NIOSH Hazardous Drugs: What You Need to Know About Safe Handling and Exposure Risks

When you hear NIOSH hazardous drugs, chemicals identified by the National Institute for Occupational Safety and Health as posing serious health risks to healthcare workers through exposure. Also known as hazardous pharmaceuticals, these are drugs that can cause cancer, birth defects, infertility, or organ damage—even from small, repeated exposures like skin contact or inhalation. This isn’t about patients taking meds at home. This is about nurses, pharmacists, and cleaners who handle these drugs every day—and the silent risks they face.

Chemotherapy drugs, a major category of NIOSH hazardous drugs used to treat cancer, are the most common. But it’s not just chemo. Antiviral drugs like ritonavir, hormone therapies like tamoxifen, and even some compounding agents like cyclophosphamide are on the list. These aren’t rare outliers—they’re daily tools in hospitals and clinics. And if you’re handling them without proper training or protective gear, you’re at risk. The NIOSH list gets updated every few years based on new research, and it’s not just about potency. It’s about how easily the drug can be absorbed through skin, how stable it is in the air, and whether it’s genotoxic.

Occupational exposure, the unintentional contact workers have with hazardous drugs during preparation, administration, or cleanup is the real problem. A single spill, a leaking IV bag, or even dust from crushed pills can expose someone. Studies show that healthcare workers have higher levels of these drugs in their urine than the general public. That’s not normal. It’s preventable. Proper ventilation, closed-system transfer devices, and personal protective equipment like double gloves and gowns aren’t optional—they’re the minimum. And yet, many clinics still rely on outdated practices because they don’t realize how serious this is.

The good news? You don’t have to guess what’s safe. NIOSH publishes clear guidelines. They tell you which drugs to watch for, how to store them, how to clean up spills, and what to do if someone gets exposed. They also explain how to train staff and document safety steps. These aren’t suggestions. They’re the standard for safe practice. If your workplace doesn’t follow them, you’re being put at risk.

Below, you’ll find real-world advice from people who’ve been there—how to spot unsafe practices, what to ask your employer, how to protect yourself when resources are tight, and what to do if you’ve already been exposed. These aren’t theory pieces. They’re survival guides from nurses, pharmacists, and safety officers who’ve seen the consequences—and found ways to stop them.