Original Article

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Year: 2025 I Volume: 7 I Issue: 4I Pages I 

 

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Occupational Safety in Oncology Nursing: Findings from a National Survey on the Handling of Cytotoxic Substances in Germany

Josh Cobb1, Patrick Jahn2, Loïc Frémond1

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1 European Biosafety Network, Belgium

2 Konferenz Onkologischer Kranken- und Kinderpflege. Germany

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* Corresponding Author: Loïc Frémond

Email address: loic.fremond@europeanbiosafetynetwork.eu

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Source of funding:  This project was supported financially by Equashield

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Conflict of interest: None

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Submission date: 10 October 2025

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Acceptance date:  29 December 2025

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Key words: Hazardous medicinal products, cytotoxic drugs, oncology nursing, occupational safety, protective equipment, Germany

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Abstract:

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Background: Oncology nurses in Germany are routinely exposed to cytotoxic drugs that classified as carcinogenic, mutagenic and reprotoxic. Continuous or repeated contact, particularly in environments where containment systems and protective measures are inadequate or inconsistent, has been associated with incidence of adverse events, including malignancies, reproductive disorders, and genetic damage. Despite existing regulations in Germany and European directives, evidence suggests variability in protective practices and uneven implementation of guidelines. This study aimed to provide a comprehensive overview of training, protective measures, handling practices, and self-reported health outcomes among oncology nurses in Germany. Methods: A national cross-sectional survey was conducted by the European Biosafety Network in collaboration with the Konferenz Onkologischer Kranken- und Kinderpflege. The questionnaire captured demographics, awareness of guidelines, training frequency, availability of protective equipment, handling practices, occurrence of spills and leaks, reporting systems, and self-reported symptoms. Results: We received 1012 responses. The workforce was predominantly female (82.0%) and highly experienced, with 54.7% reporting over a decade of exposure to cytotoxic agents. While 60.7% indicated that refresher training was provided, one quarter reported receiving no such training. Familiarity with safety guidelines was inconsistent, with more than 40% unfamiliar or unsure. Access to basic PPE, such as gloves, was nearly universal (93.0%), but fewer than one-third (32.2%) reported access to closed-system transfer devices (CSTDs). Medical monitoring was absent in nearly two-thirds of institutions. Fluid leaks during administration were reported by 83.4% of respondents, with 10.6% describing them as occasional or frequent. A small but notable proportion (8.2%) reported symptoms associated with occupational exposure. Cross-tab analyses suggested cumulative exposure effects with a higher prevalence of symptoms among nurses with longer professional experience, and reduced leakage in settings using CSTDs. Conclusion: There are substantial gaps between regulatory standards and clinical practice in Germany. While variability in training, inconsistent access to advanced protective technologies, and limited surveillance measures leave oncology nurses vulnerable to unacceptable exposure levels. Greater standardisation, investment in closed-system technologies, and improved monitoring and reporting mechanisms are urgently needed to protect this workforce and align practice with international safety standards.