Background Chemotherapy drugs pose a hazard to those administering them. This study examined the effects of individual, situational, and organisational factors on compliance with personal protective equipment (PPE), use of engineering controls, and exposures in a sample of oncology nurses (n = 1.915).

Methods Data came from the web-based NIOSH Health and Safety Practices Survey of Healthcare Workers. Survey measures included demographics, employment situation, safety practices, training, safety climate, antineoplastic drug (AD) administration, and exposures.

Results Preliminary descriptive and bivariate analyses were conducted. Two stepwise multiple regressions were computed with PPE compliance and engineering controls as outcome variables. For PPE, safety climate and familiarity with guidelines were the strongest predictors of use (both p < 0.0001). Non-profit status, hospital setting, and having more employees were also relatively strong predictors of compliance (p < 0.002 to 0.006). The strongest predictors for engineering controls were relevant policies/procedures, safety climate, and familiarity with guidelines (all p < 0.0001). Engineering control practices were also better for those in non-profit (p < 0.001) and government settings (p < 0.007). A final stepwise multiple logistic model assessed occupational exposures (skin contact and/or spill/leak of AD). Exposure risk increased with number of AD administrations (p < 0.0001), while the use of engineering controls reduced exposures by nearly 30% (p < 0.0001). Safety policies/procedures, PPE and safety climate also reduced exposures.

Conclusions This study highlights the importance of organisational and safety management practices in preventing exposures to antineoplastic agents. Exposures increased with the number of AD administrations, but policies/procedures, associated controls, and safety climate reduced risk.