NIOSH’s new Research to Practice (r2p) initiative is designed to transfer research findings, technologies, and information into effective prevention practices and products and to promote their adoption in workplaces. The goal of r2p is to decrease occupational illnesses, injuries, and fatalities by increasing the work-place use of effective NIOSH and NIOSH-funded research findings.
A vibrant example of r2p implementation is the NORA RHRT’s Hazardous Drug Working Group activities regarding the unsafe handling of hazardous drugs in health care settings, an instance in which exposure opportunity is unregulated and the hazard is high. Scientific evidence appeared in the literature several years ago documenting widespread contamination of oncology clinics and pharmacies with antineoplastic hazardous drugs in a number of university hospitals in the United States and Canada (Connor et al. 1999
). Although the Occupational Safety and Health Administration (OSHA) and professional organizations of hospital pharmacists and oncology nurses have published safe handling guidelines (OSHA 1986
), it was apparent that, despite the high potential health risk these drugs posed to workers when handled improperly, there was poor adherence to recommended standards of safe professional practice (Connor et al. 1999
). The existing gaps in the collective science include full toxicologic characterization of these drugs in health care exposure settings, industrial hygiene methods to describe exposure, adequate risk communication to affected workers, and vigilance in assuring and evaluating safe handling work practices. This single example is summarized according to the Carnegie scholarship model of discovery, integration, application, and teaching (Boyer 1990
) in .
Domains of scholarship of the NORA RHRT: hazardous drugs as an example.
Discovery scholarship—that is, new knowledge—continues to accrue and, in so doing, suggests further information gaps regarding these most toxic therapeutic drugs, many of which are known carcinogens and undisputed human reproductive and developmental toxicants. Engineering scientists are collaborating with toxicologists on the hazardous drug problem in a relevant example of integration scholarship, the making of connections across disciplines. For example, the fugitive drug particulate captured on high-efficiency particulate air (HEPA) filters in biologic safety cabinets appears to be volatilizing under the high-volume air flows passed over the filters. This volatilization presents a potential exposure to workers not currently addressed elsewhere. There is a cascade of implications for change in both engineering controls and work practices if this volatilization exposure is found to be commonplace.
The scholarship of application describes a lively engagement between affected parties in the sciences and the beneficiaries of that science to fully use the knowledge gained from both the discovery and integration activities. As an example, NORA RHRT partnered with the NORA Control Technology Team to sponsor and support a working group to review the new evidence regarding ongoing exposure of health care workers to hazardous drugs and to assess the need for change of current work recommendations. The Hazardous Drug Working Group is composed of stakeholders from all federal government agencies and regulatory bodies affected, health care worker unions, professions, home care providers, drug manufacturers, and academia. The group reviewed new evidence of exposure against existing OSHA and professional practice guidelines to determine where gaps exist in compliance and the worker knowledge base. This group produced a NIOSH Alert (NIOSH 2004
) titled “Safe Handling of Hazardous Drugs in Healthcare,” which served as an organizing focus for stakeholders to brainstorm and translate this new science base into specific work practice applications, identifying strategies to improve safe handling and enhance worker protection.
Teaching scholarship, extending and communicating knowledge to the affected public, began in this r2p effort with a health care industry “rollout” workshop in October 2004 (Alert on Reducing Occupational Exposures to Hazardous Drugs in Healthcare: Converting Theory to Practice, 3–5 October 2004 , San Antonio, TX) to raise national awareness about hazardous drug exposures and provide the scientific base for the Alert. NIOSH, OSHA, and the Joint Commission on Accreditation of Healthcare Organizations leadership opened the meeting to call the attendees to action on the part of the workers they employ. Work group members presented sessions offering real-world practical solutions to support attendees in applying new information to improve their organization’s safe handling programs.