardous Drugs Nobody Treats as Hazardous

Sometimes, hazardous drugs don’t look hazardous. Healthcare professionals may associate hazardous drugs primarily with chemotherapy and cancer treatment. However, hazardous drugs are used across a wide range of therapeutic categories and healthcare settings. This means that nurses, midwives and other healthcare professionals may encounter hazardous drugs without necessarily realizing that they present an occupational exposure risk.

A 2025 study of nurses and midwives at six Australian hospitals illustrates the extent of this challenge. When participants were asked to identify hazardous drugs, 80.6% failed to identify chloramphenicol as hazardous, 73.8% failed to identify colchicine and 68.2% failed to identify dutasteride.

This raises an important question: If a healthcare professional doesn't recognize a drug as hazardous, will the appropriate precautions be taken?

Hazardous drugs are classified according to the risks associated with their inherent toxicity, rather than simply according to their therapeutic use.

The National Institute for Occupational Safety and Health (NIOSH) identifies toxicity criteria that can make a drug hazardous, including carcinogenicity, reproductive or developmental toxicity, organ toxicity at low doses and genotoxicity. Antineoplastic drugs are therefore an important subset of hazardous drugs, but they are not the entire category.

This distinction matters, because hazardous drugs may be encountered far beyond oncology. The study notes that hazardous drugs are prescribed for conditions including epilepsy, hypertension, autoimmune diseases and cancer, creating the potential for occupational exposure wherever these medications are handled.

Consider three of the drugs included in the study. Chloramphenicol is an antibiotic. Colchicine is used to treat inflammatory conditions, while Dutasteride is used to treat benign prostatic hyperplasia. Despite their very different and familiar therapeutic uses, all three are classified as hazardous drugs, and all three were missed by a majority of participants.

The problem extended beyond a few unfamiliar medications. When participants were presented with 14 hazardous and non-hazardous drugs, they correctly identified them only half of the time. The researchers highlighted this result alongside another significant finding that only one third of participants who handled hazardous drugs reported receiving training in hazardous drug handling.

Among the 217 participants who reported handling hazardous drugs, 43.4% said they had received no hazardous-drug handling training, while another 20.3% were unsure whether they had received such training. Of those who had received training, fewer than half reported that it had taken place within the previous 12 months.

These findings highlight a fundamental requirement of hazardous drug safety: healthcare professionals first need to know that a hazard exists.

Without reliable identification and communication of hazardous drugs, even well-designed safe-handling policies may not translate into appropriate precautions at the point of care.

Recognizing the importance of personal protective equipment (PPE) does not necessarily mean PPE will be used consistently.

In the Australian study, almost ninety percent of participants were confident they could use PPE correctly. Yet one-third of those involved in preparing, administering or disposing of hazardous drugs reported never wearing PPE for these activities.

The type of drug formulation also made a substantial difference. Participants reported using PPE approximately twice as often when handling hazardous injectable drugs as when handling oral formulations.

Why the disconnect between confidence and practice?
One important factor may again be hazard recognition. A majority of participants agreed that uncertainty about which drugs were hazardous could result in them unintentionally not using PPE.

In other words, healthcare professionals can know how to protect themselves and still remain vulnerable if they do not know when those protections are required.

The traditional association between hazardous drugs and oncology can obscure the much broader scope of occupational exposure.

Protecting healthcare professionals therefore requires more than focusing on specialist oncology environments. Hazardous drug safety needs to extend to the different departments and professionals who may prepare, administer, transport or dispose of a wide range of non-oncology hazardous medications.

The study's findings also suggest that responsibility cannot rest entirely with individual healthcare professionals. Workplace safety climate was associated with PPE use, while the researchers identified measures including professional training, periodic audits, readily available PPE, electronic medical record safety messages and clear labeling of hazardous drugs as potential ways to improve safe-handling practices.

The researchers ultimately call for a multifaceted, multidisciplinary approach to improving both knowledge and practice for the handling of cytotoxic and non-cytotoxic hazardous drugs.

Healthcare professionals may encounter hazardous medications across therapeutic areas and clinical environments, and the first step toward protecting them is recognizing when a hazard is present.

Effective hazardous drug safety combines awareness and training with clear institutional policies, appropriate PPE, safe working practices and engineering controls designed to reduce occupational exposure.

The Chemfort® Closed System Drug-Transfer Device (CSTD) provides a key component of this comprehensive approach. Chemfort® is designed to mechanically prohibit the release of hazardous drugs in vapor, aerosol or liquid form during preparation and administration, helping minimize exposure of healthcare professionals and the surrounding environment. In addition, Chemfort® is compatible with all known hazardous drugs.

Because recognizing a hazardous drug is only the beginning. The next step is ensuring that healthcare professionals have the systems and tools they need to handle it safely.

Learn more about how Chemfort® CSTD supports safer hazardous-drug handling.