Chemotherapy Safe Handling Practice and Associated Factors among Nurses Working in Hemato-Oncology Unit in Addis Ababa Public Cancer Treatment Centers, Addis Ababa, Ethiopia: A Cross-sectional Study
This cross-sectional study of 219 nurses in Addis Ababa's public cancer centers reveals that while only 52.5% demonstrated good safe chemotherapy handling practices, these practices were significantly improved by having more than one year of experience, receiving specific training, and having access to safety policies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Cancer treatment often relies on powerful drugs designed to stop the rapid growth of diseased cells. These medications, known as chemotherapy agents, are life-saving for patients, but they carry a hidden danger for the people who prepare and administer them. Because these drugs are toxic by design, they can harm healthy tissue if they come into contact with the skin, are inhaled, or are accidentally ingested. For nurses working in oncology units, the daily routine of mixing doses, giving infusions, and cleaning up spills creates a constant risk of exposure. To protect themselves and their patients, medical teams follow strict safety protocols. These include wearing specialized protective gear, using ventilated cabinets to mix the drugs, and following precise rules for disposal. However, knowing the rules and following them every single time are two different things, and the gap between the two can determine whether a healthcare worker remains safe or suffers long-term health consequences.
In the bustling public cancer treatment centers of Addis Ababa, Ethiopia, a team of researchers set out to understand how well nurses were actually following these life-saving safety measures. The study focused on the hemato-oncology units, where specialists treat blood cancers and other malignancies. The researchers wanted to see not just what the nurses knew about safety, but what they actually did in their daily work. They visited four major hospitals in the city, including Tikur Anbessa Specialized Hospital and Saint Paul's Hospital Millennium Medical College, to observe and question every nurse working in these specific units. The goal was to paint a clear picture of the current reality: how many nurses were practicing safe handling, and what factors made the difference between a safe practice and a risky one.
The researchers gathered data from 219 nurses, representing nearly all the staff working in these units during the study period. They used a combination of direct observation and questionnaires to check on specific actions, such as whether nurses were using biological safety cabinets, wearing the correct masks and gloves, and properly cleaning up spills. The findings revealed a mixed picture. Just over half of the nurses, about 52.5 percent, demonstrated good practices in handling these dangerous drugs. While this is a majority, it also means that nearly half of the staff were not following the safety guidelines consistently. The study also looked at knowledge levels, finding that about two-thirds of the nurses understood the safety concepts well, yet this knowledge did not always translate into safe actions on the floor.
When the researchers dug deeper to find out what influenced these behaviors, three specific factors stood out as powerful drivers of safety. The first was experience, but in a surprising way. Nurses who had been working in the field for less than one year were significantly more likely to follow safety rules than their more experienced colleagues. The researchers suggest that newer nurses may be more cautious and fearful of the toxic effects, leading them to adhere strictly to the protocols, whereas those who have worked for many years might have become too comfortable with the environment and started to skip steps. The second major factor was training. Nurses who had received specific training on how to handle chemotherapy safely were nearly five times more likely to practice good safety measures than those who had not been trained. The third factor was access to written rules; having clear policies and procedures available in the work area made nurses more than three times as likely to follow safe practices.
The study also highlighted gaps in the physical environment and resources that made safety harder to achieve. In many cases, nurses reported a lack of necessary protective equipment, such as shoe covers or face shields, and in some units, supervisors were not actively ensuring that nurses were protected from exposure. The data showed that while most nurses wore gowns and masks, many reused disposable items they should have thrown away, and fewer than half used the specialized closed-system devices designed to prevent drug leaks during transfer. These lapses, often driven by a lack of resources or a sense of complacency, leave nurses vulnerable to the very drugs they are trying to use to heal others.
Ultimately, the research concludes that while the knowledge exists, the consistent application of safe handling practices in these Ethiopian hospitals is only moderate. The study does not present this as a failure of the nurses, but rather as a systemic issue where experience, training, and access to guidelines play critical roles. The authors emphasize that to protect the workforce, hospitals must provide regular, up-to-date training and ensure that safety policies are not just written documents but accessible tools that guide daily work. By addressing the specific factors that influence behavior, particularly the need for ongoing education and the support of experienced leadership, the medical community can better ensure that the people fighting cancer do not become casualties of the treatment themselves.
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