With the growing demand for cancer treatments, the number of healthcare workers exposed to hazardous medicinal products (HMPs) is increasing, exposing up to 12.7 million EU healthcare professionals and 40% of nurses annually .1,2 Recent advancements in cancer research present new treatment options that lead to improved outcomes. These breakthroughs also introduce challenges associated with new toxicity profiles and concerns for occupational safety.
In Europe, ensuring workplace safety in environments with hazardous substances requires an understanding and implementation of regulatory guidelines. This blog examines the CMR (Carcinogens, Mutagens, and Reproductive Toxicants) guidelines, alongside the ETUI list (European Trade Union Institute), to highlight their role in protecting workers in oncology and pharmacy. 3,4
Hazards While handling CMRs in the EUÂ
Nurses exposed to cytotoxic drugs face serious risks, including being twice as likely to experience miscarriage. 5 The European Oncology Nursing Society (EONS) gathered data on occupational safety in an anonymous online survey.6 One in five nurses reported handling hazardous cancer drugs during pregnancy and breastfeeding. Over a third of respondents noted risks of negative repercussions if pregnant or breastfeeding nurses requested alternative duties. Some nurses reported a lack of introductory education for handling HMPs. A key finding from the study is EONS’ official acknowledgment of the risks oncology nurses face when handling HMPs. To address these dangers, they recommend implementing specific safety measures, including the use of a Closed System Transfer Device (CSTD).
Overview of ETUI list and CMR Guidelines  Â
The ETUI report outlines HMPs covered under the EU’s CMR Directive 2022/431 to control and limit exposure to substances that can cause cancer, genetic mutations, or reproductive toxicity. It helps employers comply with new regulations and enhance worker safety. Based on the U.S. National Institute for Occupational Safety and Health (NIOSH) classifications and adapted to European standards, it categorizes HMDs into three toxicity levels with corresponding safety measures. It focuses on identifying, assessing, and managing the risks associated with HMD exposure in the workplace. Â
Harmful Effects of HMP Exposure in the Workplace Â
HMPs, primarily used in cancer treatment, present health risks to healthcare workers due to potential exposure during handling. Even small, ongoing doses can be dangerous, leading to acute and chronic health effects. 7 Exposure results in effects that may take years to manifest, causing thousands of cancer deaths annually, as well as numerous miscarriages, fertility issues, and congenital disabilities.8
Healthcare environments are complex, and risks arise during preparation, administration, and disposal processes. Paths of exposure include dermal absorption, inhalation, and ingestion 2. This mainly affects oncology nurses and pharmacy staff, but can also affect patients, visitors, and family members through contact with contaminated surfaces.
Recommendations for Safe Handling of HMPs from Most to Least EffectiveÂ
The ETUI report offers a hierarchy of controls to prioritize the most effective safety measures for preventing exposure.
/ Elimination: Removing the HMP
/ Substitution: Replacing the HMP
/ Engineering controls: Isolating healthcare workers from HMP
/ Administrative controls: Establishing procedures to minimize the duration, frequency, or intensity of exposure to HMP
/ Personal protective equipment (PPE): Wearing gloves, goggles, and other protective gear to reduce exposure to HMP
Strategies for Safe Handling in Chemotherapy Â
In healthcare units handling HMPs like chemotherapy, elimination and substitution isn’t feasible. The most effective measure is to implement engineering controls, which means ensuring a closed system. A fully closed system combines the use of a safety cabinet or isolator with a Closed System Transfer Device (CSTD) to provide the highest level of containment.
Without a CSTD, compounding within a safety cabinet often results in drug residues lingering on gloves, vials, and surfaces, which spreads throughout the rest of the lifecycle.9 CSTDs are essential for minimizing vapor escape and leakage, preventing exposure during both compounding and administration.
EQUASHIELD CSTD Advantages  Â
EQUASHIELD CSTDs offer proprietary technological advantages that make them safe, simple, and closed. The portfolio of products is backed by independent and peer-reviewed studies to prevent vapor escape, leakage, and microbial ingress, covering more routes of exposure than alternative solutions.
The Syringe unit is fully encapsulated, preventing not just external exposure but also plunger and barrel contamination. It features a patented closed back and utilizes sterile air drawn directly from its sealed back chamber, eliminating the need for extra steps to equalize pressure.10 This sets EQUASHIELD apart from other brands, making it the easiest and most user-friendly system available.11,12Â
Case Study of Improved Safety Practices  Â
Hospitals in Southwest Germany transitioned to EQUASHIELD’s CSTD to enhance safety in handling hazardous drugs. The head of pharmacy made this change due to exposure risks. Since integrating the system seven years ago, they have reported improved staff satisfaction, measured reduced contamination, and streamlined workflows. The improved safety standards have reduced turnover while enhancing safety and morale.
Act nowÂ
As new research emerges and technology advances, healthcare institutions must regularly update their safety protocols. Through training, updated technology, and a strong safety culture, healthcare professionals minimize risks. By following regulatory guidelines and recommendations, healthcare institutions create a safer work environment for oncology nurses and pharmacy staff.
Download this all-encompassing guide with everything you need to know : Transform Your Hazardous Drugs Management Approach with this Step-by-Step Guide
