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Report questions if oncology nurses safe from contamination from cytotoxic chemotherapy

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Nurses on cancer wards could be at risk because of a lack of monitoring by health trusts of contamination from potentially harmful cytotoxic chemotherapy drugs, a new report has claimed.

It said the vast majority of English trusts were not conducting regular environmental monitoring in the form of surface wipe-tests within cancer day units to detect possible chemical contamination.

“The risk associated with environmental contamination in cancer day wards is largely under-addressed by NHS trusts”

Paul Lindsell

The report, which was carried out by research organisation MindMetre, said its findings meant that it was impossible to estimate actual levels of contamination in UK cancer day wards.

A previous report by MindMetre in February this year used anecdotal evidence to link cancer nurses handling cytotoxic drugs with hair-loss and flu-like symptoms.

The organisation’s latest research is based on Freedom of Information requests to trusts. It enquired about current practice regarding risk assessments, environmental contamination monitoring and staff health surveillance in oncology and chemotherapy day units.

The research found only 7% of trusts carried out regular oncology nursing staff surveillance or were planning on introducing such screening programmes.

In addition, just 10% of trusts stated that they were using closed systems to prevent exposure of cytotoxic drugs to staff, or had plans in place to introduce such systems.

In contrast in the US, the National Institute of Occupational Safety and Health (NIOSH) has backed closed system devices for administering drugs to patients, the report stated.

“This underlines the need for a systematic evidence based study”

Richard Henry

NIOSH defines a closed system device as one “that does not exchange unfiltered air or contaminants with the adjacent environment”. In theory, it should protect staff administering the drug from the risk of contamination, noted the report.

Paul Lindsell, managing director of MindMetre Research, said: “This research clearly shows that the risk associated with environmental contamination in cancer day wards is largely under-addressed by NHS trusts.”

This, he said, was despite of his organisation’s previous research on the issue, which was published in February, and a “host of other commentators” indicating that nurses who regularly administered chemotherapy were “at risk of developing serious health problems”.

Richard Henry, president of the UK Oncology Nursing Society, said there was real concern about whether vapours and droplets from cytotoxic drugs on cancer wards were harming nurses.


Nurses should insist trusts obey sharps safety rules

Paul Lindsell

But he questioned whether the new report brought forward any hard scientific evidence on the subject.

“UKONS recognises the very real concerns that many nurses have. But anecdotal evidence is just that – anecdotal,” he told Nursing Times.

“If we have concerns we should have the evidence,” he said. “This underlines the need for a systematic evidence based study.”

Mr Henry said that UKONS had commissioned an independent researcher to carry out a full systematic review, looking at whether closed system drug transfer devices reduced the risk of staff contamination. The report will be published in May 2018.

All nurses on cancer wards received mandatory training on the safe handling of hazardous cancer drugs, he said, adding that regulations existed on monitoring contamination by cytotoxic drugs.

However, he noted that there was a lack of consistency between different trusts on what these rules were.

The Health and Safety Executive is responsible for occupational safety, including the Control of Substances Hazardous to Health Regulations (COSHH) 2002.

An HSE spokesman said some cytotoxic drugs were considered to be carcinogenic.

Queen's University Belfast/UKONS

Oncology nurses may be at risk from chemotherapy contamination

Richard Henry

“COSHH requires the employer to carry out a risk assessment to establish the hazards associated with products and processes they are using, and for the employer to put processes in place to control those risks,” he said.

“It also requires employers to provide information, instruction and training for all employees who use hazardous substances in their work, including the appropriate precautions and actions an employee must take to safeguard both themselves and others in the workplace,” he added.

The Care Quality Commission said that health and safety risks for staff formed part of its assessment of services.

“Where relevant, this includes specific risks relating to contamination from medications such as cytotoxic chemotherapy or other hazardous medicines,” a CQC spokeswoman said.

She added: “We expect providers to undertake risk assessments in relation to the COSHH, infection control and the general environment so that risks are identified and control measures are put in place to mitigate them.

“Where we find evidence that there is a risk in relation to cytotoxic medicines then we will always follow this up with providers to ensure that action is taken and that providers implement improvements to protect patients and staff,” she said.

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