Nurses' Use of Hazardous Drug-Handling Precautions and Awareness of National Safety Guidelines

Martha Polovich

Susan Martin

hazardous substances, environmental exposure
ONF 2011, 38(6), 718-726. DOI: 10.1188/11.ONF.718-726

Purpose/Objectives: To determine patterns of personal protective equipment (PPE) used by oncology nurses while handling hazardous drugs (HDs) and to assess knowledge of the 2004 National Institute for Occupational Safety and Health (NIOSH) Alert and its effect on precaution use.

Design: Descriptive, correlational.

Setting: The Oncology Nursing Society 31st Annual Congress in Boston, MA, in 2006.

Sample: 330 nurses who prepared and/or administered chemotherapy.

Methods: Nurses described HD safe-handling precaution use by self-report survey.

Main Research Variables: The availability and use of biologic safety cabinets and PPE.

Findings: Respondents were well educated (57% had a bachelor's degree or more), experienced (X = 19, SD = 10.2 years in nursing and X = 12, SD = 7.9 years in oncology), and certified (70%; majority OCN®). Forty-seven percent of respondents were aware of the NIOSH Alert. Thirty-five percent of all participants and 93% of nurses in private practice settings reported preparing chemotherapy. Glove use (95%-100%) was higher than that reported in earlier studies, and gown use for drug preparation (65%), drug administration (50%), and handling excretions (23%) have remained unchanged. Double-gloving was rare (11%-18%). Nurses in private practices were less likely to have chemotherapy-designated PPE available, use PPE, and use spill kits for HD spills.

Conclusions: Nurses have adopted glove use for HD handling; however, gown use remains comparatively low. Chemotherapy-designated PPE is not always provided by employers. Nurses lack awareness of current safety guidelines.

Implications for Nursing: Nurses must know about the risks of HD exposure and ways to reduce exposure. Employers must provide appropriate PPE and encourage its use. Alternative methods of disseminating safety recommendations are needed.

