Preventing the Exposure of Nurses and Health Professionals to Hazardous Drugs

Every year more than 12.7 million health professionals in Europe, including 7.3 million nurses, are exposed to carcinogenic, mutagenic and reprotoxic hazardous drugs.

The European Commission said that in 2012 up to 106,500 cancer deaths were attributed to occupational exposure to carcinogenic substances, making cancer the first cause of work-related deaths in the EU. The Carcinogens and Mutagens Directive (2004/37/EC) does not currently acknowledge the dangers of hazardous drugs in healthcare or detail how they should be prevented.

Something needs to be done now to prevent nurses and other health professionals from the deadly chemical risks during activities such as the preparation and administration of hazardous drugs, including cytotoxic drugs used to treat patients with cancer. According to EU-OSHA, these drugs represent the most dangerous chemical risk factors in healthcare and some of the most hazardous chemicals ever developed. Studies show that hospital workers who handle cytotoxic drugs are three times more likely to develop malignancy. It is estimated that in Europe each year occupational exposure to hazardous drugs produces 2,220 new cases of leukemia alone which results in 1,467 additional deaths of health professionals each year.

The health hazard for medical personnel handling these drugs is a major concern as they are not only classified as potentially carcinogenic, but also mutagenic (mutating genetic material) and reprotoxic (interfering with reproduction). Studies show that nurses exposed to cytotoxic drugs are twice as likely to miscarry and among health professionals exposed to hazardous drugs in Europe it is estimated that occupational exposure produces 17,185 incremental miscarriages each year. Occupational exposure also produces 10,108 more malformations in children each year in Europe.

Increased genetic damage has been demonstrated in nurses particularly in day hospital nurses, the group handling the highest amount of drugs during the administration process. As cancer often takes decades to emerge, a case of leukemia diagnosed in a nurse or in a pharmacist today might be the product of workplace exposures in the 1970s or the 1980s.

The EFN is working with MEPs and other expert groups to draft amendments to the Carcinogens and Mutagens Directive that will for the first time specifically address in legislation the risks to health professionals from occupational exposure to hazardous drugs and what needs to be done to protect them from contracting cancer and the reproductive problems that arise from carcinogenic drugs.

The Directive should define hazardous drugs by the agreed six characteristics they display and the EU should publish regularly a list of hazardous drugs and guidelines to prevent occupational exposure and establish a European Observatory on occupational exposure to hazardous drugs. Health professionals must receive suitable and regular information on the risks, personal protective equipment, as well as suitable decontamination, cleaning and disinfection guidelines based on surface contamination levels and type of drugs and regular monitoring of surface contamination needs to be mandatory. Also, Closed System Drug Transfer Devices need to be made mandatory for health professionals exposed to contamination from hazardous drugs.

Author: Dr Paul De Raeve, EFN Secretary General

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