NHS cancer nurses put at risk of miscarriage by toxic chemicals from insufficient protective equipment

Cancer nurses are facing an increased risk of miscarriage, infertility and other serious health conditions because NHS trusts are failing to provide adequate personal protective equipment (PPE) when handling hazardous medicines, an investigation has found.

Alison Simons, a cancer nurse of more than two decades, believes three miscarriages she suffered were linked to working on cancer wards without the proper protections. “When I was giving chemo, all we wore were plastic aprons and gloves to my wrists,” she said. “I experienced three miscarriages, and at first, I didn’t make any link between giving chemotherapy at all. In fact, it was my GP who said you give chemotherapy, don’t you?”

Speaking to her colleagues, she discovered they had experienced similar problems. “When I started talking to colleagues, they were also experiencing similar things, such as miscarriages and fertility issues,” said Ms Simons, now a senior lecturer in applied cancer practice and a doctoral student at Birmingham City University.

Samantha Toland, a nurse consultant in cancer care for 26 years and lead cancer therapy nurse at Worcestershire Acute Hospitals Trust, also suffered a miscarriage. “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,” she said. She added that she had known colleagues who had “multiple miscarriages, up to six or seven, and had to be off work for most of their pregnancy”.

The scale of the health risks

Tens of thousands of healthcare workers across the NHS routinely administer toxic drugs used in chemotherapy and treatments for rheumatoid arthritis, HIV and multiple sclerosis. Without adequate PPE, workers can be exposed to hazardous products 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 formations, abdominal pain, nasal sores and vomiting. Several studies have linked exposure to these drugs to infertility issues among healthcare workers, with research indicating a twofold increased risk of miscarriage for those exposed to antineoplastic drugs, particularly when PPE is not consistently used.

A study published last year by Professor Karen Campbell, a former president of the UK Oncology Nurse Society (UKONS), found that 97 per cent of 747 nurses surveyed 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. Of those who responded, 161 reported health impacts including headaches, hair loss, fatigue, skin irritation, nausea, dizziness and miscarriage.

Professor Campbell, a cancer nurse for 30 years, described this as an “inadequate” level of protection. She said the UK falls behind countries such as the United States, where the Centres for Disease Control and Prevention has issued an alert over the risks posed by these drugs and staff are routinely provided with full surgical gowns, masks and double gloves.

Other staff have reported recurrent miscarriages, hair loss, nausea, dizziness and fatigue, which they believe are linked to working unprotected on cancer wards.

Why protection is falling short

Despite knowledge of the risks for decades, UK guidelines allow NHS trusts to provide what has been described as the “bare minimum” for workers. Current regulations require employers to ensure exposure is “as low as reasonably practical” (ALARP), but the Royal College of Nursing (RCN) says this wording is subjective and has led to wide variations in how hospitals implement protections.

Professor Campbell said 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 [ministers] have to protect your workers, [or] ultimately you won’t have anybody working in the NHS… why would you let them suffer?” she said.

In addition to PPE, trusts should be using “closed system transfer devices” (CSTDs) – mechanically sealed and leak-proof containers for chemotherapy drugs designed to cut the risk of exposure during preparation and administration. However, only 44 per cent of staff surveyed said they consistently used these devices. Research on the effectiveness of CSTDs has yielded mixed results, with some studies suggesting they can be effective as part of broader safety protocols, while others find uncertainty about their incremental benefits over other safe-handling practices.

The UK also lacks a universally accepted definition of what constitutes a hazardous medicinal product (HMP), and there is no centralised or recognised list of such medicines. This contrasts with the European Union and the United States, which have updated legislation, clear definitions and lists of HMPs.

Calls for action

The RCN is now calling on the Health and Safety Executive (HSE) and the government to implement minimum standards for the control of hazardous medicines. It wants the wording of the regulations changed from “as low as reasonably practical” to the “lowest possible level”, which it says would require stronger controls from employers.

Louise Church, health, safety and wellbeing senior national officer 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 patients and caring for patients using these substances.”

Labour MP Luke Akehurst, who received chemotherapy himself in 2009 and has raised the issue with ministers, said the government had a moral duty to protect workers. “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 for life-threatening illness would ever want the staff who are helping us to have their health damaged,” he said. “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 HSE is being urged to act and review the evidence concerning the health risks to staff. The regulator has stated that employers have a legal duty to assess risks and implement adequate control measures, and that exposure to carcinogens must be reduced to as low as reasonably practicable.

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.”

The HSE, the Department for Work and Pensions, and the Department of Health and Social Care have been approached for comment.