Survey of Over a Thousand Oncology Nurses
A nationwide survey in Germany of more than 1,000 nurses working in hospital oncology units and specialized practices has revealed serious shortcomings in the handling of cytotoxic drugs (chemotherapy agents). The results were published in the German journal Pflegewissenschaft and were discussed by Haufe Arbeitsschutz on 2 November 2026. About a quarter of respondents had not completed any of the mandatory annual refresher courses on the safe handling of these carcinogenic, mutagenic and reproductively toxic medicines. More than 40 percent said they did not know their own workplace’s safety guidelines, and only about 60 percent used the special protective gloves intended for cytotoxic drugs. At none of the clinics where participants worked were all recommended protective measures fully applied.
Leaking Systems and Post-Shift Symptoms
The survey also paints a picture of concrete risk situations. According to many respondents, skin contact with cytotoxic drugs often occurred during infusion administration, because closed system transfer devices (CSTDs) were not used sufficiently or because infusion systems malfunctioned. Structured, well-monitored safety oversight of staff was absent in many places, as were checks such as wipe samples to detect contamination. Several nurses reported post-shift symptoms such as skin redness, rashes, headaches, dizziness, hair loss and changes in taste, symptoms that can point to exposure to these substances. The researchers call for stricter legal obligations for clinics and practices, a more active safety culture, adequate technical and personal protective equipment, and regular training. They also call for consistent compliance with the standards of TRGS 525, Germany’s technical rule on hazardous substances in healthcare facilities.
Context
The picture from Germany is consistent with earlier international research. The US National Institute for Occupational Safety and Health (NIOSH) analyzed data from the 2011 Health and Safety Practices Survey of Healthcare Workers, a large-scale survey of US healthcare staff. It covered nearly 2,100 oncology nurses and other healthcare workers who administered antineoplastic drugs (including cytotoxic drugs); the study appeared in the Journal of Occupational and Environmental Hygiene. It found that 80 percent did not always wear two pairs of chemotherapy gloves and 15 percent wore no gloves at all; 4 percent reported skin contact with the drug. It also found that 42 percent did not consistently wear a non-absorbent gown with a closed front and tight cuffs, and 12 percent said they had sometimes taken potentially contaminated clothing home. Guidelines from NIOSH, OSHA and others have existed for a long time but are not always followed. According to NIOSH, there is also no safe exposure level for carcinogenic substances.
For HSE professionals worldwide, both studies reveal the same pattern: in Germany as well as in the United States, clear rules exist for handling cytotoxic drugs and other hazardous medicines, but compliance on the work floor lags behind. Because exposure can manifest as nonspecific complaints such as headaches or rashes, the mere existence of protocols is not enough; what matters is structural training, functioning technical barriers such as CSTDs, consistent use of personal protective equipment, and independent oversight that actually checks compliance.
Source: Arbeitsschutz in der Pflege: Beruflicher Umgang mit Zytostatika: Umfrage deckt Sicherheitslücken auf, 2 November 2026
Additional research: Healthcare workers aren’t always handling antineoplastic drugs safely (NIOSH/JOEH-onderzoek)
