BILL ANALYSIS �
Senate Committee on Labor and Industrial Relations
William W. Monning, Chair
Date of Hearing: June 26, 2013 2013-2014 Regular
Session
Consultant: Gideon L. Baum Fiscal:Yes
Urgency: No
Bill No: AB 1202
Author: Skinner
As Introduced/Amended: May 24, 2013
SUBJECT
Occupational safety and health standards: hazardous drugs.
KEY ISSUE
Should the Legislature require the Occupational Safety and
Health Standards Board (OSHSB) to create an occupational safety
and health standard for the handling of antineoplastic drugs in
health care facilities?
ANALYSIS
Existing law provides for the Occupational Safety and Health
Standards Board (OSHSB), which consists of seven individuals
appointed by the Governor for four year terms. Two members must
be from the field of management, two members must be from the
field of labor, one member must be from the field of
occupational health, one member must be from the field of
occupational safety and one member must be from the general
public.
(Labor Code ��140 and 141)
Existing law empowers OSHSB, by an affirmative vote of four or
more members, to adopt, amend, or repeal occupational safety and
health standards. The procedure to adopt, repeal, or amend
occupational safety and health standards must follow the process
for promulgating regulations, unless otherwise stated in Labor
Code. (Labor Code ��142.3 and 142.4)
Existing law requires that the Department of Occupational Safety
and Health (DOSH) enforce all occupational safety and health
standards adopted by OSHSB. (Labor Code �142)
Existing law allows any employer to apply to OSHSB for a
permanent variance from any occupational safety and health
standard if the employer has an alternative practice or program
that will provide equal or superior safety for employees. The
standards board must issue the variance if it determines on the
record that the preponderance of evidence supports that the
employer's alternative practice or program are as safe as the
standard. (Labor Code �143)
Existing law requires that OSHSB develop or revise certain
specific occupational safety and health standards, including
bloodborne pathogens, hazardous substance removal work,
agricultural field sanitation, and lead-related construction.
(Labor Code ��144.7, 6380.5, 6712, and 6717)
This bill would require OSHSB to create an occupational safety
and health standard for the handling of antineoplastic drugs in
health care facilities regardless of the setting. In developing
the standard, the board must:
1) Consider input from hospitals, practicing physicians
from impacted specialties, including oncology,
organizations representing health care personnel, including
registered nurses and pharmacists, and other stakeholders,
and
2) Determine a reasonable time for facilities to implement
new requirements imposed by the adopted standard.
3) To the extent feasible, be consistent with and not
exceed recommendations in the National Institute for
Occupational Safety and Health (NIOSH) 2004 alert entitled
"Preventing Occupational Exposures to Antineoplastic and
Other Hazardous Drugs in Health Care Settings," as updated
in 2010.
This bill would define "Antineoplastic drug" as a
chemotherapeutic agent that controls or kills cancer cells.
This bill would also make findings and declarations on the
dangers of inappropriate handling of antineoplastic drug in an
occupational setting.
Hearing Date: June 26, 2013 AB 1202
Consultant: Gideon L. Baum Page 2
Senate Committee on Labor and Industrial Relations
COMMENTS
1. What are Antineoplastic Drugs?
Antineoplastic Drugs (also known as cytotoxic drugs) are drugs
or agents used in chemotherapy cancer treatments to prevent
the development, maturation, or spread of cancerous cells.
For the patients who take these drugs, side effects include
hair loss, fatigue, blood problems, and other health hazards.
Although developed for cancer treatments shortly after the end
of the Second World War, concerns about occupational exposure
were not raised until the 1970s.
According to the Center for Disease Control (CDC), the effects
of exposure to Antineoplastic Drugs in the workplace can be
quite significant. For example, a 2007 study on
Antineoplastic Drug exposure in the workplace showed that
nurses exposed to these drugs/agents took longer to conceive
and had lower birthrates. Several studies have also shown a
link between increased exposure to Antineoplastic Drugs and
cancer. In short, the CDC recognizes Antineoplastic Drugs as
a potential occupational health risk.
