Healthcare workers more likely to handle chemo drugs safely when management makes safety a priority

Chemotherapy drugs are designed to kill cancer cells and improve the health of a cancer patient. However, these drugs pose a health and safety risk to healthcare workers who administer them. Immediate exposure to these drugs can cause skin and eye irritation, sore throat, dizziness, hair loss, and allergic reactions. Female nurses may face pregnancy-related issues like infertility, birth defects, and miscarriages, and oncology nurses face higher risks of leukemia and other cancers.

The National Institute for Occupational Safety and Health has issued guidelines for safe handling of liquid chemotherapy drugs, but many workers fail to follow safety procedures. A team of University of Georgia researchers analyzed data from a national survey of 1,800 hospital and clinic nurses who work with these drugs to better understand why.

The answer, it seems, may boil down to the employees’ perceptions that safety is a priority where they work, said lead author David DeJoy, emeritus professor of health behavior and promotion at UGA’s College of Public Health. This is a concept known as safety climate, which results from organizational attitudes and actions related to safety.

An employee will learn quickly whether safety is a top priority, said DeJoy. “The behaviors they see others performing or the attention given to safety by managers and supervisors – that’s the raw material for climate perceptions,” he said.

Without an emphasis on safe handling practices and the use of appropriate engineering controls, unsafe behaviors can become the norm, especially since accidents don’t happen every day. But when they do, the outcomes can be serious.

Survey respondents were asked to recall any adverse events they’d had in the previous seven days. Fourteen percent of nurses said they had experienced a spill, a leak or even skin contact with the drugs. “The fact that the percentage was that high is somewhat concerning,” said Todd Smith, assistant professor in the department of applied health science at Indiana University’s School of Public Health and co-author on the study.

“If we’re seeing this many nurses have an adverse event in the past seven days, then the exposure during their career or even within the past year could be highly significant.”

There are a variety of safety controls in place to protect nurses including engineering controls, which are meant to minimize exposure to the hazard, and a four-part ensemble of personal protective equipment (PPE). But they have to use them, said DeJoy.

Nurses were more likely to use recommended PPE and engineering controls when they believed that their organization leaders emphasized safety. Management’s commitment to safety is crucial to improving adherence to safe handling guidelines, said DeJoy.

“What that boils down to is having a systematic, proactive approach to safety,” he said. “Employers need to create an environment where safety is a priority, and they need to demonstrate and communicate that every day.”

UGA biostatistics doctoral candidate Mr. Henok Woldu, recent UGA health behavior and promotion doctoral graduate Dr. Mari-Amanda Dyal, and Dr. Andrea L. Steege and Mr. James M. Biano with the National Institute for Occupational Safety and Health were co-authors on this study.

The paper “Effects of Organizational Safety Practices and Perceived Safety Climate on PPE Usage, Engineering Controls, and Adverse Events Involving Liquid Antineoplastic Drugs Among Nurses” appears in the July volume of the Journal of Occupational and Environmental Hygiene. It is available online here:

– Lauren Baggett

Posted June 29, 2017.