Safeguarding health: predictors of good antineoplastic drug handling among nurses in the National Cancer Institute of Malaysia

Antineoplastic drugs (AD), essential in chemotherapy for cancer treatment, pose significant occupational health risks to healthcare workers, particularly nurses involved in drug preparation, administration, and disposal. Repeated exposure, inadequate adherence to safety standards, and the absence of comprehensive local guidelines further compound these risks. A cross-sectional analytical study was conducted among 166 nurses from the National Cancer Institute of Malaysia (NCI). Participants were selected using proportionate stratified random sampling based on their work units, and data were collected through a validated self-administered questionnaire. Analyses included chi-square, Fisher’s exact tests, and simple logistic regression to assess associations, followed by multiple logistic regression to identify predictors. Factors studied included sociodemographic (age, gender, marital status, education level), employment (work experience, work unit, training), knowledge and attitude on AD handling practices, and organisational (workload, workplace safety climate). The response rate was 96.9%, and 66.3% of participants demonstrated good AD handling practices. Three factors were associated with good practices: workload (average number of patients per workday, and per workday involving AD) and attitude level. Multivariable analysis identified workload as the sole significant predictor (AOR = 0.825, 95% CI = [0.718, 0.947], p = 0.006). The study recommends adopting acuity-based staffing models that align nurse workload with patient complexity in oncology settings. The Ministry of Health (MOH) should also consider implementing nurse-to-patient ratio guidelines specific to cancer centres and incorporating workload thresholds into occupational safety audits, as addressing workload is essential to improving AD handling practices and ensuring both healthcare worker safety and quality patient care.

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