[MCOH-EH] [EXTERNAL] Re: [External] Medical surveillance for employees who work with hazardous drugs

[Swift, Melanie D., M.D., M.P.H.]

Hi Elizabeth, we presented our experience with hazardous medication medical surveillance at Mayo at the 2024 AOHC. We do offer surveillance. It is “opt out” for nurses, pharmacists & others who are identified as handling hazardous medication, and “opt in” for workers who have less exposure (like housekeeping staff). The surveillance interval is every 2 years and consists of an electronic questionnaire. We included an optional CBC initially, but after evaluating our data, we determined this was not helpful. Over 50% had some CBC abnormality and on regression analysis there was no association between lab abnormalities and exposure frequency, intensity, or duration, exposure to a spill, or spill cleanup.

We’ve found that the most valuable part of the questionnaire is a question asking if they have any safety concerns in their work area. Some workers feel more comfortable reporting concerns to OHS, and we’ve been able to facilitate improvements in communication, training or procedures.
I hope this helps. We do plan to publish our experience, so stay tuned!

Melanie

Melanie Swift, MD, MPH
Professor of Medicine
Vice Chair, Division of Public Health, Infectious Diseases and Occupational Medicine
Medical Director, Mayo Clinic Physician Health Center<https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/referrals>
Associate Medical Director, Occupational Health Service
Vice Chair, Institutional Biosafety Committee
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905

From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Winters, Tom (BIDMC - Occupational Health)
Sent: Monday, July 28, 2025 12:07 PM
To: MCOH-EH <mcoh-eh at mylist.net>
Cc: Elizabeth Esty <ELIZABETH.ESTY at cuanschutz.edu>; mcoh-eh at mylist.net
Subject: [EXTERNAL] Re: [MCOH-EH] [External] Medical surveillance for employees who work with hazardous drugs

At several Harvard teaching hospitals we have post exposure programs, no annual surveillance
Tom Winters



On Jul 28, 2025, at 11:35 AM, Esty, Elizabeth via MCOH-EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>> wrote:

Hi All,

I've tried to look through the archive, but I don't see anything addressing this topic since 2017. (It's very possible I missed something.)

I've recently begun working in a medical center occupational health clinic. We have a medical surveillance program for employees who work with hazardous drugs that adheres to OSHA standards<https://urldefense.com/v3/__https://www.osha.gov/hazardous-drugs/standards__;!!AIv8Mrc!-LpJ_2E5zKb_xbDRcMmEyB1czgsW7ik4hFMKNj6102xLpXDnPpJCnI8ip7NrHF2x5h9VHSelnTniq0eThXYIon7m$>, USP 800 and ONS/ASCO guidance. We also use NIOSH materials, including the 2024 update<https://urldefense.com/v3/__https://www.cdc.gov/niosh/newsroom/updates/upd-12-20-25.html*:*:text=Updates*20in*20the*202024*20list,Drug*20Exposure*20in*20Healthcare*20webpage.__;I34lJSUlJSUlJQ!!AIv8Mrc!-LpJ_2E5zKb_xbDRcMmEyB1czgsW7ik4hFMKNj6102xLpXDnPpJCnI8ip7NrHF2x5h9VHSelnTniq0eThcLMEs8J$> on list of hazardous drugs.

We've been debating whether or not to expand surveillance to housekeepers and OR staff with frequent exposures and to nurses who handle only oral drugs on the NIOSH list.

I reached out to several larger hospital systems and found that at least two do not have surveillance programs of any kind. They've decided that their employees don't have significant exposures and that the challenge of linking exposure to outcome is too great to make surveillance effective. The Joint Commission appears not to require a program.

I would love to know how other medical center occupational health centers across the US (and abroad) are approaching medical surveillance. If your medical center is opting not to surveille at all, please let me know.

Thank you,
Elizabeth Esty


Elizabeth Esty, M.D., M.P.H.
Board Certified in Occupational and Environmental Medicine
Assistant Program Director, University of Colorado Residency in Occupational and Environmental Medicine
Department of Environmental and Occupational Health
University of Colorado Anschutz Medical Campus
Level II Certified, Colorado Division of Workers' Compensation
elizabeth.esty at cuanschutz.edu<mailto:elizabeth.esty at cuanschutz.edu>
303-229-2325<tel:303-229-2325>

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