Abstract
BackgroundThree decades of research findings have documented the health effects of handling hazardous drugs. Oncology nurses are vulnerable due to frequent administration of antineoplastics, low adherence to equipment use, reported barriers to use, and perceived low risk of health effects. No interventions have been tested in a controlled, multi-site trial to increase nurses’ use of protective equipment when handling hazardous drugs. The Drug Exposure Feedback and Education for Nurses’ Safety (DEFENS) study will compare the efficacy of education (control) versus an audit and feedback intervention (treatment) on nurses’ self-reported use of personal protective equipment when handling hazardous drugs. The treatment intervention will include tailored messages based on nurses’ reported barriers to protective equipment use.Methods/DesignThe DEFENS Study is a cluster randomized controlled trial. We are enrolling cancer centers and will recruit nurse participants in April 2015. Eligible cancer centers employ at least 20 eligible registered nurses in the chemotherapy infusion setting and have on-site phlebotomy resources. Eligible participants are nurses who work at least 0.40 full-time equivalent hours in the chemotherapy infusion setting and have not received an antineoplastic drug for a health problem in the past year. An encrypted, user-authenticated website will administer surveys and deliver control and treatment interventions. The primary endpoint is the change in score on nurses’ reports of the Revised Hazardous Drug Handling Questionnaire between baseline and approximately 18 months later. A baseline survey is completed after informed consent and is repeated 18 months later. Nurses in all sites who experience a drug spill will also report incidents as they occur; these reports inform the treatment intervention. Plasma will be obtained at baseline, approximately 18 months later (the primary endpoint), and with drug spill occurrences to measure hazardous drugs levels and to inform the treatment intervention. Potential mediators include knowledge of hazardous drug handling and perceived risk of drug exposure. We will examine whether personal factors and organizational factors moderate the intervention effects.Trial registrationClinicaltrials.gov NCT02283164, registered 31 October 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0674-5) contains supplementary material, which is available to authorized users.
Highlights
Three decades of research findings have documented the health effects of handling hazardous drugs
The National Institute for Occupational Safety and Health (NIOSH) 2004 recommendations are included in the 2013 American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards [9]
Published guidelines include the use of personal protective equipment (PPE), comprised of two pairs of chemotherapy-tested gloves, single-use disposable gowns, eye protection during specific activities, and respiratory protection when vapor exposure is possible
Summary
Scientists have documented the pernicious effects of handling hazardous drugs such as antineoplastics [1,2,3,4,5]. Potential mediators Both knowledge of PPE and perceived risk of hazardous drug exposure are hypothesized to mediate the potential effects of the intervention on PPE use These measures will be obtained at baseline at the individual participant level, after the educational module has been viewed, and at the post-intervention assessment. The hypothesis is that there will be a significant intervention effect such that nurses in sites receiving the treatment, in addition to the web-based educational module, will report higher PPE use scores compared to nurses in sites randomized to receive only the control. Aim 3 will determine whether the treatment intervention effect on PPE use is moderated (strengthened or weakened) by personal (experience, education, certification) and organizational factors (workloads, practice environments, safety organizing).
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