Implementation and Evaluation of Safe Handling Precautions Training for Oncology Nurses: An Experimental Design

Keywords: occupational health, antineoplastic drugs, oncology nurses, safe handling precautions


Antineoplastic drugs are a hazard for both patients and healthcare workers. Health workers may be exposed to antineoplastic drugs by inhalation, ingestion or direct skin contact during the preparation, transport, administration, storage and disposal of antineoplastic drugs. The study aims to evaluate the impacts of the training on the safe handling precautions and oxidative stress parameters for oncology nurses. The study was an experimental study without a control group. This study included 23 oncology nurses who were involved in the preparation and administration of antineoplastic drugs. Training effectiveness was evaluated with the safe handling precautions questionnaire and blood samples of oncology nurses. After the training, the frequency of using the closed system transfer devices and changing the chemotherapy glove every 30 min in preparation of antineoplastic drugs significantly increased in the post-test. The post-test 8-hydroxy-2′-deoxyguanosine mean of the nurses was found to be significantly lower than pre-test and follow-up.  The training program provided a positive contribution to increasing the use of safe handling precautions and reducing oxidative damage. According to the results of this study, the training program can be used to develop protective health behaviors, and to reduce occupational exposure.


Abudawood, M., Tabassum, H., Almaarik, B., & Aljohi, A. (2020). Interrelationship between oxidative stress, DNA damage and cancer risk in diabetes (Type 2) in Riyadh, KSA. Saudi Journal of Biological Sciences, 27(1), 177-183.

Al-Azzam, S. I., Awawdeh, B. T., Alzoubi, K. H., Khader, Y. S., & Alkafajei, A. M. (2015) Compliance with safe handling guidelines of antineoplastic drugs in Jordanian hospitals. Journal of Oncology Pharmacy Practice. 21(1), 3-9. 10.1177/1078155213517128

Ben-Ami, S., Shaham, J., Rabin, S., Melzer, A., & Ribak, J. (2001) The influence of nurses' knowledge, attitudes, and health beliefs on their safe behaviour with cytotoxic drugs in Israel. Cancer Nursing. 24(3), 192-200.

Blair, A., Zheng, T., Linos, A., Stewart, P. A., Zhang, Y. W., & Cantor, K. P. (2001) Occupation and leukemia: A population-based case—control study in Iowa and Minnesota. American Journal of Industrial Medicine. 40(1), 3-14. 10.1002/ajim.1066

Boiano, J. M., Steege, A. L., & Sweeney, M. H. (2014) Adherence to safe handling guidelines by health care workers who administer antineoplastic drugs. Journal of Occupational and Environmental Hygiene. 11(11), 728-740. 10.1080/15459624.2014.916809

Centers for Disease Control and Prevention. (CDC). (2019) Hazardous Drug Exposures In Healthcare.

Connor, T., McLauchlan R., Vandenbroucke, J. (2007) International Society of Oncology Pharmacy Practitioners (ISOPP) standards of practice. Safe handling of cytotoxics. Journal of Oncology Pharmacy Practice. 13(3), 1-81.

DeJoy, D. M., Smith, T. D., Woldu, H., Dyal, M. A., Steege, A. L., & Boiano, J. M. (2017) Effects of organizational safety practices and perceived safety climate on PPE usage, engineering controls, and adverse events involving liquid antineoplastic drugs among nurses. Journal of Occupational and Environmental Hygiene. 14(7), 485-493. 10.1080/15459624.2017.1285496

Di Minno, A.; Turnu, L.; Porro, B.; Squellerio, I.; Cavalca, V.; Tremoli, E.; Di Minno, M.N. (2016) 8-hydroxy-2-deoxyguanosine levels and cardiovascular disease: A systematic review and meta-analysis of the literature. Antioxidants & Redox Signaling. 24(10), 548-555.

