NIOSH issues fentanyl safety recommendations for health care workers

Washington — New guidance from NIOSH is intended to help protect health care workers from exposure to illicit, non-pharmaceutical fentanyl, a synthetic opioid considered up to 50 times more potent than heroin.

Nurses, nursing assistants, physicians, technicians, therapists, phlebotomists and pharmacists are among the workers who may be exposed to fentanyl, according to NIOSH. Primary routes of exposure include inhaling powders or aerosols, making contact with mucous membranes, and ingestion. Also a concern is secondary exposure to items that break the skin, such as needlesticks.

Any primary exposure “can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression,” NIOSH states. Brief skin contact, however, is not likely to trigger an overdose and can be treated with prompt decontamination.

NIOSH advises workers who face potential fentanyl exposure to:

• Coordinate with emergency personnel to determine patients’ potential contamination levels and assess possible hazards.
• Refrain from touching your eyes, nose or mouth after coming in contact with surfaces in areas of possible contamination. Don’t eat, drink, smoke or use the restroom in these areas.
• Wash hands or other unprotected skin with soap and water after possible exposure. Don’t use alcohol-based hand rubs, as these could boost absorption through the skin.
• Consider using personal protective equipment such as disposable filtering facepiece respirators, goggles, powder-free nitrile gloves and sleeve covers.

Health care workers who care for patients with suspected or confirmed fentanyl exposure should launder their clothes at an in-house facility, if available. Separate exposed clothing and place in a labeled polyethylene bag.

The Centers for Disease Control and Prevention notes that it has not compiled occupational exposure data for illicit fentanyl, and that federal or consensus occupational exposure limits don’t exist. The agency adds that it intends to update the recommendations as new research is made available.