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    American Society for Testing and Materials. (2005). ASTM D6978-05 standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs. West Conshohocken, PA: Author.
    American Society of Health-System Pharmacists. (2006). ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy, 63, 1172-1191. doi:10.2146/ajhp050529
    American Society of Hospital Pharmacists. (1985). Technical assistance bulletin on handling cytotoxic drugs in hospitals. American Journal of Hospital Pharmacists, 42, 131-137.
    Connor, T.H. (1993). An evaluation of the permeability of disposable polypropylene-based protective gowns to a battery of cancer chemotherapy drugs. Applied Occupational and Environmental Hygiene, 8, 785-789.
    Falck, K., Gröhn, P., Sorsa, M., Vainio, H., Heinonen, E., & Holsti, L.R. (1979). Mutagenicity in urine of nurses handling cytostatic drugs. Lancet, 1, 1250-1251. doi:10.1016/S0140-6736(79)91939-1
    Fransman, W., Roeleveld, N., Peelen, S., de Kort, W., Kromhout, H., & Heederik, D. (2007). Nurses with dermal exposure to antineoplastic drugs: Reproductive outcomes. Epidemiology, 18, 112-119.
    Fuchs, J., Hengstler, J.G., Jung, D., Hiltl, G., Konietzko, J., & Oesch, F. (1995). DNA damage in nurses handling antineoplastic agents. Mutational Research, 342, 17-23. doi:10.1016/0165-1218(95)90086-1
    Harrison, B.R. (2001). Risks of handling cytotoxic drugs. In M.C. Perry (Ed.), The chemotherapy source book (3rd ed., pp. 566-582.). Philadelphia, PA: Lippincott Williams and Wilkins.
    Harrison, B.R., & Kloos, M.D. (1999). Penetration and splash protection of six disposable gown materials against fifteen antineoplastic drugs. Journal of Oncology Pharmacy Practice, 5, 61-66.
    Kyprianou, M., Kapsou, M., Raftopoulos, V., & Soteriades, E.S. (2010). Knowledge, attitudes and beliefs of Cypriot nurses on the handling of antineoplastic agents. European Journal of Oncology Nursing, 14, 278-282. doi:10.1016/j.ejon.2010.01.025
    Mahon, S.M., Casperson, D.S., Yackzan, S., Goodner, S., Hasse, B., Hawkins, J., … Witcher, V. (1994). Safe handling practices of cytotoxic drugs: The results of a chapter survey. Oncology Nursing Forum, 21, 1157-1165.
    Martin, S. (2003). Chemotherapy handling and effects among nurses and their offspring (Unpublished doctoral dissertation). Columbia University, New York, NY.
    Martin, S. (2005). Chemotherapy handling and effects among nurses and their offspring [Abstract]. Oncology Nursing Forum, 32, 425.
    Martin, S., & Larson, E. (2003). Chemotherapy-handling practices of outpatient and office-based oncology nurses. Oncology Nursing Forum, 30, 575-581. doi:10.1188/03.ONF.575-581
    McDiarmid, M.A., Oliver, M.S., Roth, T.S., Rogers, B., & Escalante, C. (2010). Chromosome 5 and 7 abnormalities in oncology personnel handling anticancer drugs. Journal of Occupational and Environmental Medicine, 52, 1028-1034. doi:10.1097/JOM.0b013e3181f73ae6
    National Institute for Occupational Safety and Health. (2004). Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Retrieved from
    Nieweg, R.M., de Boer, M., Dubbleman, R.C., Gall, H.E., Hesselman, G.M., Lenssen, P.C., … Slegt, J.H. (1994). Safe handling of antineoplastic drugs: Results of a survey. Cancer Nursing, 17, 501-511.
    Occupational Safety and Health Administration. (1986). Guidelines for cytotoxic (antineoplastic) drugs (Publication No. 8-1.1). Washington, DC: Author.
    Occupational Safety and Health Administration. (1995). Controlling occupational exposure to hazardous drugs. Retrieved from
    Occupational Safety and Health Administration. (1996). Controlling occupational exposure to hazardous drugs. Occupational Safety and Health Administration. American Journal of Health-System Pharmacists, 53, 1669-1685.
    Oncology Nursing Society. (1988). Cancer chemotherapy guidelines: Modules I-V. Pittsburgh, PA: Author.
    Polovich, M. (2003). Safe handling of hazardous drugs. Pittsburgh, PA: Oncology Nursing Society.
    Polovich, M., Whitford, J.M., & Olsen, M. (2009). Chemotherapy and biotherapy guidelines and recommendations for practice (3rd ed.). Pittsburgh, PA: Oncology Nursing Society.
    Selevan, S.G., Lindbohm, M.L., Hornung, R.W., & Hemminki, K. (1985). A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. New England Journal of Medicine, 313, 1173-1178. doi:10.1056/NEJM198511073131901
    Stajicj, G.V., Barnett, C.W., Turner, S.V., & Henderson, C.A. (1986). Protective measures used by oncologic office nurses handling parenteral antineoplastic agents. Oncology Nursing Forum, 13(6), 47-49.
    Stücker, I., Caillard, J.F., Collin, R., Gout, M., Poyen, D., & Hémon, D. (1990). Risk of spontaneous abortion among nurses handling antineoplastic drugs. Scandinavian Journal of Work, Environment and Health, 16, 102-107.
    Testa, A., Giachelia, M., Palma, S., Appolloni, M., Padua, L., Tranfo, G., … Cozzi, R. (2007). Occupational exposure to antineoplastic agents induces a high level of chromosome damage. Lack of an effect of GST polymorphisms. Toxicology and Applied Pharmacology, 223, 46-55. doi:10.1016/j.taap.2007.05.006
    Valanis, B., McNeil, V., & Driscoll, K. (1991). Staff members' compliance with their facility's antineoplastic drug handling policy. Oncology Nursing Forum, 18, 571-576.
    Valanis, B., & Shortridge, L. (1987). Self protective practices of nurses handling antineoplastic drugs. Oncology Nursing Forum, 14(3), 23-27.
    Valanis, B., Vollmer, W., Labuhn, K., & Glass, A. (1997). Occupational exposure to antineoplastic agents and self-reported infertility among nurses and pharmacists. Journal of Occupational and Environmental Medicine, 39, 574-580. doi:10.1097/00043764-199706000-00013
    Valanis, B., Vollmer, W.M., & Steele, P. (1999). Occupational exposure to antineoplastic agents: Self-reported miscarriages and stillbirths among nurses and pharmacists. Journal of Occupational and Environmental Medicine, 41, 632-638.
    Valanis, B., Vollmer, W.M., Labuhn, K., Glass, A., & Corelle, C. (1992). Antineoplastic drug handling protection after OSHA guidelines. Comparison by profession, handling activity, and work site. Journal of Occupational Medicine, 34, 149-155.
    Valanis, B.G., Vollmer, W.M., Labuhn, K.T., & Glass, A.G. (1993a). Acute symptoms associated with antineoplastic drug handling among nurses. Cancer Nursing, 16, 288-295.
    Valanis, B.G., Vollmer, W.M., Labuhn, K.T., & Glass, A.G. (1993b). Association of antineoplastic drug handling with acute adverse effects in pharmacy personnel. American Journal of Hospital Pharmacy, 50, 455-462.
    Yoshida, J., Kosaka, H., Tomioka, K., & Kumagai, S. (2006). Genotoxic risks to nurses from contamination of the work environment with antineoplastic drugs in Japan. Journal of Occupational Health, 48, 517-522. doi:10.1539/joh.48.517