After two years of the program, the researchers found little difference in the use of PPE between the two groups and no change over the course of the study. The researchers cite several possible reasons the intervention was not successful, including the quality of the content and technology barriers that may have made watching the video modules difficult.

Dr Friese said another issue is that the protective devices are cumbersome. Nurses report that the gear is hot, uncomfortable, and it can be difficult to safely apply and use. The researchers propose undertaking new efforts to develop better PPE that is easy to use, affordable, and protective against hazardous drug exposure.

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They also call for collecting data through a registry to identify and track the health risks from exposure. A previous study by Friese and colleagues found that nearly 17% of nurses who work in outpatient chemotherapy infusion centers said they had been exposed to chemotherapy on their skin or eyes.


Dr Friese suggests nurses should work together and with their managers to be sure that policies and procedures conform to the latest recommendations from the Oncology Nursing Society, the National Institute for Occupational Safety and Health, and the United States Pharmacopeia.

Nursing practice is somewhat safer today because drug preparation activities are centralized to dedicated areas with biological safety cabinets and increased use of closed-system transfer devices (CSTDs). Yet in 2019, some oncology nurses still “mix” chemo and some in the field question the efficacy of CSTDs. “We also have no registry to track exposures and health effects attributed to exposures. I conduct research but also continue to staff an inpatient unit and take care of patients on chemo. I want to let my nurse colleagues know this is still a concern and that they need to protect themselves,” Dr Friese told Oncology Nurse Advisor.

A greater number of oncology nurses need to work with their practice leaders to be sure their preparation and administration policies and procedures conform to evidence-based guidelines. Dr Friese said nurses must be vigilant about reporting unsafe conditions to their leaders and take other steps. “They need to encourage their peers to protect themselves when handling hazardous drugs. Our work suggests that fellow nurses influence an individual nurse’s decision to wear PPE. We have to protect each other, and that starts with protecting yourself.”


1. Friese CR, Yang J, Mendelsohn K, McCullagh MC. Randomized controlled trial of an intervention to improve nurses’ hazardous drug handling. Oncol Nurs Forum. 2019;46(2):248-256.