Knowledge, Attitudes and Practices on the Safe Handling of Cytotoxic Drugs among Nurses at Apeksha Hospital, Sri Lanka

Abstract

Background: Cytotoxic drugs (CDs) play a critical role in cancer treatment. However, their handling poses significant occupational health risk to nurses. Adherence to safe handling practices is essential to minimize exposure and potential adverse effects. Global evidence shows persistent gaps between recommended guidelines and everyday practice. In Sri Lanka, especially within the country’s main cancer centre, Apeksha Hospital; there is limited data on nurses’ knowledge, attitudes, and practices, highlighting the need for focused evaluation. Objective: To assess the knowledge, attitudes, and practices regarding the safe handling of CDs among nurses at Apeksha Hospital, Sri Lanka Methods: A descriptive cross-sectional study was conducted among 152 registered nurses working in Oncology units at Apeksha Hospital, who were selected through simple random sampling. Data were collected using a pre-tested, structured, paper-based, self-administered questionnaire comprising four sections: socio-demographic details, knowledge, attitudes, and practices regarding the handling of CDs. Descriptive statistics, including frequencies and percentages, were used to analyse data. Results: Of the nurses, 68% (n=103) were aged 25-29 and 51% (n=78) had formal training on cytotoxic-drug safety. Nurses demonstrated strong foundational knowledge on cytotoxic-drug safety, with 99% (n=151) recognising glove use and 93% (n=141) recognising hand hygiene. However, knowledge regarding more specific aspects of Personel Protective Equipment (PPE) use was less consistent as only 61% (n=93) knew gowns are single-use, and 54% (n=82) correctly identified the need to change gloves every 30 minutes. Exposure was routine with 99% (n=150) administered drugs, 77% (n=117) cleaned spills, and 88% (n=134) disposed of waste, but protective measures lagged with just 48% (n=73) wore gowns, 45% (n=68) goggles, and 29% (n=44) prepared drugs inside a bio-safety cabinet. Although 43% (n=65) endorsed the guidelines strictly, the findings highlight a persistent knowledge-practice gap in PPE use. Conclusions: Despite a high recognition of glove use and hand hygiene, nurses at Apeksha Hospital exhibit a significant gap between knowledge and practice regarding cytotoxic-drug safety. This persistent knowledge-practice gap highlights the urgent need for enhanced training, stricter enforcement of PPE protocols, and improved safety infrastructure to ensure a safer working environment for sta