German cancer nurses and occupational exposure to cytotoxic drugs: A cross-sectional study with a mixed-methods approach.

PURPOSE: Cytotoxic drugs (CDs) pose considerable occupational health risks to oncology nurses due to their carcinogenic, genotoxic, and teratogenic properties. This study investigates the prevalence of CD-related symptoms among German oncology nurses and assesses the implementation of safety measures in clinical practice.

METHODS

A mixed-methods, cross-sectional survey was conducted among 400 oncology nurses attending 14 CD safety training courses in Germany. Quantitative data captured demographics, symptom prevalence, and workplace safety measures, while qualitative data were derived from open-ended questions on specific exposure events. Descriptive statistics and qualitative content analysis (Mayring method) were applied.

RESULTS

One-third (33.75 %) of nurses reported symptoms attributed to CD handling, mainly skin reactions (51.58 %), headaches (41.48 %), and altered taste sensations (28.15 %). Qualitative data revealed that exposure mainly occurred during CD administration (35 %) and was linked to improper management (56 %), especially through defective or incorrectly handled infusion systems. Protective measures were inconsistently applied: while 80.47 % of institutions had SOPs, 64.12 % provided safety training, no site implemented all recommended measures. Only 60.42 % of the nurses used cytotoxic-proof gloves; other PPE components were rarely used. Subgroup analyses indicated that nurses with CD-related symptoms were more likely to work in settings with fewer technical and organizational safeguards.

CONCLUSION

This study highlights critical gaps in CD safety protocols in German oncology practice. Inadequate training, insufficient technical controls, and inconsistent PPE use contribute to occupational exposure risks. Enhancing protective strategies, promoting a strong safety culture, and improving institutional accountability are essential to safeguard oncology nurses and reduce CD related health risks.