Predictors of Adherence to Safe Handling Practices for Antineoplastic Drugs: A Survey of Hospital Nurses

December 9, 2015
NIOSH Update:

Press Office Contact: Nura Sadeghpour (202) 245-0673

A new article from the National Institute for Occupational Safety and Health (NIOSH) looks at predictors of adherence to recommended safe handling practices for administration of antineoplastic drugs (ADs). This study analyzed survey responses from nurses employed by hospitals and found that training, familiarity with safe handling guidelines, and availability of engineering controls and personal protective equipment (PPE) were associated with better adherence to safe handling practices and fewer reported spills of ADs. The paper will be published in the March issue of the Journal of Occupational and Environmental Hygiene and is currently available as an e-pub.

Results are derived from the 2011 Health and Safety Practices Survey of Healthcare Workers, the largest federally-sponsored survey of U.S. healthcare workers that addresses safety and health practices around hazardous chemicals. Previously, NIOSH reported on other findings from this survey which showed that safe handling guidelines are not always followed when handling ADs. The current paper examines associations between a number of factors (administrative and engineering controls, work practices, nurse perceptions, and nurse and hospital characteristics) and three outcomes reported by nurses: use of personal protective equipment (PPE), activities performed while wearing gloves previously used to administer antineoplastic drugs, and spills of antineoplastic drugs.

Specific findings of the study included the following:

  • Familiarity with safe handling guidelines and training in safe handling practices were associated with consistent use of more PPE items.
  • Availability of PPE was associated with more PPE use and fewer reported spills of ADs.
  • Use of closed system drug-transfer devices and luer-lock fittings was associated with fewer spills.
  • Nurses who administered ADs more frequently reported more spills and reported performing more activities with potential for environmental contamination (e.g. touching bed controls, touching door knobs, using phones while wearing gloves previously used to administer ADs).
  • Respondents who felt they had adequate time to take safety precautions reported fewer spills.

Commitment from all levels of healthcare organizations is essential to adequately protect workers from ADs, many of which are recognized carcinogens with no safe level of exposure. Adherence to best practices for safe administration of ADs requires the efforts of employers (providing engineering controls, PPE, training in safe administration, and adequate time for workers to adhere to safe practices) and healthcare workers (seeking out training, consistently following facility procedures, and reporting safety concerns).

This study was designed to provide ideas about factors associated with adherence to safe handling guidelines. The findings should help NIOSH, partners, employers, and healthcare workers better understand current health and safety practices among healthcare workers who administer ADs and suggest avenues for further research about increasing adherence to these guidelines. To access the paper online, visit: icon

NIOSH is the federal agency that conducts research and makes recommendations for preventing work-related injuries, illnesses, and deaths. To learn more about healthcare worker safety and health, visit More information can be found at

Page last reviewed: December 9, 2015