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Yun and Park: Oncology Nurses' Knowledge of Safety Guidelines and Compliance with Safe Handling of Antineoplastic Agents in a Tertiary Hospitall
Original Article

Asian Oncology Nursing 2016; 16(4): 251-260.

Published online: 31 December 2016

DOI: https://doi.org/10.5388/aon.2016.16.4.251

Oncology Nurses' Knowledge of Safety Guidelines and Compliance with Safe Handling of Antineoplastic Agents in a Tertiary Hospitall

Ji Hyun Yun1, Jeong Yun Park2

1Department of Nursing, Asan Medical Center, Seoul, Korea.

2Department of Clinical Nursing, University of Ulsan, Seoul, Korea.

Address reprint requests to: Park, Jeong Yun. Associate professor, Department of Clinical Nursing, University of Ulsan 86 Asanbyeongwon-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-5333, pjyun@ulsan.ac.kr

Received 16 November 2016       Revised 19 December 2016       Accepted 20 December 2016

© 2016 Korean Oncology Nursing Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the knowledge and compliance of guidelines for safe handling of antineoplastic agents among the oncology nurses.

Methods

The participants were 186 nurses from oncology-hematology unit, and outpatient's infusion room in a tertiary hospital. The levels of knowledge of safety guidelines and compliance with safe handling of antineoplastic agents of oncology nurses were measured using structured questionnaires from October 1 to November 30, 2014.

Results

Oncology nurses' knowledge of guideline for safe handling of antineoplastic agents presented an average 79.7 out of 100 points. Compliance with safe handling of antineoplastic agents presented an average 4.28 (range: 2.9~5) out of 5 points. The knowledge of guidelines for safe handling of antineoplastic agents was related with oncology experience (F=3.78, p=.012). There were positive relationships of knowledge and compliance with safe handling of antineoplastic agents (r=0.23, p=.002).

Conclusion

The findings showed that there was a need to establish efficient guidelines for the safe handling of antineoplastic agents and develop our structured, continuous educational program for the improvement of safe practices related to the handling of antineoplastic agents. The developed and enhanced that guideline and educational program would contribute to improvement of staff and patient safety related to the handling of antineoplastic agents.

Keywords: Antineoplastic Agents, Guidelines, Protective Equipments, Knowledge, Compliance

Figures and Tables

Table 1

Characteristics of Subjects (N=186)

aon-16-251-i001
Characteristics Categories n (%) M±SD
Age (year) ≤30 131 (70.4) 28.1±4.7
31~40 47 (25.3)
≥41 8 (4.3)
Marital status Married 48 (25.8)
Other 138 (74.2)
Education Diploma 13 (7.0)
Bachelor 150 (80.6)
≥Master 23 (12.4)
Work site Oncology/hematology ward 164 (88.2)
Oncology infusion room 22 (11.8)
Position Staff nurse 179 (96.2)
Charge nurse 7 (3.8)
Nursing experience (year) <1 26 (14.0) 5.3±4.7
1~5 77 (41.4)
6~10 57 (30.6)
≥11 26 (14.0)
Oncology experience (year) <1 28 (15.1) 4.3±3.4
1~5 86 (46.2)
6~10 59 (31.7)
≥11 13 (7.0)
In-service education about chemotherapy 186 (100.0)
Experience exposure of antineoplastic agent* Yes 120 (64.9)
No 65 (35.1)
Health concern due to handling of Strongly agree 72 (38.7)
Agree 100 (53.8)
Disagree 13 (7.0)
Strongly disagree 1 (0.5)

*1: no response.

Table 2

Questions Answered Correctly: Knowledge of the Guidelines for Safe Handling of Antineoplastic Agents (N=186)

aon-16-251-i002
Rank Items Correct answer
n (%)
1 The administration environment such as patient care area and equipment (infusion pumps, carts, bed tables, etc.) are contaminated by concerned. 185 (99.5)
2 There is a risk of exposure of antineoplastic drug when spike a drug bag. 182 (97.8)
3 Close lid on waste container with sealed plastic bag of hazardous waste material. 181 (97.3)
4 It is acceptable to storing food and beverages or eating food. 181 (97.3)
5 The guardians of patient receiving chemotherapy should be required of management to exposure of antineoplastic agents. 179 (96.2)
6 Spill kit is used with treating a broken antineoplastic Agent. 179 (96.2)
7 Personal protective equipment (PPE) is disposed as the plane of PPE exposed to antineoplastic agents goes inside. 175 (94.1)
8 There is a risk of exposure of antineoplastic drug When other agent injected into the port of tube filled antineoplastic drug. 174 (93.5)
9 Cleanse the skin using soap and water when exposed to chemotherapy drugs. 167 (89.8)
10 As the surface of a delivery the drug containers (bag, syringe) is not little residue left a drug, it’s not necessary to wear gloves when to assess them.* 165 (88.7)
11 When handling the body fluids of patients who have received hazardous drugs, the disposable glove is used. 149 (80.1)
12 If bed linens of clothing become contaminated with antineoplastic drug or body fluid of patients received chemotherapy, they are treated contaminated laundry in a sealed plastic bag. 148 (79.6)
13 To use powder-gloves is acceptable to administrate a antineoplastic drugs.* 130 (69.9)
14 Hand hygiene used water free sanitizer (alcohol gel) after injection antineoplastic drug is acceptable.* 74 (39.8)
15 If it sealed plastic bag it can be placed in a non main in the bag.* 55 (29.6)
16 There is specific a spectrum of safe exposure each antineoplastic agents because of exposing agents inevitably.* 49 (26.3)

*Reverse question.

