Cancer nurses are being exposed to “hazardous” medicines linked to an increased risk of miscarriage and infertilitybecause NHS trusts are failing to give them vital PPE, The Independent can reveal.
Tens of thousands of healthcare workers administer toxic drugs such as chemotherapy and treatments for rheumatoid arthritis, HIV and multiple sclerosis, but most are routinely provided with just a plastic apron and gloves as protection, an investigation by The Independent and Channel 4 News has found.
Nurses have revealed that they have suffered recurrent miscarriages, which they believe could be linked to working unprotected on cancer wards, while other staff have reported experiencing hair loss, nausea, dizziness and fatigue.
Without adequate PPE, workers can be exposed to hazardous products either by breathing them in, through contact with contaminated surfaces or spills, or if a liquid is absorbed through the skin.
Last September, the NHS West Midlands Cancer Alliance published guidance warning that “inadequate control measures” could cause miscarriage, birth defects, liver damage, abnormal cell formation, abdominal pain, nasal sores and vomiting, while several studies have linked exposure to these drugs to infertility issues in healthcare workers.
In the United States, the Centers for Disease Control and Prevention issued an alert to its healthcare workers over the risks posed by the drugs – but UK guidelines allow NHS trusts to provide the “bare minimum” of protection for workers.
Now the UK regulator, the Health and Safety Executive (HSE), is being urged to act and review the evidence concerning the health risks to staff.
Alison Simons, a cancer nurse for more than two decades, fears her miscarriages were linked to working without the necessary protection.
Describing the working environment at the start of her career in the mid-1990s, she said: “When I was giving chemo, all we wore were plastic aprons and gloves to our wrists. I experienced three miscarriages, and at first, I didn’t make any link between [these and] giving chemotherapy at all. In fact, it was my GP who said ‘You give chemotherapy, don’t you.’
“When I started talking to colleagues, they were also experiencing similar things, such as miscarriages and fertility issues.”
Ms Simons, who is now a senior lecturer in applied cancer practice and a doctoral student at Birmingham City University, warned that, despite knowing what safety measures should be implemented, many trusts are still not putting them in place.
“It’s particularly frustrating because we know there are things out there to protect us, and they’re not being used. It does beg the question, are we not worth it?” she said.
Samantha Toland, a nurse consultant in cancer care for 26 years and lead cancer therapy nurse at Worcestershire Acute Hospitals NHS Trust, who teaches students alongside Ms Simons, said: “I, too, experienced a miscarriage in between my two children, but didn’t think anything of it... It was more when I started teaching; we both concluded that this was bigger than we thought it was.”
Ms Toland said her current trust is very good on the matter, but in previous workplaces, controls were lacking. She said: “I’ve had colleagues who have had multiple miscarriages, up to six or seven, and had to be off work for most of their pregnancy.
“The concern is that nurses are not getting the level of protection they should have... There’s that feeling when you know there are things that could help, and nobody seems to be putting those into place. That’s when you feel a bit disheartened by it all.”
Professor Karen Campbell, a former president of the UK Oncology Nurse Society, said the risks posed by such medicines have been known for decades, but the consequences are more visible now because of the growing number of people undergoing cancer treatment.
Professor Campbell published a study last year based on a survey in which 97 per cent of the 747 nurses who took part said they were primarily given only plastic aprons when administering cancer drugs. Just 62 per cent were given the correct gloves, labelled for use in chemotherapy, while 53 per cent were given general-purpose gloves.
Professor Campbell, who has been a cancer nurse for 30 years, said this was an “inadequate” level of protection, adding that the UK falls behind countries such as the US, where staff are routinely given full surgical gowns and masks and are double-gloved. Of those who answered the survey, 161 reported health impacts such as headaches, hair loss, fatigue, skin irritation, nausea, dizziness, and miscarriage.
As well as PPE, trusts should be using “closed system transfer devices”, which are mechanically sealed and leakproof containers designed to cut the risk of exposure during both the preparation and the administration of chemotherapy drugs. However, only 44 per cent of staff said they consistently used these.
Professor Campbell said that despite evidence of the risks, authorities have been reluctant to standardise practice.
“I think it’s probably a very big can of worms to open up... My main fear is that the workforce is quite young, it’s women, and they don’t have much of a voice. You have to protect your workers, [or] ultimately you won’t have anybody working in the NHS... why would you let them suffer?” she said.
Labour MP Luke Akehurst, who received chemotherapy himself in 2009 and has raised the issue with ministers, said the government has a duty to protect healthcare workers. He said: “This is about the NHS staff who are there for when you are really acutely ill. These are the people who are saving your life through cancer treatment, and none of us who have been through a life-threatening illness would ever want the staff who are helping us to have their health damaged.”
“[Ministers and the NHS] have a moral responsibility [to ensure] the safety of workers, that’s what we’re about as a Labour government, but particularly people who are working on such an important task as saving people’s lives.”
The Royal College of Nursing (RCN) is calling on the HSE and the government to implement minimum standards for the control of hazardous medicines. The current regulations require employers to ensure that exposure is “as low as reasonably practical”, but the RCN said interpretation of the wording is subjective and has led to variations in how hospitals implement protections. It wants it to be changed to the “lowest possible level”, which it said would require stronger controls to be implemented by employers.
Louise Church, the senior national officer covering health, safety and wellbeing for the RCN, said: “The RCN recognises that these are vital treatments for patients, but what we want to see is that nurses and staff are properly protected when they are handling tools and caring for patients using these substances.”
An NHS spokesperson said: “The safety of NHS staff is paramount, and NHS trusts have a duty in law to protect staff from being exposed to hazardous medicinal products – with clear regulations and guidance in place on the handling of these substances.”
A government spokesperson said: “The safety of NHS staff is non-negotiable, and there are clear legal duties on employers to ensure healthcare workers handling hazardous medicinal products are properly protected at all times. We are working closely with the Health and Safety Executive and NHS England to ensure concerns raised by professional bodies are fully considered and staff are listened to. The HSE is actively reviewing the evidence presented and whether any further action or clearer guidance is needed.”
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