Oncology nurses commonly encounter spills of hazardous drugs in the course of treating patients, according to a report published in the Clinical Journal of Oncology Nursing.1

The research was part of the Drug Exposure Feedback and Education for Nurses’ Safety (DEFENS) behavioral study (ClinicalTrials.gov Identifier: NCT02283164). The study was conducted at 12 sites over a duration of 2 years, with 378 nurses participating.

Nurses were surveyed regarding details around spill events, including their own procedures. Participants also reported on their use of 6 types of personal protective equipment (PPE), which were disposable gowns, respirators, eye protection, shoe coverings, 2 pairs of chemotherapy gloves, and 1 pair of chemotherapy gloves.

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More than half (57%) of the nurses in the study had 10 or fewer years of oncology nursing experience, and 4% had more than 30 years of experience. There was no statistically significant difference in participant characteristics among nurses who reported a spill (n=51) compared with those who did not report a spill (n=327). A total of 61 unique spills were reported, with 11 of the 12 facilities having reported spills.

The mean spill volume was 28.8 mL, and paclitaxel, gemcitabine, and anthracycline were the drugs most commonly spilled. Spills often occurred even when closed-system transfer devices were used.

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Spill kits were used during 42 spills. Overall, the researchers reported that appropriate PPE was insufficiently used during spill events. All but 2 participants wore some form of PPE during a spill event. However, 19 participants wore only 1 PPE item, 16 wore only 2 PPE items, and only 3 participants used 5 PPE items.

The researchers supplied a set of several guidelines for preventing hazardous spills, handling hazardous drugs while administering them, and managing spills when they happen.

“These findings have important implications for oncology nurses, leaders with oversight over chemotherapy infusion settings, and key policy stakeholders,” wrote the researchers in their report.


Friese CR, Wong M, Fauer A, Mendelsohn-Victor K, Polovich M, McCullagh MC. Hazardous drug exposure: case report analysis from a prospective, multisite study of oncology nurses’ exposure in ambulatory settings. Clin J Oncol Nurs. 2020;24(3):1-7.