Nurses’ and midwives’ knowledge and safe-handling practices related to hazardous drugs: A cross-sectional study

Background: Hazardous drugs are inherently toxic and can present an occupational exposure risk to healthcare professionals. Hazardous drugs are regularly prescribed for people to treat a variety of medical conditions. Aim: To explore nurses’ and midwives’ knowledge and practices related to the safe handling of hazardous drugs. Also, to discover if controls of risk are available to support nurses and midwives to implement best practices when handling hazardous drugs in health care settings and if there are any obstacles to using these controls. Method: This was a cross-sectional study using a convenience sample of nurses and midwives at six Australian hospitals from a metropolitan health care service. In the self-administered, validated online questionnaire, participants were asked to identify hazardous drugs and their use of hazard controls, including personal protective equipment. Variables for self-efficacy, perceived barriers, perceived risk, interpersonal influences, and workplace safety climate were also measured. Results: A total of 217 nurses and midwives reported they handled hazardous drugs. The questionnaire was completed in full by 156 participants (71.9 %). Participants predominantly identified as women (196/217, 90.3 %) and had completed a bachelor's of nursing (139/217, 64.1 %). The hazardous drugs chloramphenicol, colchicine, and dutasteride were frequently not identified as hazardous (80.6 %, 73.8 %, and 68.2 %, respectively). A total of 78 (35.9 %) participants reported having received hazardous drug handling training, of which 34 (43.6 %) stated it was in the past 12 months. Participants (181/203, 89.2 %) agreed or strongly agreed that they were confident that they could use personal protective equipment correctly and were provided with the best available personal protective equipment (163/203, 80.3 %). Despite this, personal protective equipment was never worn by approximately a third of participants who reported being involved in preparing, administering, and disposing of hazardous drugs (32.2 %, 29.8 %, and 30.9 %, respectively). Conclusion: Nurses and midwives did not always recognise hazardous drugs, and, although they were confident in using appropriate personal protective equipment, some reported never wearing it. A multi-faceted multidisciplinary intervention is needed to improve both knowledge and practice for handling both cytotoxic and non-cytotoxic drugs by nurses and midwives.