Dranitsaris, G., Johnston, M., Poirier, S., Schueller, T., Milliken, D., Green, E., & Zanke, B. (2005) Are health care providers who work with cancer drugs at an increased risk for toxic events? A systematic review and meta-analysis of the literature. Journal of Oncology Pharmacy Practice. 11(2), 69-78. 10.1191/1078155205jp155oa

Gómez-Oliván, L. M., Miranda-Mendoza, G. D., Cabrera-Galeana, P. A., Galar-Martínez, M., Islas-Flores, H., SanJuan-Reyes, N., … & García-Medina, S. (2014) Oxidative stress induced in nurses by exposure to preparation and handling of antineoplastic drugs in Mexican hospitals: a multicentric study. Oxidative Medicine and Cellular Longevity. 2014.

He, B. Y., Mendelsohn-Victor, K., McCullagh, M. C., & Friese, C. R. (2017) Personal protective equipment use and hazardous drug spills among ambulatory oncology nurses: Results from a mailed survey. Oncology Nursing Forum. 44(1), 60-65.

Honda, M., Yamada, Y., Tomonaga, M., Ichinose, H., & Kamihira, S. (2000) Correlation of urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG), a biomarker of oxidative DNA damage, and clinical features of haematological disorders: a pilot study. Leukemia Research, 24(6), 461-468.

Kosgeroglu, N., Ayranci, U., Ozerdogan, N., & Demirustu, C. (2006) Turkish nurses’ information about, and administration of, chemotherapeutic drugs. Journal of Clinical Nursing. 15(9), 1179-1187.

Ladeira, C., Viegas, S., Pádua, M., Gomes, M., Carolino, E., Gomes, M. C., & Brito, M. (2014) Assessment of genotoxic effects in nurses handling cytostatic drugs. Journal of Toxicology and Environmental Health, Part A. 77(14-16), 879-887. 10.1080/15287394.2014.910158

Mahboob, M., Rahman, M. F., Rekhadevi, P. V., Sailaja, N., Balasubramanyam, A., Prabhakar, P. V., … & Grover, P. (2012) Monitoring of oxidative stress in nurses occupationally exposed to antineoplastic drug. Toxicology International. 19(1), 20-24.

Mahmoodi, M., Soleyman-Jahi, S., Zendehdel, K., Mozdarani, H., Azimi, C., Farzanfar, F., … & Asgari, E. (2017) Chromosomal aberrations, sister chromatid exchanges, and micronuclei in lymphocytes of oncology department personnel handling anti-neoplastic drugs. Drug and Chemical Toxicology. 40(2), 235-240.

Momeni, M., Danaei, M., & Askarian, M. (2013) How do nurses manage their occupational exposure to cytotoxic drugs? A descriptive survey in chemotherapy settings, Shiraz, Iran. The International Journal of Occupational and Environmental Medicine (The IJOEM). 4, 102-106.

Moretti, M., Bonfiglioli, R., Feretti, D., Pavanello, S., Mussi, F., Grollino, M. G., … & Buschini, A. (2011) A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project. BMC Public Health. 11(1), 195-205.

NIOSH. (2004). Preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings.

NIOSH. (2016) NIOSH list of antineoplastic and other hazardous drugs in healthcare settings, 2016. Publication Number 2016-161 (Supersedes 2014-138).

Occupational Safety and Health Administration (OSHA). (2016) Controlling occupational exposure to hazardous drugs. hazardousdrugs/controlling_occex_hazardousdrugs.html.

Olgun, N., & Şimşek, H. (2010) The use of protective measures by nurses who prepare and administer chemotherapeutic drugs and factors these measures affecting. Journal of Hacettepe University Faculty of Nursing. 17(2), 13-23. (Original work published in Turkish).

