EU OSHA Update on Hazardous Medicinal Products: What You Need to Know

Introduction

The latest update from the European Agency for Safety and Health at Work (EU OSHA) highlights a significant shift in workplace safety, particularly for healthcare workers who handle Hazardous Medicinal Products (HMPs).1

This update stems from the most recent changes to Directive 2004/37/EC, which now incorporates reprotoxic substances and features an indicative list of HMPs.2 These developments aim to increase worker safety, particularly for healthcare professionals prone to exposure from preparation and administration of HMPs.

A Brief Background

Understanding Directive 2004/37/EC

Directive 2004/37/EC, commonly referred to as the Carcinogens, Mutagens, and Reprotoxic substances Directive (CMRD), is a key piece of legislation aimed at protecting workers from exposure to hazardous substances.

Initially, it addressed carcinogens and mutagens, ensuring worker safety from risks such as cancer and genetic anomalies. Through amendments, most notably Directive 2022/431/EU, the scope has widened to cover reprotoxic substances—agents harmful to human reproduction.

The significance of this expansion can’t be understated, as it includes many hazardous medicinal products, making this legislation more responsive to the risks encountered by healthcare and related sectors.

The Importance of the Recent Update

The EU Commission’s latest OSHA update establishes an indicative list of HMPs to assist employers in identifying potential hazards. This list couples with enhanced guidelines that stress replacing harmful substances wherever possible or relying on tools, such as closed systems and CSTDs, to minimize exposure.

Key Changes in the Update

The most noteworthy alterations include the following:

/ Addition of Reprotoxic Substances

Reprotoxic substances are now fully recognized under the CMR framework. This step amplifies protection for workers handling substances linked to fertility issues, birth defects, or developmental disorders.

/ Indicative List of Hazardous Medicinal Products

For the first time, there’s an EU-endorsed indicative list of HMPs. This includes antineoplastics, immunosuppressants, and antiviral medicines, among others. These drugs, while vital for treating patients, present risks to healthcare workers due to their classification as Category 1A or 1B carcinogens, mutagens, or reprotoxic agents.

This list offers clarity for employers performing risk assessments and deciding on safety measures.

/ Expanded Employer Obligations

Employers are now mandated to introduce robust safety protocols. This includes offering regular worker training, conducting detailed risk assessments, substituting hazardous substances where feasible, and using closed systems to prevent exposure.

overview of regulatory changes EU OSHA

Employer Responsibilities

Under these updated guidelines, employers are required to adopt a proactive approach to minimize workplace hazards. Here’s a breakdown of what’s expected:

1. Comprehensive Risk Assessment

Employers must evaluate all possible exposure routes—dermal, respiratory, and oral—when handling HMPs. Data must be renewed regularly and made available to authorities upon request.

2. Implementation of Closed Systems

Where substitution isn’t possible, a closed technological system must be employed. Closed System Transfer Devices (CSTDs), like those offered by EQUASHIELD®, play a important role here, preventing exposure and minimizing contamination.

3. Worker Training and Information

Employers must ensure all workers handling HMPs receive regular training. This includes understanding potential risks, proper handling protocols, and how to react in case of exposure incidents.

4. Hygiene and Safeguards

Worker safety goes beyond prevention—employers are required to provide protective clothing, hygiene facilities, and regular health surveillance to detect early signs of exposure-related conditions.

employer responsibilities for worker safety with HMD HD

Impact on Healthcare Workers

A Healthier Workplace for Medical Professionals

These updates are set to transform how healthcare workers like pharmacists, oncology nurses, and pharmacy technicians handle cytotoxic medications. With exposure linked to serious health risks—including cancer, miscarriages, and respiratory issues—the provision of safer environments is long overdue.

For example, studies reveal nurses handling cytotoxic drugs are three times more likely to develop malignancies compared to those not exposed.3 The new OSHA recommendations emphasize protective measures to reduce these distressing statistics.

