- Lifesaving drugs harm those who handle them: Chemotherapy agents, antivirals, and immunosuppressants can potentially cause cancer, genetic damage, or reproductive harm in the staff who prepare, administer, and dispose of them.
- The law exists but is not applied: The EU’s 2022 directive revision required closed-system handling and exposure monitoring by April 2024, yet a survey of German oncology nurses shows most wards still lack them.
- Exposure is structural, not a training gap: Nurses with 15 years on the ward report spills at similar rates to those in their second year, pointing to missing learnings and improvements, and a lack of implemented engineering controls.
- Parliament can add political weight: A plenary vote on the joint employment and health committee report would put member states on notice that enforcement, not new legislation, is the priority.
Some medicines that save patients’ lives also inadvertently put the people who prepare and administer them at risk. Hazardous medicinal products (HMPs) are a category of substances that includes chemotherapy drugs, antivirals, and immunosuppressants. They are classified as hazardous because they carry a recognised risk of causing cancer, damaging genetic material, or harming reproductive health. The European Parliament’s employment and health committees have already voted to say so; the full Parliament has the chance to confirm that view this autumn.
These hazardous properties are what make the drugs effective as treatments, but they are also what make them dangerous to anyone who prepares, administers, or disposes of them at work. While patients accept exposure to these substances in exchange for a chance at remission or cure, the clinicians and support staff around them are exposed at work without choice.
Occupational exposure to HMPs is completely unacceptable, and it is also entirely avoidable. Closed-system transfer devices, isolators, and appropriate protective equipment are designed to interrupt the principal routes of occupational exposure — dermal and mucosal contact, inhalation of aerosolised droplets, and accidental ingestion — at every stage of preparation, administration, and disposal. Properly implemented, these controls have been shown to reduce contamination significantly. The technology to remove this risk already exists and is available today. What remains uncertain is whether it reaches the healthcare workers across Europe who need it.
HMPs extend well beyond the cytotoxic agents used in oncology to antivirals, immunosuppressants, and other substances classified as carcinogenic, mutagenic, or reprotoxic. This puts pharmacists, porters, and cleaning staff at risk alongside oncology nurses, together with a range of other people across the entire lifecycle of an HMP.
In 2022, the EU revised the Carcinogens, Mutagens and Reprotoxic Substances Directive to bring these products within its scope for the first time. Once transposed, it requires closed-system handling wherever a safer alternative is unavailable, staff training, and employer monitoring of exposure, in line with the hierarchy of controls under EU occupational health and safety law. The transposition deadline passed in April 2024. On paper, then, every healthcare worker in the Union handling these substances should now be protected accordingly.
Whether that protection has been implemented and has reached healthcare workers in practice is a separate question, and one we set out to answer.
What the ward tells us
Together with Germany’s oncology nursing society, the Konferenz Onkologischer Kranken- und Kinderkrankenpflege (KOK), we surveyed more than 1,000 oncology nurses across Germany last year, in the first national assessment of implementation since the deadline passed. It found that more than three-quarters had experienced a cytotoxic spill in the course of treatment. Close to four in 10 were still connecting infusions to the patient’s line by hand at the bedside, a manual step that bypasses the very protection a closed system exists to provide. Fewer than one in five had routine access to a closed-system transfer device.
Fewer than one in six hospitals conducted surface wipe sampling for residual contamination, and only two per cent of respondents had ever undergone biological monitoring, a blood or urine test capable of detecting the drugs’ metabolites in the body. Exposure did not decline with seniority: a nurse with 15 years on an oncology ward reported spills at a broadly comparable rate to one in her second year. That pattern points away from a training deficit and towards something structural: an absence of the engineering controls, monitoring systems, and reporting culture the directive presumes are already in place.
This bears on the workforce crisis in its own right. Occupational exposure of this kind is cited by nurses among their reasons for leaving oncology and haematology wards, and it is a plausible deterrent to those weighing whether to enter the specialism. A retention strategy that overlooks the physical toll of the job, including, for those who are pregnant or breastfeeding, a well-documented reprotoxic risk, addresses only part of the problem it purports to solve.
Germany operates one of Europe’s more developed hospital systems and one of its more established traditions of workplace regulation. If implementation is this uneven there, there is little reason to expect it to be more consistent elsewhere, across a workforce that, on some estimates, runs into the millions. That gap between the directive’s requirements and the evidence from the ward is what the European Parliament’s Employment and Public Health committees placed on the record on 3 June, when they adopted a joint report on the EU’s health workforce crisis. The report addresses occupational exposure to hazardous medicinal products directly, calling on the Commission and member states to enforce the existing directive rather than introduce new obligations.
From directive to enforcement
This is not new legislation; it introduces no obligation that does not already exist in law. What the report does is record, with broad cross-party committee support, a judgement that the principal barrier to protecting healthcare workers is no longer the absence of rules but the inconsistency of their enforcement. A directive protects no one until it has been transposed, resourced, and enforced nationally, and more than two years past the deadline, our data suggest that chain is still failing for most of the nurses we surveyed.
The report now awaits a vote of the full Parliament, expected this autumn. An own-initiative report carries no binding force, so its value lies almost entirely in the political weight Members of the European Parliament (MEPs) are willing to attach to it. The committee vote suggests that weight is considerable, and the plenary has the opportunity to confirm it, unambiguously.
Nurses and other healthcare workers absorb a great deal on behalf of the patients in their care. What we owe them in return is straightforward: that the risk be measured rather than assumed away, and that the findings be acted on rather than filed. A plenary vote will not close the distance between the directive and the ward by itself. But it would put every member state on notice, in writing, that the distance has been observed, and is expected to close.
