Episode 308: Hazardous Drugs and Hazardous Waste: Personal, Patient, and Environmental Safety

“One of the things that I know Dr. [Tom] Connor worked on very heavily in his career is the long-term impact on the health of nurses and other exposed healthcare workers. We definitely need more longitudinal studies, which are difficult to do. And it’s not something that you see every day where I talk to chemo nurses and said, ‘Hey, I’ve been in this 20 years. It hasn't bothered me at all.’ Well, until it does. Therefore, it’s so important when we’re training incoming nurses—how very important it is to start with these practices early in the career and throughout the career,” Charlotte A. Smith, RPh, MS, senior regulatory advisor at Waste Management PharmEcology Services in Milwaukee, WI, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a conversation about hazardous drug and waste disposal.

Music Credit: “Fireflies and Stardust” by Kevin MacLeod

Licensed under Creative Commons by Attribution 3.0 

Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by April 19, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: Learners will report an increase in knowledge related to hazardous drugs and hazardous waste.

Episode Notes 

• Complete this evaluation for free NCPD. 
• Oncology Nursing Podcast episodes:
  • Episode 209: Updates in Chemo PPE and Safe Handling
  • Episode 142: The How-To of Home Infusions
• ONS Voice articles:
  • Two Oncology Nurses Implement Process to Allow Patients to Disconnect Pumps From the Comfort of Their Own Homes
  • The Oncology Nurse’s Role in Oral Anticancer Therapies
  • Strategies to Promote Safe Medication Administration Practices
• ONS Safe Handling of Hazardous Drugs Learning Library
• ONS position statement: Infusion of Antineoplastic Therapies in the Home
• ONS book: Safe Handling of Hazardous Drugs (fourth edition)
• ONS course: Safe Handling Basics
• Clinical Journal of Oncology Nursing articles:
  • Environmental Risk Factors: The Role of Oncology Nurses in Assessing and Reducing the Risk for Exposure
  • Oral Chemotherapy: A Home Safety Educational Framework for Healthcare Providers, Patients, and Caregivers
  • Oral Chemotherapy: An Evidence-Based Practice Change for Safe Handling of Patient Waste
  • Reconciliation and Disposal of Oral Medication: Creating a Safe Process for Clinical Research Personnel
• Pharmacy Practice News article: Applying NIOSH Hazardous Drug Assessment of Risk Principles To Home Healthcare (by Charlotte Smith and Tom Connor)
• Books mentioned in this episode:
  • Silent Spring by Rachel Carson
  • Our Stolen Future by Theo Colborn, Diane Dumanoski, and John Peterson Myers
  • Generations at Risk by Ted Schettler, Gina Solomon, Maria Valenti, and Annette Huddle
• Drug Enforcement Agency: National Prescription Drug Takeback Day
• Environmental Protection Agency: Final Rule: Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 Listing for Nicotine
• MD Anderson Cancer Center: Chemotherapy at Home: 9 Things to Know (patient resource)
• Memorial Sloan Kettering Cancer Center: Safe Handling of Chemotherapy and Biotherapy at Home (patient resource)
• National Institute for Occupational Safety and Health:
  • Hazardous Drugs in Healthcare Settings
  • Managing Hazardous Drug Exposures: Information for Healthcare Settings
  • NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.

To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Highlights From This Episode

“A hazardous waste is a chemical, some of which are drugs, that EPA has determined is hazardous to the environment. Hazardous waste may be listed waste, which are given actual numbers, or they may be characteristic waste, which meets certain levels of concern, such as ignitability or toxicity. Only a small percentage of drug waste meets the EPA’s definition of hazardous waste, including a number of chemotherapy drugs.” TS 2:09

“The poster child for hazardous waste is warfarin, which, as you may be aware, is not only appropriate for managing clotting time but is also available commercially as rat poison. This is an example of how chemicals can serve more than one purpose and why dosage and regulation are so important.” TS 4:04

“Some of your listeners may have been around long enough to remember the book Silent Spring, by Rachel Carson, in which she eloquently exposed the risks to many species by the widespread use of DDT, an insecticide, at that time. More recently, the book Our Stolen Future by Theo Colborn, a pharmacist, Diane Dumanoski, and John Peterson Myers, raised the specter of the effects of endocrine disruption on wildlife and humans. The effects of drugs like diethylstilbestrol, or DES, once given during pregnancy, on the fetus, impacted the risk of cancer and other untoward effects in the offspring. The book remains a dramatic reminder of the risk of exposure to hazardous chemicals, including drugs.” TS 9:37

“Providing a homecare checklist for both the nurse and the patient and family is a simple way to keep track of all areas that need to be covered. For example, who in the household may be at most risk from exposure? This list includes infants, elderly family members, caregivers, pregnant family members, even pets. Is there a secure area to store the drug that cannot be reached by children?” TS 14:21

“I think what happens—we become so into our routine that what we do on a daily basis, we just kind of go through and do it without always thinking about it. And we can forget that not everyone has the same context of understanding these risks that the medications have to both the environment and the individual exposed to them. And I know it’s challenging to put on all the gowns and the gloves and whatnot. And, you know, it gets in the way of doing their job. It's important to educate each individual potentially exposed to these drugs, as if they do not have the understanding that we do. So embedding those consistent safety practices into daily routine is so imperative to ensure safe handling of hazardous drugs and then the proper disposal of hazardous waste pharmaceuticals.” TS 18:55