Table 3-1

Compliance with Personal Protective Equipment & Hand Hygiene (N=186)

aon-16-251-i003
Items Assessment Spiking IV bags IV medication Oral medication Disposal Handling body fluid
M±SD M±SD M±SD M±SD M±SD M±SD
Glove 4.66±0.72 4.73±0.63 4.85±0.59 3.53±1.70 4.87±0.41 4.13±1.07
Mask 4.62±0.82 4.69±0.68 4.81±0.55 N/A 4.76±0.66 N/A
Gown 2.00±1.45 1.90±1.46 2.39±1.67 N/A 2.05±1.55 N/A
Hand hygiene N/A 4.16±1.04 4.60±0.77 4.21±1.08 N/A N/A

N/A= not applicable; IV= intraveous; M= mean; SD= standard deviation.

Table 3-2

Compliance with Environmental Protective Measures for Minimizing the Exposure to Antineoplastic Agents (N=186)

aon-16-251-i004
Type of activity Items Compliance
M±SD
Pre-Administration Visually inspect the contents of the delivery bag 4.51±0.87
IV Infusion IV tubing primed with nondrug 4.97±0.33
IV tubing primed with nondrug-containing fluid when complete 4.82±0.67
When other agent needed to administer, the injection is used into the port of tube filled antineoplastic drug* 1.66±0.93
Inspecting the catheter insertion site whether the leak 4.47±0.71
Inspecting the connection site whether the leak 4.46±0.70
When Spiking of IV Containers, place absorbent pad or gauze under tubing 3.03±1.63
Perform the spiking of IV containers below eye level 4.63±0.78
Parenteral injection (IV push, IM, SC) Do not expel air from syringes before injecting agents† 2.49±1.76
Recap needles after injecting agents 4.00±1.48
Disconnect a needle from syringe and discard the needle into puncture-proof container* 1.28±0.86
Oral administration Place the drug into medicine cup avoid touching drug 4.08±1.18
Post-Administration Seal contact material in plastic bag for transport to hazardous waste container 4.92±0.33
Place sealed plastic bag in hazardous waste container 4.93±0.30

*Reverse question; †Except missing value; M= mean; SD= standard deviation.

Table 4

Oncology Nurses' Knowledge and Compliance of Safety Guideline on Antineoplastic Agents according to General Characteristics (N=186)

aon-16-251-i005
Characteristics Categories Compliance (1~5) Compliance (1~5)
M±SD t or F (p) M±SD t or F (p)
Age (year) 20~30 12.67±1.38 1.49
(.228)		 4.16±0.34 1.92
(.150)
31~40 13.04±1.04 4.23±0.31
≥41 12.62±1.51 4.36±0.23
Marital status Single 12.90±1.34 0.71
(.400)		 4.16±0.34 4.90
(.028)
Married 12.71±1.30 4.28±0.29
Education Diploma 12.54±1.27 1.43
(.241)		 4.22±0.32 0.14
(.874)
Bachelor 12.71±1.36 4.18±0.34
≥Master 13.17±0.94 4.21±0.32
Work site Oncology/hematology ward 12.79±1.28 0.97
(.327)		 4.16±0.33 13.19
(＜.001)
Oncology infusion room 12.50±1.53 4.42±0.23
Nursing experience (year) ＜1 12.15±1.54 2.26
(.083)		 4.15±0.41 1.67
(.176)
1~5 12.81±1.27 4.16±0.34
6~10 12.91±1.27 4.19±0.28
＞11 12.89±1.18 4.32±0.29
Oncology experience (year) ＜1a 12.07±1.51 3.78
(.012)
a＜b		 4.18±0.41 1.05
(.371)
1~5 12.77±1.35 4.17±0.34
6~10b 13.00±1.11 4.18±0.30
＞11 13.23±0.93 4.35±0.22

M= mean; SD= standard deviation.

Table 5

Predictor for Cancer Preventive Behaviors (N=95)

aon-16-251-i006
Variables B SE ß t p
(Constant) 2.72 0.16
Health literacy 0.15 0.07 .20 2.33 .022
Cancer knowledge 0.04 0.01 .51 5.88 <.001
Adj. R2=.34, F=24.85, p<.001

Notes

This article is a revision of the first author's master's thesis from University of Ulsan.

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