Background
In the UK control of substances Hazardous to Health Regulations (COSHH) define chemotherapy as a hazardous substance. Therefore, it is imperative that employers assess the risk and take suitable precautions for their employees. The ‘Safe Handling of Cytotoxic Drugs in the workplace’ recommends a hierarchy of protection; closed systems and personal protection equipment (PPE) to reduce the exposure to cytotoxic drugs. In the UK, closed systems are not mandatory, and the evidence base for use is inconclusive. The hazards of exposure can be assumed to mirror those for cancer patients receiving cytotoxic drugs, with the toxicology effects reported include carcinogenicity, teratogenicity and mutagenicity. Since 2008 there have been validated surveys developed which have been used globally to understand the attitudes, knowledge and occupational factors and use of the hierarchy of protection. Others have tried to elicit the link between health concerns and administering chemotherapy. Currently there has been no global systematic review of the literature regarding experiences and perceptions of cancer nurses handling and administration cytotoxic drugs.
Methods
This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and the PRISMA model for organising information. The methodology of Framework analysis was used to underpin the analysis and synthesis for presentation. Registered on Prospero [CRD42022289276].
Results
Ninety papers were identified; 44 full texts were reviewed and 20 papers that met the final inclusion criteria were included in the review. Initial findings were placed in categories of papers and included: personal factors; knowledge of hazards; perceived conflict of interest.
Conclusions
Analysis identified the area of interests to be about team concern when dealing with hazardous chemotherapy instead of being solely an individual pursuit in protecting oneself. This highlights that there is a complex interplay between organisational responsibility, team-efficacy and self-perception of risk based on implementation of guidelines and education.