Safety with CSTDs

In the life cycle of HMPs from manufacture to disposal, as set out in the European Commission Guidance for the Safe Management of HMPs at work 2023, a closed system in healthcare means the use of biological safety cabinets (BSCs), containment isolators and closed system transfer devices (CSTDs). Isolators and BSCs are effective in preventing contamination and occupational exposure in the preparation of HMPs in the pharmacy, whilst CSTDs are effective across the whole life cycle of HMPs and in particular in the administration of HMPs on the wards.

EQUASHIELD® CSTDs offer industry-leading solutions. With features like a closed-back syringe plunger and leak-proof design, these devices minimize contamination better than other alternatives.4

Complementary Solutions and Prevention

When discussing protective measures, CSTDs are just the beginning. Employers and healthcare facilities can also reduce exposure risks by leveraging pharmacy automation systems.

The Role of Automation in HMP Handling

Advanced technologies like EQUASHIELD® Mundus Mini HD automate processes, reducing manual manipulation and potential exposure points. Robots and automated systems ensure precision, decrease errors, and boost staff safety.

Cross-sector Applications

Beyond healthcare, these updates emphasize protective measures in waste disposal, veterinary care, and even hospital cleaning staff working with contaminated linens or equipment.

By using a combination of CSTDs, automation, and routine safety training, all industries involved in HMP handling can meet OSHA’s directives while fostering safe working conditions.

Taking Action for Safer Workplaces

Employers, healthcare professionals, and safety managers must align their practices with these updated OSHA regulations.

If you’re unsure where to start, EQUASHIELD®’s EQ Academy offers incredible resources—including tutorials and webinars—on safe HMP handling practices. Their closed system transfer devices and pharmacy automation solutions are trusted by industry leaders to meet the highest safety standards.

Consider the following actionable steps to ensure compliance and protect workers handling HMPs:

/ Perform an updated risk assessment for all hazardous materials.

/ Transition to closed systems like EQUASHIELD® CSTDs.

/ Train all relevant staff using OSHA-aligned education programs.

/ Explore automation solutions to further minimize handling risks.

steps for ensuring workplace safety compliance

Safeguarding the Future for Healthcare Workers

The EU OSHA update represents a fundamental step forward in protecting workers from the risks posed by Hazardous Medicinal Products. By emphasizing preventative systems like CSTDs and prioritizing worker well-being, employers can create safer, more efficient work environments.

Businesses have a responsibility to not only meet these updated standards but also to safeguard their teams and reduce the long-term impacts of exposure. With comprehensive strategies and advanced solutions like those from EQUASHIELD®, compliance is not just achievable—it’s a path to a healthier workforce.

Need help upgrading your safety measures? Contact EQUASHIELD® or visit EQ Academy today to explore how you can enhance your workplace safety while adhering to the latest OSHA directives.



Additional resources:

  1. Prevent Hazardous Drug Exposure – in Healthcare Workers
  2. Hazardous drugs may be invisible, but they are everywhere, and they have real consequences
  3. Closed Systems vs. CSTDs: What’s the Difference?
  4. Navigating European CMR and ETUI Guidelines in Healthcare Environments

Navigating European CMR and ETUI Guidelines in Healthcare Environments

With the growing demand for cancer treatments, the number of healthcare workers exposed to hazardous medicinal products (HMPs) is increasing, exposing up to 12.7 million EU healthcare professionals and 40% of nurses annually .1,2  Recent advancements in cancer research present new treatment options that lead to improved outcomes. These breakthroughs also introduce challenges associated with new toxicity profiles and concerns for occupational safety. 

In Europe, ensuring workplace safety in environments with hazardous substances requires an understanding and implementation of regulatory guidelines. This blog examines the CMR (Carcinogens, Mutagens, and Reproductive Toxicants) guidelines, alongside the ETUI list (European Trade Union Institute), to highlight their role in protecting workers in oncology and pharmacy. 3,4 

Hazards While handling CMRs in the EU 

Nurses exposed to cytotoxic drugs face serious risks, including being twice as likely to experience miscarriage. 5 The European Oncology Nursing Society (EONS) gathered data on occupational safety in an anonymous online survey.6 One in five nurses reported handling hazardous cancer drugs during pregnancy and breastfeeding. Over a third of respondents noted risks of negative repercussions if pregnant or breastfeeding nurses requested alternative duties. Some nurses reported a lack of introductory education for handling HMPs. A key finding from the study is EONS’ official acknowledgment of the risks oncology nurses face when handling HMPs. To address these dangers, they recommend implementing specific safety measures, including the use of a Closed System Transfer Device (CSTD). 