2. The 2004 NIOSH Alert
The National Institute for Occupational Safety and Health
(NIOSH), which is a part of the Centers for Disease Control
and Prevention (CDC), published an alert in 2004 "to increase
awareness among health care workers and their employers about
the health risks posed by working with hazardous drugs and to
provide them with measures for protecting their health." The
alert concluded with:
"Recent evidence summarized in this Alert documents that
worker exposure to hazardous drugs is a persistent problem?
In all studies involving examination of surface wipe samples,
Hearing Date: June 26, 2013 AB 1202
Consultant: Gideon L. Baum Page 3
Senate Committee on Labor and Industrial Relations
researchers have determined that surface contamination of the
workplace is common and widespread. Also, a number of recent
studies have documented the excretion of several indicator
drugs in the urine of health care workers. Results from
studies indicate that worker exposure to hazardous drugs in
health care facilities may result in adverse health effects?
To minimize these potentially acute (short-term) and chronic
(long-term) effects of exposure to hazardous drugs at work,
NIOSH recommends that at a minimum, employers and health care
workers follow the recommendations presented in this Alert
(emphasis added)."
The NIOSH alert made set forth the following recommended
procedures:
1) Assess the hazards in the workplace:
� Evaluate the workplace to identify and assess
hazards before anyone begins works with hazardous
drugs.
� Regularly review the current inventory of
hazardous drugs, equipment, and practices, seeking
input from affected workers.
� Conduct regular training reviews with all
potentially exposed workers in workplaces where
hazardous drugs are used.
1) Handle drugs safely:
� Implement a program for safely handling
hazardous drugs at work and review this program
annually on the basis of the workplace evaluation.
� Establish procedures and provide training for
handling hazardous drugs safely, cleaning up spills,
and using all equipment and personal protective
equipment properly.
� Establish work practices related to both drug
manipulation techniques and to general hygiene
practices.
1) Use and maintain equipment properly:
Hearing Date: June 26, 2013 AB 1202
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Senate Committee on Labor and Industrial Relations
� Develop workplace procedures for using and
maintaining all equipment that functions to reduce
exposure - such as ventilated cabinets, closed-system
drug-transfer devices, needless systems, and personal
protective equipment.
3. Proponent Arguments :
Proponents argue that registered nurses and healthcare workers
by the nature of their work, which involves ill patients,
contagious diseases, medical equipment and chemical exposures,
are in constant danger of being exposed to harmful substances
without even knowing it. Proponents note that nurses and
other healthcare workers, who transport, prepare, administer
and dispose of hazardous drugs can be exposed to these toxic
agents in the air or on work surfaces, clothing, medical
equipment and other surfaces. As a result, proponents note
that nurses, other healthcare workers and nonclinical workers
are at risk for exposure to hazardous drugs, which proponents
argue can cause cancer, reproductive and developmental
problems, allergic reactions and other adverse effects that
can be irreversible even after low-level exposures.
4. Opponent Arguments :
None on file.
5. Prior Legislation :
SB 432 (DeLeon) of 2011would have required the Occupational
Safety and Health Standards Board (OSHSB) to develop an
occupational safety and health standard for lodging
housekeepers. SB 432 was held in the Assembly Appropriations
Committee.
SUPPORT
American Federation of State, County and Municipal Employees,
AFL-CIO
Hearing Date: June 26, 2013 AB 1202
Consultant: Gideon L. Baum Page 5
Senate Committee on Labor and Industrial Relations
Association of Northern California Oncologists (If Amended)
BD Medical Surgical Systems
California Healthcare Institute
California Labor Federation, AFL-CIO
California Nurses Association
California Pharmacists Association
California Professional Firefighters
National Lawyers Guild Labor & Employment Committee
OPPOSITION
None on file.
Hearing Date: June 26, 2013 AB 1202
Consultant: Gideon L. Baum Page 6
Senate Committee on Labor and Industrial Relations