There are many lessons that were learned from the Covid pandemic. One of them is the importance of providing personal protective equipment (PPE), with associated protocols, to guard medical staff from harm.
This should, obviously, be the case at all times. True, in a national emergency, it may prove more difficult to achieve. But there can be no excuse for NHS cancer nurses being exposed to toxic chemicals linked to miscarriage and infertility due to inadequate PPE, as The Independent reports on Thursday.
These are not trivial risks, still less newly discovered phenomena. For decades, many thousands of healthcare workers have administered a range of drugs used in otherwise life-saving treatments for conditions such as cancer chemotherapy, for rheumatoid arthritis, HIV and multiple sclerosis – and it is known that toxic chemicals are involved.
Yet this is happening with inadequate PPE – with merely a standard plastic apron and gloves, according to nurses. The joint investigation by The Independent and Channel 4 News reveals the potential consequences of this failure – nurses who have come into contact with hazardous compounds have suffered recurrent miscarriages, among other problems. This, they believe, could be linked to working unprotected on cancer wards. Other staff have reported suffering hair loss, nausea, dizziness, and fatigue.
These suspicions are backed up by a number of authorities. The NHS West Midlands Cancer Alliance, for example, recently published guidance, with warnings that such “inadequate control measures” could indeed lead to miscarriage, birth defects, liver damage, abnormal cell formations, abdominal pain, nasal sores and vomiting. Other studies have substantiated fears about inducing infertility. The American CDC (Centres for Disease Control and Prevention) has already issued an alert about how these substances can adversely affect the health of nurses and others, yet the national guidelines still permit NHS trusts to provide the “bare minimum” for workers, such as a plastic apron and gloves.
The precautionary principle seems to have been neglected in this branch of healthcare, as has any sense of cost-benefit. The life-altering price paid by the workers affected by, say, infertility, is beyond quantifying; the cost of better PPE is well within the resources of even the most hard-pressed trust. As well as that, NHS trusts should be using “closed system transfer devices”, sealed and leak-proof devices for the drugs used in chemotherapy to help reduce exposure during transportation, preparation and administration. One study, as revealed by our investigation, suggests this is only done in about half of cases.
Given that all employers owe a duty of care for those working for them, and that the NHS acknowledges that health service trusts have a duty in law to protect staff from being exposed to hazardous medicinal products, it is beyond belief that this state of affairs is allowed to persist.
The current regulations only require employers to ensure that exposure is “as low as reasonably practical”, which may explain some of the apparent complacency, and the Royal College of Nursing is therefore right to want that amended to “lowest possible level”, which would be neither onerous nor expensive.
There should indeed be minimum standards of control for hazardous medicines, and more awareness among trust management teams that these drugs can make people sick as well as save lives. It would be useful if a statutory definition and national list of hazardous medicinal products were drawn up to reduce any doubts about which are the most hazardous, make sealed containers for them mandatory and ensure incidents and claims about exposure are logged and managed.
Such regulations would also be better understood and obeyed if they were statutory and nationally applied. It is something for Wes Streeting, secretary of state for health and social care, and his counterparts in the devolved administrations to consider, even though they have other political matters distracting their attention.
