Hazardous Drug Dangers of Being in the Medical Field

This article is the fourth part of a multi-part series of hazards within the medical field. Catch up on parts one, two, and three.

The healthcare sector is one of the largest and most complex in the U.S. The U.S. Bureau of Labor Statistics found 16 million medical-related jobs, profiting about $2.7 trillion annually. Overall, the healthcare industry accounted for 18% of gross domestic product (GDP) in 2020. 

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The healthcare sector benefits from a robust medical research and development system, cooperating with higher education and the technology industry. 

The hazardous drugs used to treat patient illnesses are a growing concern for unprotected healthcare workers in their workplaces. The chance that hazardous drugs will harm healthcare workers depends on several factors, including toxicity, potency, physical and chemical properties, formulation, workplace activity, and route of exposure. 

The following article breaks down the various hazardous drug dangers of being in the medical field. 

Aerosolized Medications

Aerosolized delivery of medications is advantageous to the patient, as it directly delivers the drug to the target organ and respiratory tract rather than indirectly via oral or parenteral routes.

Aerosolized mucolytics and antibiotics primarily treat chronic lung infections in bronchiectasis and cystic fibrosis. Other aerosols include anti-inflammatory medications to treat severe asthma and prevent lung transplant rejection, shortness of breath, and migraine headaches. 

Respiratory therapists, nurses, physicians, or other healthcare workers may administer aerosolized medications. These workers may have repeated low-dose exposures to various agents or cumulative dosing of the same agent, which may cause side effects such as nervous system stimulation, constricting blood vessels, and suppressing immunity. 

Workers have also reported decreased pulmonary function testing and acute respiratory symptoms. Repeated exposure to antibiotics could pose a risk of developing drug-resistant strains, fungal infection of the HCP, or possible allergic reactions.

There are currently no OSHA standards or ACGIH guidelines for aerosolized medication. 

Anesthetic Gasses

The anesthetic gasses and vapors that leak into the surrounding room during medical procedures are considered waste anesthetic gasses. This exposure can occur through a leak in the anesthetic delivery system, the patient’s mask, improper use of the gas scavenging system, or through the patient's residual gas exhalation. 

The toxic gasses include nitrous oxide and halogenated agents (vapors), such as halothane, enflurane, isoflurane, and desflurane. Healthcare professionals who work in hospitals, operating rooms, and dental offices are potentially exposed to waste anesthetic gasses and are at risk of occupational illness.

Chronic exposure to waste anesthetic gasses may result in reproductive toxicity. Acute health effects include drowsiness, fatigue, depression, impaired judgment, headache, and nausea. 

Antineoplastic Drugs

Antineoplastic drugs account for most NIOSH-defined hazardous medications, including antiviral drugs, hormones, and bioengineered drugs. Antineoplastic drugs, also known as chemotherapy, cytotoxic, and oncology drugs, treat cancer, arthritis, multiple sclerosis, and other non-cancer medical conditions.

Exposure to antineoplastic drugs can occur in many different hospital areas, including the shipping and receiving area, hospital pharmacy, inpatient and outpatient cancer wards, laundry, and hospital waste collection areas.

Researchers have studied the presence of these drugs in the urine of hospital personnel and found dermal exposure as the main route of exposure. Handling patient excreta is potentially harmful to workers administering antineoplastic medications because they are known to be present in urine, saliva, sweat, feces, vomit, etc.  

Healthcare workers exposed to chemotherapy drugs have an increased risk of leukemia and other cancers, adverse reproductive outcomes, and chromosomal damage. 

Nitric Oxide

Nitric oxide (NO) is used as inhalation therapy to treat pulmonary hypertension in adults and newborns through a ventilator. 

The primary safety concerns regarding inhaled NO therapy are the potential exposure to nitrogen dioxide (NO2), formed by the reaction between NO and oxygen. This oxidation process is relatively slow but increases in high-oxygen environments.

Healthcare workers exposed to NO2 may experience irritation of the eyes, skin, mucous membranes, and respiratory tract. Long-term exposure can lead to infertility.

Pentamidine

Pentamidine is an antimicrobial agent used to treat severe pneumocystis pneumonia (PCP). This pneumonia commonly occurs in immunocompromised patients, such as patients with acquired immune deficiency syndrome (AIDS). 

Healthcare workers, including respiratory therapists, nursing staff members, and physicians, administer pentamidine in hospital and airborne isolation therapy rooms. Potential routes of exposure are inhalation, ingestion, and skin absorption. 

Direct health effects associated with pentamidine exposure include chest tightness, cough, conjunctivitis, hematologic abnormalities, perinasal paresthesia, and numbness. Previous studies have also linked pentamidine exposure to bronchospasms, decrements in certain lung functions, reproductive issues, and tuberculosis.