Overview of ETUI list and CMR Guidelines   

The ETUI report outlines HMPs covered under the EU’s CMR Directive 2022/431 to control and limit exposure to substances that can cause cancer, genetic mutations, or reproductive toxicity. It helps employers comply with new regulations and enhance worker safety. Based on the U.S. National Institute for Occupational Safety and Health (NIOSH) classifications and adapted to European standards, it categorizes HMDs into three toxicity levels with corresponding safety measures. It focuses on identifying, assessing, and managing the risks associated with HMD exposure in the workplace.  

Harmful Effects of HMP Exposure in the Workplace  

HMPs, primarily used in cancer treatment, present health risks to healthcare workers due to potential exposure during handling. Even small, ongoing doses can be dangerous, leading to acute and chronic health effects. 7 Exposure results in effects that may take years to manifest, causing thousands of cancer deaths annually, as well as numerous miscarriages, fertility issues, and congenital disabilities.8  

Healthcare environments are complex, and risks arise during preparation, administration, and disposal processes. Paths of exposure include dermal absorption, inhalation, and ingestion 2. This mainly affects oncology nurses and pharmacy staff, but can also affect patients, visitors, and family members through contact with contaminated surfaces.  

Lifecycle of hazardous drugs in the hospital

Recommendations for Safe Handling of HMPs from Most to Least Effective 

The ETUI report offers a hierarchy of controls to prioritize the most effective safety measures for preventing exposure.  

/ Elimination: Removing the HMP 

/ Substitution: Replacing the HMP 

/ Engineering controls: Isolating healthcare workers from HMP 

/ Administrative controls: Establishing procedures to minimize the duration, frequency, or intensity of exposure to HMP 

/ Personal protective equipment (PPE): Wearing gloves, goggles, and other protective gear to reduce exposure to HMP 

Strategies for Safe Handling in Chemotherapy  

In healthcare units handling HMPs like chemotherapy, elimination and substitution isn’t feasible. The most effective measure is to implement engineering controls, which means ensuring a closed system. A fully closed system combines the use of a safety cabinet or isolator with a Closed System Transfer Device (CSTD) to provide the highest level of containment.  

Without a CSTD, compounding within a safety cabinet often results in drug residues lingering on gloves, vials, and surfaces, which spreads throughout the rest of the lifecycle.9 CSTDs are essential for minimizing vapor escape and leakage, preventing exposure during both compounding and administration. 

EQUASHIELD CSTD Advantages   

EQUASHIELD CSTDs offer proprietary technological advantages that make them safe, simple, and closed. The portfolio of products is backed by independent and peer-reviewed studies to prevent vapor escape, leakage, and microbial ingress, covering more routes of exposure than alternative solutions.

EQUASHIELD CSTD technological advantages

The Syringe unit is fully encapsulated, preventing not just external exposure but also plunger and barrel contamination. It features a patented closed back and utilizes sterile air drawn directly from its sealed back chamber, eliminating the need for extra steps to equalize pressure.10 This sets EQUASHIELD apart from other brands, making it the easiest and most user-friendly system available.11,12 

Equashield syringe unit technology

Case Study of Improved Safety Practices   

Hospitals in Southwest Germany transitioned to EQUASHIELD’s CSTD to enhance safety in handling hazardous drugs. The head of pharmacy made this change due to exposure risks. Since integrating the system seven years ago, they have reported improved staff satisfaction, measured reduced contamination, and streamlined workflows. The improved safety standards have reduced turnover while enhancing safety and morale. 

Act now 

As new research emerges and technology advances, healthcare institutions must regularly update their safety protocols. Through training, updated technology, and a strong safety culture, healthcare professionals minimize risks. By following regulatory guidelines and recommendations, healthcare institutions create a safer work environment for oncology nurses and pharmacy staff.  

Download this all-encompassing guide with everything you need to know : Transform Your Hazardous Drugs Management Approach with this Step-by-Step Guide