Onbaşı, K., Noyan, T., Çebi, A., & Kıroğlu, F. (2011) 8-OHdG levels in patients with allergic rhinitis. Bakırköy Tıp Dergisi. 7(3), 104-107. 10.5350/BTDMJB201107305 (Original work published in Turkish)

Oncology Nursing Association (Turkey) (OHD). (2009). Guidelines for safe use standarts for antineoplastic drugs. (Original work published in Turkish)

Özcan, O., Erdal, H., Çakırca, G., & Yönden, Z. (2015) Oxidative stress and its impacts on intracellular lipids, proteins and DNA. Journal of clinical and experimental investigations. 6(3), 331-336. (Original work published in Turkish)

Pender, N. J., Murdaugh, C. L. & Parsons M. A. (2015) Health promotion in Nursing Practice (Seventh ed.). Pearson Education Inc. New Jersey.

Polovich, M., & Martin, S. (2011) Nurses' use of hazardous drug-handling precautions and awareness of national safety guidelines. Oncology nursing forum. 38(6), 718-726.

Power, L. A. (1990) ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Americam. Journal of Health-System. Pharmacy. 47(5), 1033-1049. 10.1093/ajhp/47.5.1033

Power, L. A., & Coyne, J. W. (2018) ASHP guidelines on handling hazardous drugs. American Journal of Health-System Pharmacy. 75(24), 1172-1193. 10.2146/ajhp180564

Ratner, P. A., Spinelli, J. J., Beking, K., Lorenzi, M., Chow, Y., Teschke, K., … & Dimich-Ward, H. (2010) Cancer incidence and adverse pregnancy outcome in registered nurses potentially exposed to antineoplastic drugs. BMC Nursing, 9(1), 15-26. 10.1186/1472-6955-9-15

Rekhadevi, P. V., Sailaja, N., Chandrasekhar, M., Mahboob, M., Rahman, M. F., & Grover, P. (2007) Genotoxicity assessment in oncology nurses handling anti-neoplastic drugs. Mutagenesis. 22(6), 395-401.

Riley, S. L. (2009) Compliance to the national guidelines for the safe handling of antineoplastic agents by oncology registered nurses (Master thesis). Northern Kentucky University, Nursing Department, Kentucky, USA.

Rizalar, S., Tural, E., & Altay, B. (2012) Nurses’ protective measures during chemotherapy preparation and administration in Turkey. International Journal of Nursing Practice. 18(1), 91-98.

Serafini M, Del Rio D. (2004) Understanding the association between dietary antioxidants, redox status and disease: Is the total antioxidant capacity the right tool? Redox Report. 9(3), 145-152.

Sessink, P. J. M., Sewell, G., & Vandenbroucke, J. (2015) Preventing occupational exposure to cytotoxic and other hazardous drugs. European Policy Recommendations.

Tagesson, C., Källberg, M., Klintenberg, C., & Starkhammar, H. (1995) Determination of urinary 8-hydroxydeoxyguanosine by automated coupled-column high performance liquid chromatography: a powerful technique for assaying in vivo oxidative DNA damage in cancer patients. European Journal of Cancer, 31(6), 934-940.

Topçu, S., & Beşer, A. (2017) Oncology nurses’ perspectives on safe handling precautions: A qualitative study. Contemporary Nurse. 53(3), 1-20.

Turhan, N., Çelik, H., Duvan, C. İ., Onaran, Y., Aydın, M., & Armutcu, F. (2012) Investigation of oxidative balance in patients with dysmenorrhea by multiple serum markers. Journal of the Turkish German Gynecological Association. 13(4), 233-236.

Valavanidis, A., Vlachogianni, T., & Fiotakis, C. (2009) 8-hydroxy-2′-deoxyguanosine (8-OHdG): a critical biomarker of oxidative stress and carcinogenesis. Journal of Environmental Science and Health Part C. 27(2), 120-139. 10.1080/10590500902885684

How to Cite
Topçu S, Beşer A, Ergör OA, Konyalıoğlu S. Implementation and Evaluation of Safe Handling Precautions Training for Oncology Nurses: An Experimental Design. NHSJ [Internet]. 2022Dec.5 [cited 2024Jun.25];2(4):308-1. Available from: