Is it time for stricter rules to protect oncology nurses?


Independent research organisation MindMetre, which regularly addresses patient and healthcare worker safety across Europe, is urging a rethink about protection for oncology nurses when handling hazardous drugs

A report published on the MindMetre website in February has highlighted the issue of nurses who administer cytotoxic chemotherapy drugs being exposed to the harmful effect of oncology drugs. The research and analysis organisation has looked at recent pieces of evidence emerging in Europe and as a result has raised the question as to whether official guidelines should be interpreted more rigorously and specific legislation introduced to better protect oncology nurses.

Oncology drugs are among the most potent and MindMetre has examined anecdotal evidence that suggests chemotherapy nurses in UK NHS Trusts may be sustaining harm as a result of exposure to the hazardous cytotoxic drugs they are handling in their day-to-day duties. The report says that although this evidence is, at present, purely anecdotal and cannot be regarded as quantitative, the fact that harm from occupational exposure is being reported at all would suggest that this area of healthcare worker safety merits further investigation, as well as better standards of healthcare worker protection.

The testimonies of chemotherapy nurses up and down the UK describe a range of symptoms from significant hair loss, to flu-like symptoms, to an unusually high incidence of miscarriages. The report says, given that there is no significant difference between European countries in terms of oncology nurse occupational protection standards, it can be assumed that the situation is likely to be similar across the other main economies of Europe.

MindMetre says Spain saw an investigation last year by the official prosecutor, which examined staff and union complaints about nurse exposure to (and damage from) cytotoxic drugs. As a result it imposed a mandatory increase in standards regarding the preparation and administration of these hazardous substances.

Reports at the time noted that “Technicians... were able to verify the presence of cytotoxics on work surfaces, in the air or in the urine of exposed persons. In relation to the possible adverse effects that chronic occupational exposure to low levels of concentration of compounds with cytotoxics can cause, [the investigation] warns that these effects ‘may be subclinical and not be obvious for years or generations of continuous exposure.’”

The research note says that the legal process around this case is ongoing. One member of staff has been awarded compensation for damage sustained from exposure to cytotoxic drugs. However, it is noteworthy that radically improved systems have been introduced to protect healthcare workers right across the cytotoxic drug preparation and administration cycle. In particular, the hospital now uses Closed System Transfer Devices (CSTDs) that eliminate any escape of cytotoxic drugs and it has introduced measures in pharmacy and ward that reduce contamination rates to virtually zero, thereby better protecting care staff.

Insufficient monitoring

MindMetre questions whether the contamination levels between pharmacy and point of administration are always regularly or thoroughly investigated and sites the absence of consistently collected evidence in the cytotoxic drug administration trail in a majority of hospitals.

It goes on to argue that, given the number of patients requiring treatment with chemotherapeutic agents is predicted to increase, further efforts to reduce occupational exposure to anti-cancer drugs, including the refinement and wider use of CTSDs, should be explored.

The issue of oncology nurse exposure is being discussed on the European stage, with the publication of Preventing occupational exposure to cytotoxic and other hazardous drugs, European Policy Recommendations, launched in the European Parliament on 26 April 2016. The paper notes that although the increasing risk has been widely recognised across Europe – including bodies such as the European Agency for Safety and Health at work – there is not yet any specific legislation, guidelines or minimum standards which precisely defines processes in EU member states on handling cytotoxic drugs.

Back in November 2015, the European Parliament did call on the Commission to take action on this issue. This new paper launched in April calls for legislation to be put in place and includes a specific recommendation on CSTDs. In the meantime, MindMetre says it will continue to monitor the situation.

The full report can be downloaded at